Tenckoff Catheter Worry

[Ken Shelmerdine]

Just lately I've noticed that the tenckoff (the tube that sticks out of my abdomen not the extention) looks noticably thinner about 4 inches from the exit site and I think its beacause it has rubbed against the waistband and belt of my trousers over a period of time. I've started taping it higher now so as this doesn't happen but I'm scared that because it's thinned out it could puncture at any time, aspecially because I will be holidaying overseas in 7 weeks time.

Has anyone here experienced this and if so has the tube ever punctured because of it. If it does then is it repairable or do you have  have surgery to insert a new one?

[KICKSTART]

Hi Ken ..how ironic is should be replying to you ! About 6 months ago i sprung a leak ! Now the good news or the bad ? If the leak is one the part from out of your stomach up to the tungsten metal connector then its surgery not repair . if its from the metal connection up to the end you use for dialysis then its just a replacement (you should be having that part replaced every 6 months anyway. I was lucky and just needed the end part changing. Could i just ask do you not cover your catheter with a dressing ? Mine is always covered (exit site) then the rest held in place with tape. If its from your exit site then a dressing would probably be better protection than using tape . I was taught never to leave my exit site uncovered ans never have. The dressing are called 'Mepore' if you want to cover it up ..

[florida.flyer]

 
I cover my exit site with the square gauze (they call it a sponge...?)  but I was told that the antibiotic I use (mupirocin) can erode the plastic and to check it often.  but I certainlyl understand your concern! I would flip out if I had to look at abdominable surgery again. (didn't care for it the first time!)

[Kini]

Hi, my daughter's cath. ( which is almost 5 yrs. old now ) is sticking out of her exit site just a tad... I believe the Dr. said the first cuff is exposed but it's been that way all this time and it seems just fine ( knocking on wood) . Her exit site was never an issue and all she does is wash each night in the shower, she works and never covers it, nor does she put anything on it on a daily basis. She has sprung a leak a few times in the tubing below the main Cath. to the stomach, but we just clap it off and the PD nurse can replace it. If your going over seas, maybe you ask your PD nurse for an extra end to carry with in case and by all means keep a pair of clap sisscors on hand. I travel to Hawaii a lot, and want my daugter to go so much and I know these are the items I would have on had. Also I would carry a bottle Vanco. powder form and the st. water to mix it with,, some needles ect. JUST IN CASE... it's always better to be safe then sorry. My best to you and HAPPY HOLIDAY !!!   

[Rerun]

Call your home training nurse and have her/him take a look at it to ease your fears.

                                                         

[MiSSis]

I recently was switched from Fresenius' Safe-Lock system to their Stay-Safe system and it required a 12" extension to be added to my original catheter which I've had almost 5 years now.  With the extension, my catheter now hangs down to my knees and I didn't quite know what to do with all of it.  I wash and bandage my cath every day so I just tried to wind this long thing around and then tape it to the 4x4 sponge that I'd used.  But what I did by doing this was to create a stress point where the flexible tubing met the end of the red connector on the original cath.  As a result several weeks ago I sprung a leak.  To make a really long story short, the PD nurse was able to cut off the damaged portion of the catheter and re-insert the red connector (the 12" extention is attached to this connector).  Although my center hadn't experienced a leak in a PD catheter in more than the 5 years that I've been on PD, Fresenius does have a catheter repair kit available for just this purpose.  I've got to believe that Baxter would have something similar available. 

For sure I'd be asking your PD nurse or doctor to inspect your cath especially before your trip and hopefully they'll just be able to make a simple repair and surgery won't be necessary.

Good Luck!

By the way, I"m very careful now how I wind and tape up my catheter each day to prevent this from happening again.  I so do not want to go thru another surgery if I can help it!!!

[Ken Shelmerdine]

Thanks all for your replies. Kickstart it's not a problem with the exit site itself. I'll explain. When I first started pd I found that I had to anchor the catheter pointing downwards slightly otherwise I'd get drain alarms all night. If I anchored it horizontally just following the natural way it pointed after it comes out of the exit site or worst still pointed it up slightly, I couldn't drain properly in a lay down position.

So, its position for two years has been pointing down slightly from the exit site and achored with micropore tape  just after end of the dressing (topper swab and mefix tape) so it's achored about 3 inches from the exit site. Rather than letting the rest of the tube just dangle down my pants, (sounds like i'm bragging doesn't it lol) I curl it round and up towards my upper abdomen and tape it just by before the extension meets the minicap valve. So its in a letter 'C ' shape. The bottom tip of the C is the exit site and the top tip is the minicap.

Its the bottom curve of the catheter in the C shape with has been rubbing against the waistband if my pants and that's where it looks thinner. But the good news is that yesterday  I anchored it slightly upwards so that the bottom curve didn't come anywhere near my trouser waistline but all day I was thinking I'll have to change the position when I get to bed because Ill never drain properly. But I didn't, I thought so what, if I have a bad night I'll throw a sicky in the morning and catch up on my sleep. But guess what: No drain problems! so now I can keep it away from my waistband. I'm just scared that it's worn to far and it will go anyway.

[KICKSTART]

Glad you found something that might work ? The only other thing i can suggest is cover the 'thin bit' with a dressing to pad it out a bit ? It might be wise to get the renal unit to check it over ..or are you worried they might say it needs changing ?

[Ken Shelmerdine]

..or are you worried they might say it needs changing ?

Yes I'm terrified.

[okarol]

  I hope you get it worked out soon.

[paris]

Ken, I am sorry this is happening right now.  Let us know what they tell you.  Hopefully it won't need to be changed.   

[Ken Shelmerdine]

Thanks Karol and Paris

[carson]

Ken, I was on PD for 10 yrs. I found that certain cleansers were really bad for it: peroxide, bactriban, polysporin etc. The catheter on the exit site side of the titanium sprung a leak 3 times. They figured it was from the cleansers, etc, they had suggested I use. They would simply cut the catheter off where the leak was, add a new titanium connector, and ta-da, I was as good as new. HOWEVER, after this happened the third time the leak was quite close to my abdomen and the catheter was now only about 1.5 inches long (not including the extension). They did suggest replacing it, but I ended up going on hemo anyway so I just had it removed. I wouldn't worry too much until it gets cut down too close to be able to use easily.

[Ken Shelmerdine]

Thanks Carson that's good to know that they can do repairs exit side. If it burst and they did a repair I'd still have 4 inches. I'm not as anxious now.

[Ken Shelmerdine]

My home sister took a look at it last week. He said it didn't look like it was about to puncture and he's seen worse. I'm taking no chances. I'm taping it well away from my waistband and covering every part of the cath up to the titanium connector with tape.

That was the good news. The bad news is that I have a fungal exit site infection. (Yeast) For about a week or two I've noticed that the exit site has been a bit tender and and sore with small specs of a brownish gunge in and around the hole each time I change my dressing.
I had to call in the CAPD drop in centre on Saturday to pick up an antibiotic. (Local chemist closed on Saturday.) 

I have a theory about this and I'm going to put it into practice. Here in the UK you completely cover the gauze dressing with mefix tape which comes on a 4 inch wide roll. You cut a piece then peel the backing paper off and cover the dressing so the whole exit site becomes air tight. I believe that this causes stagnancy because the exit sight is damp with the residue of betadene and bacrobahn. Fungal growths can thrive in such conditions.

So for the last few days I've dressed it only with gauze and used micropore tape round the edges so as to allow some air to get through and it does seem to have improved. Whether the improvement is due to taking this action or the antibiotic I don't know.

What I do know is that whenever I get any kind of wound or cut, it never heals properly under a dressing or bandaid, it just seems to fester
and it's only when I take the dressing off that it starts to heal. I think that this has been happening ever since I had the cath put in because even though it hasn't been infected until now, it has always been red looking and very slightly tender. Already since I started using an non air tight dressing , it is starting to look more pinky and less inflamed.

[pelagia]

  I know you don't need fungus to worry about in addition to the thin tubing.  Hope it clears up quickly with some aire exchange.

[KICKSTART]

Ken , i noticed your comments on covering your exit site ? I have had mine covered from day one and was told to always keep it covered ..but not in the way you describe!! Try asking for some dressings called Mepore , they are a gauze type pad with a sticky edge .. no need for any extra tape around it and they are breathable , i have always used these with no problem.

[Ken Shelmerdine]

Thanks Kickstart I'll ask my home sister and see if I can get it supplied. Last night I broke all the rules, I took a shower with the dressing off
and bathed the exit sight with hot anti bacterial soap and hot water. I've never actually bathed it before. I just normally take a shower with the site still covered with the old dressing, dry myself off and take off the old dressing and swab with betadene before apllying a new dressing. I thought what the hell, I'm going to bathe it as you would do with any skin inflamation. This morning it's looking nice and pinky with no discharge.

[KICKSTART]

I hope you can get hold of some Mepore dressings as they will cover the exit site but still let it breathe ..also i notice you are using Betadene. Its interesting what you find out in different parts of the country , when i was in Scotland we used Betadene but when i moved to the north we use Normasol ( which is sterile water) I was told betadine was old hat and not the best thing to use on exit sites ..so this may also be something worth asking about . When i shower i use a special dressing called Tegaderm which is waterproof , i think possibly the fact that you shower with your old dressing in situ then change after may be holding some moisture and im really suprised your renal team arent more on the ball !! Get the dressings , get the Normasol and ask for some Tegaderms 

[Ken Shelmerdine]

Actually the hospital (Manchester Royal no longer uses betadene for exit site cleansing and all new patients are being supplied with bottles of saline. It's just that they haven't got round to changing everyone's prescription with Baxter Homecare yet. I didn't know you could get tagiderm as a normal part of your supplies. I've only been given a one off supply of abot 20 for when I go swimming on holiday in a few week stime. I'll now see about getting them on a regular basis. Thanks for the info Kickstart and hope you soon recover from the heart attack.

[Ken Shelmerdine]

Actually the hospital (Manchester Royal no longer uses betadene for exit site cleansing and all new patients are being supplied with bottles of saline. It's just that they haven't got round to changing everyone's prescription with Baxter Homecare yet. I didn't know you could get tagiderm as a normal part of your supplies. I've only been given a one off supply of abot 20 for when I go swimming on holiday in a few week stime. I'll now see about getting them on a regular basis. Thanks for the info Kickstart and hope you soon recover from the heart attack.

[KICKSTART]

Ken , i actually got my Tegaderms via my GP and not the hospital , i did have a bit of a fight because they are expensive , but i told them i couldnt get my exit site wet and was only allowed to shower so what choice did i have if they wouldnt provide them! You might have a bit of a fight but its worth a try !

[Ken Shelmerdine]

Thanks Kickstart I'm on to It when I'm feeling a bit better. Felt unusally crappy this last couple of days. Had to come home from work yesterday and today. Can't put my finger on what's wrong, just lacking a bit of energy and sleeping like a baby. I get parnaoid that when I feel like this, i've reached the stage when I'll start exeriencing thr real physical affects of this desease. But it does happen from time to time but within 48 hours I'm right as rain again. Hope so too this time.

Ennough of me whow are your felling today. Have you thought any more about your dogs yet now you've had more time to think.
I know you are feeling down but your usual opimism and positive outluck and great strengh in spite of the lack of support from your family and your prevoius housing problems has been inispiration not only me but many on this forum.

This has gone off thread a bit but I have never stopped thinking about the problems you are going through at the moment and I beg you and urge you not to give up the fight. Our thoughts and prayers at IHD are and will, always with you.

[mikey07840]

My dialysis center changed to a new dressing called Primapore from smith & nephew. It breathes much better than the old dressings we used to use.

[mikey07840]

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