back up fistula for HD when you are on PD - pls your thougts

[lunadatura]

Hiya

I have been on ccPD since august of 2009 and have done well with the overnight D and a day time exchange.

The same time i got a my PD Catheter i got a back up hemo fistula installed in my left arm. It clogged within a week. The surgeon installed another fistula in my right wrist. I used it when i travelled to Hawaii in center and they did a bad job on my last session and clogged.

Apparently I dont have factor five  - hypercoagulation factor - but i still clott really well.

My surgeon appears reluctant to install another hemo access when i have had such troubles with my previous two. This surgeon has mapped my viens and says that there are 2-3 good possible access left in my arms. The viens in my left non dominant would require a two step procedure and there is another good access in my upper right dominant hand.

My question is if you were in my shoes what would you - have the 3rd fistula for back up hemo install or just rely on my PD catheter knowing that this limits me for travelling to some places and puts in at needing a jugular tunnel cath if i run into troubles with my PD. ? YOUR THOUGHTS???

[monrein]

Given your experiences with the last two fistulas I'm pretty sure that I'd count on PD continuing to work for some time to come and if it comes to the point where hemo becomes a necessity I'd go with the chest catheter until a new fistula could be done and you'd have the permacath while it matures.

You don't want to use up all those veins that you may need later (and fistula spots aren't a dime a dozen) and I think I'd be seeking out the "superest" superstar of vascular surgeons to consult with the next time any fistula were attempted.  Of course vein mapping as well would go along with this but most likely that was done the first two times also.

As for traveling to places where PD isn't available...no one loves traveling more than I do but it's not worth risking a fistula for any reason IMO and if and/or when the time comes and you have to go to hemo, consider learning to stick yourself to ensure consistency and quality. 

Best of luck.

[tito]

I do PD and I travel - they are not mutually exclusive. You just need to have PD supplies delivered to your destination.

I don't think I would risk another access gone wrong. I would wait and continue PD as long as possible. It is my understanding that PD does not go all at once. I believe you will have warning and can get an access prepared at that time.

[Jie]

If I were in your shoes, Lunadatura, I would not have any fistula at all. Before I had my PD cat surgery, I had a long thought to whether to have a fistula surgery at the same time. My final decision was No. I don't like the unnecessary surgery.  My PD may last long enough until I have a transplant. I have done PD for about 15 months and my cycler has had more than 40,000 miles in it. So, travel is not a problem with PD.

[Rerun]

Do PD as long as you can and enjoy life.  Why interrupt that with surgery and recovery!  When you need hemo you will get a temp cath and then they will work on your arm.  Don't ruin any more possible sites in your arm.  When you need it you will use it and it will stay open for you.

[Quickfeet]

I had a fistula put in my arm and it clotted after a week. My surgen refused to mess with it again, because I don't have very good veins and it was just a backup.

[GeeWillikers]

I actually had my fistula done first.  It's healthy and mature now, and it's never been used.  I have it for "back-up" just as you describe..  It gives me a little extra sense of security, but I don't think I'd press to have one done if 1)  I'd already had problems with fistulas, and 2)  my PD was going as well as possible.

[lunadatura]

Thanks IHDers for your input - its pretty clear that i should reserve my viens for a time in the future that I might really need them. I have seem folks at the D center with acess in their thighs and i dont want to have to go there...!!

[*kana*]

I am currently on PD and have a back up fistula.  I wanted it because PD wont last forever and I refuse to have a cath in my heart.  I work as a Cardiac sonographer and I see first hand what poor cleaning on the techs part can do to ones heart.  I perfer to not get a Staph infection in my heart and have to have open hearth surgery or worse die from it.  It is a reality and more common than one would ever think, trust me I see it.  I see too many young people come in with infected caths that need their heart valves replaced or die from sepsis.   When you get Staph in your body it is a very bad thing, worse than having a vascular access in ones groin.  Staph is on everyone skin so it is only a matter of time before it makes it way into the cath and heart. 

I guess we base our decisons on what we see and know.  I am terrified of a cath in my heart because I see too much.       

[adairpete]

I'm currently on PD and had a fistula done the same time they put in the PD catheter.  Haven't had to use the fistula (absolutely love PD!), but after my negative experiences with the catheter am loving having the fistula back up rather than going through another catheter.  However, each situation is unique and seeing as how you had a couple fistulas clog and you've been doing PD for over a year, there may not be a good reason to have another fistula done.  Hope you stay well!