PD after surgery

[Jenabcd]

Hi people;  I haven't been here for a while...just been moseying along, doing my PD, and all going OK.  Welllll... I had to have my gall bladder out this past week.  My neph said NO PD until it's healed (3 incisions), at least 4 weeks.  He wanted a cardio-vascular surgeon there to put in a tunneled catheter.  The surgeon said 'you only have to wait a week.'   I told him to call my neph, and agree.  Again, my neph said NO. He was very firm.  Put in a tunneled catheter, so she can do hemo while she heals, 4-6 weeks.  Then my neph goes on vacation!  (How dare he! lol)  My surgeon did my surgery 2 hours earlier than scheduled, so the cardio-vascular surgeon couldn't make it to my surgery to put in the cath!  Then the surgeon says that I can start PD immediately. The back-up neph didn't completely like the idea, but he said the surgeon has the final word.  HUH??  So I went back to PD 2 days after surgery. (A few days ago) Yesterday, as I was cleaning my exit site, I noticed that around my belly button incision it was all white and spongy. I called my dialysis nurse who said that's not right. She talked to a dr., called me back, and said go to the E.R.  After spending the entire day there, the dr. said it's leaking, but  it'll be fine.  My husband was a livid. I was just nervous.  Yep, continue PD he said.  I stayed up all last night, keeping an eye on it.  The white, spongy area is bigger.  I only ultra filtered half of what I have been UFing, and I can see where at least some of that is!  Any ideas?  Anyone else agree that it's ok to continue PD while I'm leaking it?  (It's leaking inside, into my skin/tissues...I don't see any wetness on the outside.  Thank you so much in advance!

[peleroja]

Hmmmm, I've never had this happen to me, but it sure sounds like you need to be in the hospital until this is resolved.  Leaking inside is not a good thing.  I'm sure others will have more profound input!

[Jie]

I think both surgeon and neph are right. However, it is safer to do the neph's way. If the cut has not been completely healed, only small amount of solution can be used each time.

[Jenabcd]

Yes, I'm only filling half the amount as usual, and only at night right now.  (I'm dry during the day, whereas I'm usually not).  By morning, the big white lumpy/spongy spot is quite big around my incision, so it's obvious leakage in there.  Scary to me!

[cookie2008]

I would have insisted what the neph said and have a cath put in until healed. When I was on pd the fluid went into the sak around my lungs 10days in the hospital.  I am now on home hemo with nxstage.

[M3Riddler]

Hi people;  I haven't been here for a while...just been moseying along, doing my PD, and all going OK.  Welllll... I had to have my gall bladder out this past week.  My neph said NO PD until it's healed (3 incisions), at least 4 weeks.  He wanted a cardio-vascular surgeon there to put in a tunneled catheter.  The surgeon said 'you only have to wait a week.'   I told him to call my neph, and agree.  Again, my neph said NO. He was very firm.  Put in a tunneled catheter, so she can do hemo while she heals, 4-6 weeks.  Then my neph goes on vacation!  (How dare he! lol)  My surgeon did my surgery 2 hours earlier than scheduled, so the cardio-vascular surgeon couldn't make it to my surgery to put in the cath!  Then the surgeon says that I can start PD immediately. The back-up neph didn't completely like the idea, but he said the surgeon has the final word.  HUH??  So I went back to PD 2 days after surgery. (A few days ago) Yesterday, as I was cleaning my exit site, I noticed that around my belly button incision it was all white and spongy. I called my dialysis nurse who said that's not right. She talked to a dr., called me back, and said go to the E.R.  After spending the entire day there, the dr. said it's leaking, but  it'll be fine.  My husband was a livid. I was just nervous.  Yep, continue PD he said.  I stayed up all last night, keeping an eye on it.  The white, spongy area is bigger.  I only ultra filtered half of what I have been UFing, and I can see where at least some of that is!  Any ideas?  Anyone else agree that it's ok to continue PD while I'm leaking it?  (It's leaking inside, into my skin/tissues...I don't see any wetness on the outside.  Thank you so much in advance!

I was always told to wait at least a week after surgery depending on the type of surgery. Was the surgery an open incision or laproscopically?  Usually with laptoscopically they use 3 or 4 small incisions. Also with laproscopic gall bladder surgery, they pump you full of air and it takes time for this to leave the body which is another reason why they like you to wait a while. But I have never heard of waiting 4 weeks, but your neph may have his reasons as we dont know your history or details.


Regarding your PD site, I would get it looked at asap. White and spongy doesnt sound like leaking, but i may be wrong. Does it hurt? This could be an iexit site infection which would need to be treated.  I'm not sure why you would go to the ER as they are not familiar with dialysis. I was on PD for 12 years and anytime I had an issue to be looked into, I first would have  the PD nurse look at it along with the neph if available. If your neph is unavailable, there should be another one on call that should be able to determine what to do.  If it was anything like peritonitis, i would go directly the the unit for antibiotics.

///M3R

[KICKSTART]

I had my pd cath put in and did an exchange the very same day (well the nurse did) From there i did my exchanges and training , there was no gap between pd cath being fitted and starting pd nor did i have a line put in while it did.

[lawphi]

It does not sound like your doctors are on the same page after your gallbladder was removed.  Your nephrologist is worried about an abdominal infection from the surgery settling into your catheter and compromising it.  You also risk adding scar tissue by pouring pd fluid on an irritated lining.  Your surgeon is considering your comfort level and doesn't deal with the special issues your renal status adds to this case on a daily basis.

As to your perma catheter, you can receive one under twilight.  The surgery schedule should not have prevents you from receiving one.  In fact, your cystectomy surgeon is qualified to insert a catheter.

While it is a lesson earned, listen to your nephrologist and don't ask other doctors for medical advice in which you have already received an answer to.  I sincerely apologize if that sounds harsh. 

Leaking from a surgical incision is normal, but should be watched closely.  It is the body trying to heal the incision rather than pd fluid oozing out. 

[Jenabcd]

Thanks all.  Riddler, it's not the exit site, it's one of the incision sites.  The fluid isn't coming out;  it's leaking on the inside. 

Lawphi,  it's not harsh at all;  it's the truth, and it's what I kept telling the surgeon.  My neph was on vacation when the time came to have the surgery.   When I had the initial appt in the surgeons office, he said I don't need the catheter.  I said, "unless you get that OK'd with MY dr, then yes I do."   He called my dr, who was firm in his answer...NO, PUT THE CATHETER IN.   Iin the hospital, the surgeon was very condescending, and when I'd tell him that my neph was firm about not letting me start PD immediately, and wanting me to go to hemo temporarily, he finally said "you keep telling me that, but I'm telling you, it's ok to start PD."  Then, my nephs back-up from his same office came to me and said "the surgeon ranks above us, and has to make that decision.   I had never heard such a thing. He is a general surgeon.  Renal function and dialysis in any form is not his specialty, and I was not happy that the back-up neph bowed down to the condescending surgeon.  I sent an e-mail to MY neph yesterday, who is back from vacation, and I have an appt with him on Thursday afternoon.   I have also talked to a person who has been a nurse for years, and has gone on to higher education in nursing, and has also worked on renal floors of hospitals.  She couldn't believe it.  I have LOTS of information from her, and my surgeon was wrong in every way.  I also have an article now, that says that it has been proven that there is lots of proof of leakage and peritonitis when patients have gone back to PD after laparoscopically getting their gb out.

My surgeon said that he does not put in the perma-catheters.  He's the one who told me that it has to be a cardio-vascular surgeon.  I was definitely not asking this guy for any advice.  I had him in one ear, being a jerk, going against MY dr's orders,  and in the other ear I had MY neph's back-up, saying that the surgeon has the final say. 

I also agree about the ER's knowing nothing about dialysis, etc.   I called my dialysis nurse.  SHE called that same back-up neph, and they are the ones who sent me to the ER... all for naught.   This has been frustrating, to say the least, but I definitely did not go looking for another dr's advice.  I was on the same page as MY dr, who was gone.

[lawphi]

Gotch ya!  My reading comprehension was off!