Tell me about ..

[KICKSTART]

The removal of a PD catheter (the good ,bad and ugly) and tell me about having a fistular made , aftercare, what you could and couldnt do and recovery time. In fact anything you may think is useful . 

[spacezombie]

I've had four different PD caths and a permacath. The first time I had a PD cath removed, it was with a local. I was young and scared and it wasn't very fun. I would suggest asking for some happy-time meds! haha. But it wasn't too bad. All other times I've asked to be put under for PD cath-related surgery. The permacath was put in under a local, but this time I had the drug Versed ( http://en.wikipedia.org/wiki/Midazolam ). That drug made me laugh at everything that was happening and not remember much at all of the procedure. When I woke up in the recovery room, I was still laughing at everything I saw. I thought a blueberry muffin was the funniest thing ever. So I recommend that drug if you're nervous.

I hope everything goes well for you!

[KICKSTART]

 

[Restorer]

I've only had a PD cath removed at the same time that another one was placed in the same tunnel/exit site. It was supposed to be a laparoscopic repositioning of the existing catheter, but I guess once they got in they decided it was easier to replace the catheter.

I ended up with two laparoscopic portholes, a reincision over the almost-healed scar from the previous cath placement, and a slightly reopened exit site.

[spacezombie]

I've only had a PD cath removed at the same time that another one was placed in the same tunnel/exit site. It was supposed to be a laparoscopic repositioning of the existing catheter, but I guess once they got in they decided it was easier to replace the catheter.

The same thing happened to me once! Then I guess they tested the cath out after placement with some dialysis fluid... and they left my just-cut belly full of fluid. It slowly leaked out of the holes over the course of two days.

[RichardMEL]

I found the fistula surgery easy, but I was under general (YAY!) so woke up with a mildly sore wrist(where the join is) but it cleared really quickly. I was in overnight and back at work a day later - really a bit of a non issue in terms of getting the fistula made up. It took time to mature though - you usually get a ball or other squeeze thing to squeeze to exercise the fistula. That was a bit of a nothing it was all good. Didn't have to use it for 2 years though so it was ultra mature by the time they stuck it.

Now it's big and throbbing.. just the way it's supposed to be  

[dwcrawford]

No problem at all with inserting the HMO type cath or fistula.  Started dialysis that same night.  Fistula is  mature  but unfortunately no tech at my center are.  The glue the incision and washed it off in a days or so.

Now my question.  How much does it hurt to removed the hen cathater?  Do I need to take a driver with me next week?

[billybags]

Hi kickstart, When my husband had his tube out it did'nt take too long, ther was just a bit of pain, lets face it they do cut you. He had mild stomach ache for a few days, he only took paracetamol thats all. Have they given you a date yet?

[spacezombie]

How much does it hurt to removed the hen cathater?  Do I need to take a driver with me next week?

PD Cath, I'd get a driver. Hemo permacath, personally, I was fine after about five minutes. But I had my permacath removed in clinic with just a shot to numb it. I could have scheduled a more elaborate surgery to have it removed, but I just wanted them to rip the thing out right there.

[KICKSTART]

Thanks guys but could you give me a bit more info please . PD catheter out ..done under local? any sedation? how many cuts ? how many stitches? how long to recover? any restrictions ,eg no lifting?  Fistular , again size of cut ? prep for fistular to be made ? how many stitches? could you not use your arm properly for a while ? eg carrying things, driving etc? Again is it done under local ? with sedation ? Sorry but after that tunnel line i wont take a doc's word for anything now !

[spacezombie]

One PD Cath done under local, the rest general. Each time there would be a cut somewhere near the exit site about an inch and a half to two inches long, usually with internal stitches. Most of the time they try to recut on one of my old cuts from when the put the cath in. The actual exit site hole, they've always left without stitches. Once, they packed the exit site full of gauze and I was annoyed by this. But it wasn't that bad, my nurse removed it for me. It was sore as any abdominal surgery might be, but I usually recovered very quickly. There were lifting restrictions for a short time. If you do have this done with a local, I would demand some sort of sedation or happy medicine in order to make it more pleasant for you. There is no reason to be scared and uncomfortable during the surgery.

I think my experience with the getting the first PD cath out with a local was bad because they were also putting in a permacath at the same time. And they didn't sedate me! And I had to take out my hearing aids and couldn't hear any of the nurses talking to me. It doesn't have to be like that and shouldn't, so make sure they listen to you and give you what you need to be relaxed.

[KICKSTART]

Thanks Spacezombie     Any info on having a fistular made ? I was told the intention would be to take out my pd cath and also make a fistular at the same time !! Im just a bit worried about the state i will be in , as i have to manage alone !

[spacezombie]

It seems like you won't be able to drive home, if that was what you were planning on. Is there someone that can help you with this? Or perhaps the hospital can give you information about a ride service or you could arrange a taxi?

[RichardMEL]

KS it's "fistula" (no r).

as for if you can drive home afterwards - probably - except that they would probably say no if you're only having a local (?!?!!) for it (I had a general so I have NFI.. it doesn't seem like it should be done under local - I would NOT want to be watching that! LOL.

Once you have a fistula, assuming it is in your arm, you shouldn't wear tight clothing on that arm, or lift heavy items with the arm and NEVER have injections or BP taken on that arm. Basically they want it left alone as much as possible. Try not to sleep on it and so on.

It will probably take time to get used to the "thrill" but after awhile you won't notice it.

I can't really think of anything else to say about the fistula op. For me it was painless and relatively quick and I was pretty right as rain the next morning.

I wouldn't take out a permacath until the fistula was mature and working properly, but if you have a tunnel line AND a permacath then I could understand that if they are using the tunnel line for the hemo. It will take 4-6 weeks for the fistula to mature enough to be useable (and that may vary) so you definitely need some sort of access to do hemo with. If you're taking about your PD cath then yes that would need to come out - they probably want to kill two birds with one stone so to speak.

[tyefly]

I had my fistula done 6 weeks ago and I could not drive home nor did I want to.  My arm was numb but my head was still on meds.    I ended up having a problem with numbness in my lower arm.  I had a upper arm fistula and so I was very disappointed with so much numbness, which is still numb after all these weeks.  This is nerve damage according to my surgeon and it was the results from my nerve being compresses too long during surgery.   The clamp I guess was pinching the nerve.   I am supposed to slowly regain feeling with 6 months or so.   My fistula is now ready to use and I will start D this next Tuesday.  I think fistulas are like art work. Each one has it's own design.    I hope yours goes well

[Yvonne]

John has had his fistular now since April 2008.  He had it done under local, went in at 7.30 in the morning and was home by 4.O clock the same day, never been any trouble, the only thing is he is right handed and they put it into his right wrist so he must not lift too much. (Gets him out of doing a lot of jobs)

[KICKSTART]

Thanks everyone for your imput , it gives me a better idea of what to expect ! RichardM ..opps sorry for the R    I have to laugh at dialysis one of the ladies calls it her Fiscula !

[RichardMEL]

It's not normally put in the "dominant" arm if they can help it. Mine is in my left (and I'm right handed) which is good as it leaves me a free arm to do things I am already used to doing (though I have to change to wearing my watch in my right wrist instead of left). I guess if they have to use the dominant arm they will.

[KICKSTART]

Im left handed so no way am i having it in that arm ! Being on my own i need it fully functional !

[KICKSTART]

Forgot to add .. how long is the cut ? how many stitches? (fistula)
Do you always feel pain when the needles are put in for dialysis? (i know there are creams etc , but do you get used to needles?)

[RichardMEL]

I can only speak for me.. stitches? can't remember...

as for do you feel the needles? It is true as the skin hardens and your fistula gets used to being needled you do feel the pain less. I would say 60-70% of needles I don't really feel (just a bit of pressure as it goes in). The others I feel usually small pricks when they use a unused or "new" spot (which is good for the fistula, unless buttonhole is used). On rare occasions it's very painful but that's pretty rare. I don't use a local or any cream.

[dwcrawford]

I use the cream... seems  to work well as long as they don't his a spot that didn't get creamed.  My cut is about 3 inches across.  No stictches as they used glue.  4 1/2 months now and there is very little scar.  Fistula isn't as big as other's I've seen but surgeon approved!  NO pain after surgery.. really.  Not even an aspirin required.  No pain until first stick... then I said "sh*t" and worse.  It helps to scream and cuss.  Threaten them with bodily pain if they hurt you.  For guys, knee them in the ......  For gals, well just figure something out.

[KICKSTART]

Interesting that they use glue !  I also believe they start you off with small gauge needles ? Gawd i feel like a novice, after all those years on PD having to start over again !

[Brianna!]

Yes they start off with smaller gauge needles. then when the fistula matures more, they use bigger gauge ones. I don't use any numbing stuff, because my center won't let me. =[ I want to though. My fistula is pretty new though, so that's why it hurts so much for me. The scar is very little. But there are no stiches. Like someone said, they use glue. I'm getting used to the "sticks" though. When you build up scar tissue, you don't feel it very much. Unless they use a new spot.