fistula vs permacath

[cookie2008]

My surgeon says it sounds like a kitten purring, I can watch mine raise up and down to beat of my heart, my scar is from my shoulder to the bend in my arm, the scar looks better now May will be 2 years since it was raised.

[MooseMom]

Yep, woodsman, it is weird.  I'm still getting used to it.  I've had it only since March; I'm still pretty new at this stuff.  I've known for years that I would eventually be on dialysis, but it has only been since T-giving last year that my egfr dipped below 20, which is the cutoff point for being eligible for getting on the transplant list.  And that's pretty much when it all hit that fan.  But like everything else, I'll get used to it, and you will, too.  We'll both reach the point where feeling the thrill will be reassuring.

I hope you will be able to take some comfort from the fact that you are basically a healthy man.  It really does make all the difference.  I'm sorry, I don't remember...are you considering transplantation?

[Trikkechickk]

Carson,

My Neph told me it was okay to go up to 20lbs.  My fistula is in my upper left arm and I have done weights on and off most of my life.  Maybe since I was "in shape" I could do the weight with out  alot of strain.

Get rid of those damn catheters - they drove me crazy.  As far as needles, at first I was apprehensive, but then I just decided to "DO IT".  Now is you get a medical instrument which name ends in "scopy" (colonoscope, etc), then I start running - FAST!

Cindy

[Ken Shelmerdine]

I had my fistula done about 18 months ago in my wrist  under local anaesthetic. It wasn't a pleasant experience but if you feel any pain they just keep giving more and more local until the site is totally numb. Immediately after the op. there didn't seem to any 'buzz...trill...thrill' but the surgeon said it was there but very faint. I must admit I didn't feel too optimistic but when I woke up the next morning amazingly it was buzzing away.

 What has since happened is that the vein has split off into two! Sort of like a letter 'Y'. with the single vein starting about 4 inches above the op scar in my wrist and after about an inch further up my arm the vein development branches out into two. Its the left side of the 'Y' which is needled and this left side has now developed in my upper arm so I have about a 6 inch gap between the arterial and venous which means minimum recirculation which is good. 

They say my fistula is good and there is never any problem needling it but I can only achieve a 350 pump speed when they have needled dead centre. Most of the time I run at 300. Several posts on this thread say that they can actually hear their fistula but the only time I hear it is if I rest it on my pillow or put my ear to my arm .

Overall, although it is working well it doesn't seem to have developed into the large robust looking vein I expected (perhaps I should be thankful for that as my arm still looks a pretty normal shape) Maybe its because the blood flow is divided over the two veins and one compromises the other. At first the doctor considered tying off the other vein then decided not to because since I'm getting an adequate D the branched out vein could be considered as an alternative if ever I had a bad blow to give vein being used a rest.

As for the needles, at first it did hurt like hell but at the end of the day you've got to tell yourself that its only momentarily as the needle pierces the skin. Today I hardly feel anything at the arterial site because I think the skin has toughend up, sort of 'numbed out' Still feel a bit of pain at my venous but even that's starting to toughen up a bit.

[Hazmat35]

I was scared to death to get my Fistula (upper left arm).  But afterwards, it was really no big deal.  I was more scared and nervous than I needed to be. 

My Surgeon put me on the Twilight meds, so I was "awake" the entire time.  I didn't feel anything, but a little pressure at times. 

I have about a 3 inch Scar just above the bend in my elbow, that is hardly noticeable.  But, since they have used it for the last 6 months, I have scaring up and down the length of my arm from the needle punctures.  THAT PART doesn't look so great! 

I've been told that a Cath is much harder on the blood vessels and in the long run can do harm to you, VS. the Fistula.  Good luck. 

[Desert Dancer]

Hi, Lisa -

I see this post is a little old, but I will throw in my  anyway.

I had my permacath inserted and fistula created within three days of each other. The permacath scares the crap out of me because I've read all the studies about infection rates. The sooner I can get this thing out the better, and I can't WAIT to get a shower again. A catheter - while great for avoiding needles - will never be a permanent solution for me. They're just too risky in the long run. My nephrologist tells me they have a 100% infection rate at the 12 month mark.

I experienced far more anxiety about the fistula surgery than was strictly called for; it actually turned out to be rather anticlimactic. My scar starts just above my wrist and is only two inches long. My surgeon cleared it for use at five weeks out, but my training nurses and I didn't want to push it so we waited till seven weeks out. I went straight to buttonholes with 15 ga needles. I had to stick the arterial with sharps nine times - and the venous side 11 times - before switching to blunts. The venous side has continued to be just a little bit tricky, as the act of creating the buttonhole seems to have caused that one to turn ever so slightly, so I have to palpate it very carefully to make sure I've got the angle right. But with every cannulation it has gotten easier and easier and I hope to get both buttonholes cannulated on the first try by the end of this week.

The most painful part of it right now is just getting through the skin; it's very tight around the needle and I really have to push to get it through. The pain (for me) is just about the same as if you hadn't worn earrings in a long time and the hole closed up; ever have that happen? I expect it will just take time and repetition for the hole to remain open and the scar tissue to toughen up. In the meantime, it's only five minutes of pain out of my day; as soon as I get flashback and get the needle taped the pain is gone.

I actually find the thrill and the bruit to be quite comforting, as it means my lifeline is alive and well! The only time it freaks me out is when I feel a palpitation in my heart and then half a second later I can hear it in my fistula. Otherwise I imagine with time I could use it to lull me to sleep.

As far as what it looks like: who cares? Vanity fights a losing battle there. As a matter of fact, I'm trying to come up with a few really tall tales to tell children if they notice it and ask (as children will). You can get little kids to believe anything. 

[LoneHighway]

I was not worried about what a fistula would look like, in fact I was hoping it would be very prominent and make people stop and stare, and then I could tell them about it.    I joked to friends that I wanted it to look like I had AA batteries in there. I've always been very "vascular" and somewhat muscular, so I thought the fistula would look like that only bigger.

Well it took 3 surgeries over 6 months, but I finally found a doc who knew how to do it, and I got a great one. Here is a picture of it 2 WEEKS after it was done. Do you think they'll be able to hit it? 

As for the thrill, I think of it just like a cat's purring, feels exactly like that.

[tyefly]

  man .... what nice arms you have......  and your fistula too..............LOL

     YUP    I think your right.....  they WILL  hit that.....first shot......LUCKY DUCK...

[lawphi]

We felt the same way.  Aside from the scars, my husband has no bulging. He sticks himself through button holes and feels little discomfort.

My surgeon said it is usually the patients with grafts that have the issue with clots and gross arms.  We had a fistula clot on the wrist due to low blood pressure.  It was reworked and a site on the upper arm is functioning great.

We were in a car accident and the seat belt jiggled my husband's catheter  a little.  It could cause major damage if it was ripped out or damaged.  You would have to get flat on the ground and have a third party apply direct, intense pressure for 15 minutes compared to being able to apply pressure yourself to a fistula or tying it off.  There is not even time to call 911 if the catheter comes out. 

[miket]

I had a permacath and loved it. It served me well for 7 months.

[tbarrett2533]

Fistula= shower
Fistula= better clearance rates (usually)
Fistula= can last a very long time (if you take really good care of it and have 'good' veins)

Enough said................... 

I PERSONALLY love my CAPD cath out of ALL The "other" dialysis access' .................... just saying