Need Advice from PD Folks

[TaylorMN]

Hello all:
My husband just started dialysis (in center hemo) two weeks ago.  He is going to try PD so we will be seeing a surgeon regarding the catheter soon.  The home dialysis training nurse gave us the impression he would have some choice as to the location of the catheter site.  What do you recommend?  Above the pants line for less rubbing against pants?  He is 78 years old and doesn't need to look cute shirtless or show off his biceps so that's not an issue.  Just thought you all would have some good advice.  I am so thankful for this website.  Any other advice for us would be welcome.  THANKS!
Rita

[jeannea]

Not sure. I didn't get much choice. Maybe when you have your pre-op appt you can discuss it with the doctor. But I think they put it where they think it will work best regardless of how you think your panys will fit. You might be allowed to choose left or right but since I had a previous transplant I didn't even get that choice.

[CHeatherS]

Gosh, I sure wish that I would have had some good counsel and advice before I had mine done back in March.  The surgeon measured me on a Friday, and I was supposed to go in for surgery on Monday, but I got sick over the weekend and had to cancel.  So then two weeks later I am in for surgery and go in with sweat pants and she comes in and says she needs to measure me (I am not thinking clearly by that time).  I told her that these aren't the pants I usually wear.  Well, she put it too low so all of my pants won't fit.  I had to wear overalls for the first month, and only now can find some pants (very very low riders) when I am empty in the daytime.  It's a real bummer.  I think that it's best to have it higher above the belt line so that it's NOT going to rub against or interfere with the pants at all.  You won't want a belt or pants pushing on the tender exit site or the tunnel.  So talk this over carefully with the surgeon and hopefully he/she has some experience at this. 

Good luck and blessings on this!

Heather

[Jie]

Unless it is an emergency, every one should have a choice. I  like it above the belt. This was what I had.

[cath-hater]

They'll probably recommend "above" the belt line. Like others have said, I think it's better that way. I could imagine if the belt line was constantly rubbing againt my exit site, it would cause alot of irritation and/or infection.

[HouseOfDialysis]

Mine is just above the belt line, but a touch higher wouldn't have been bad.

[WishIKnew]

You all seem to have the how high issue covered, but here's my thought.  I sleep on my right side and my catheter is more on the right side.  I wish I'd have had it centered or even more on the left.  As it is I set of the drain alarm more frequently because I'm sleeping soundly on my right side and block the tubbing.

[wildcat]

You do have a choice as to where it goes.  Most surgeons don"t have good bedside manner, and never ask patients.   Insist on this and make sure you tell everyone, doctors, nurses, etc, who will be caring for him while he is in the hospital getting this done.

It all depends on where he wears his pants.  Some of the seniors wear them higher than normal.  I would try to get the cathater placed above the belt line of his pants, unless he wears his belt line up real high.  Main thing is to get it above or below the belt line to avoid rubbing. 

[Alisa]

I as well never got a choice or asked an opinion for that matter.  My placement was just at the waist line (annoying) on the left side.  There is no BEST place to put this but I agree to take into account the side you sleep on.

[peleroja]

I didn't have a choice.  Due to my large belly roll they had to give me a pre-sternal exit site (just to the right of the top of my left breast).  I never had any problems, so when I had to have it one a second time, I went with pre-sternal again.

[Kay]

Hi there!
We were encouraged to choose a position and side that would be easy to do the exchange - bearing in mind the need for aseptic technique  - so he chose below the belly button slightly to the right. However, because he likes to sleep on this side  he does find it a nuisance. However doing it all left handed would not have been good.  I think if you google up there is a VCR about positioning of the catheter  - wish we had seen this first.
One thing we are glad of - the whole technique was done under local anaesthetic -brilliant! The hospital here in Brighton UK pioneered this blind technique.
Good luck with it all,
Kay

[Willis]

I just got my PD cath a few weeks ago and I insisted that it go on the left side. Due to a problem with my left shoulder it is very painful if I have to sleep on my left side for an extended period. As for how high, like many others, I didn't even consider that option. Mine is just below my belt line and fortunately seems to be just right for me. If anything, I think it could be an inch or two lower.

 

[Mike_NC]

I wasn't given a choice either. When I met with the surgeon, he showed me where he was going to place it and I wasn't offered a choice. Mine is level with my navel, about 3-4 inches to the left. I'm glad mine is above my belt line.  I have to sleep on my right side or I get alarms all night long. I was told that generally, people sleep on the opposite side from where the cath is placed. Obviously, that's a case by case basis, being everyone is different, but that seems to be the 'guideline' that was told to me.

[Quickfeet]

My gosh, the best part of my catheter surgery.  First meeting, I told the surgeon above the belt. Then the scheduling nurse asked me again. Then on the follow up apt. I was asked again where I wanted the catheter. Fast forward to the day of the surgery. The nurse asks where I want it. Then the doctor comes in again and asks me where I want it. He even puts a circle where he will put it. So I was asked at least five separate times where I wanted my catheter each time I said above my belt line. Post-op I wake up to find it placed far below my belt line. I asked my mother if the doctor said anything about it. She said the doctor told her everything went perfect. To me, that is a p*ck up! If you aren't going to do what I pick, why ask me five times. And if there was a medical reason why lie to my mother? A year later and I still want tell this guy off. I wish we had a smiling with steam shooting out it's ears.

[HouseOfDialysis]

I wasn't given a choice either. When I met with the surgeon, he showed me where he was going to place it and I wasn't offered a choice. Mine is level with my navel, about 3-4 inches to the left. I'm glad mine is above my belt line.  I have to sleep on my right side or I get alarms all night long. I was told that generally, people sleep on the opposite side from where the cath is placed. Obviously, that's a case by case basis, being everyone is different, but that seems to be the 'guideline' that was told to me.

I generally sleep on my back, but I get slow flow alarms while sitting up the first two hours on the cycler. However, if I sleep contorted and almost on my stomach, no alarms... Odd.

[Marina]

I had  my  PD  cath done  over  7yrs  ago.  I  wasn't  asked  where  I  wanted  it.    I  was  just  asked  if  I  was  right  or  left  handed.   They usually  put  in  on  the  less  dominant  side. It  makes  perfect sense to me, since the  dominant hand  will be the  one  doing  the  connection.
Mine  was  placed roughly  3 inches  to  the  right  of the  belly  button, and close  to   2 inches   below. 
It  worked  perfectly  fine  there.   I  do  tend to  sleep  on  my  sides, so having the   cath  more  towards  the  center helped.

My  brother  went  in  a  day  before  surgery to get  measured by  PD  nurse.
The  cath  wasn't  even placed  where  the  nurse  marked  it.
It  was placed  right  at the  belt  line,  which  is  not  a good  place  for it.
Maybe  it  was  a communiction  error  or  a misunderstanding.   Maybe  the  nurse  marked  where  the  belt  line was  and the surgeon  thought  that's  where  the cath  should  be  place,  IDK.

[Willis]

Something I just learned while getting training for PD (my cath surgery was 3 weeks ago)...the doctor controls what DIRECTION the cath will lay also. Something called a "tunnel" and my PD nurse kept feeling horizontally across from the belly-button to the exit site. But mine was looped upward and comes down vertically from the top. I think that's good because the tubing lies flat naturally when pointing downward. Seems it might be more awkward if the "lie" of the tubing was out toward my left side. But the PD nurse seemed to think mine was unusual. And I have no idea if this is something the surgeon decides once he gets inside the abdomen or not.

 

[Marina]

Something I just learned while getting training for PD (my cath surgery was 3 weeks ago)...the doctor controls what DIRECTION the cath will lay also. Something called a "tunnel" and my PD nurse kept feeling horizontally across from the belly-button to the exit site. But mine was looped upward and comes down vertically from the top. I think that's good because the tubing lies flat naturally when pointing downward. Seems it might be more awkward if the "lie" of the tubing was out toward my left side. But the PD nurse seemed to think mine was unusual. And I have no idea if this is something the surgeon decides once he gets inside the abdomen or not.

Yes  each  surgeon has  their  own  particular  techniques.
My surgeon  did  a  "double cuff"  on  me.     My  nurses  were  wondering why  he  would do such a  thing.
We didn't  ask  at  that  time.    We  later  found  out, he  was  trying  a new  technique.  He  only  did  two  of  those  double  cuffs.               Maybe he  wasn't happy  with them   
But it  turned  out  beneficial for  me.  I  never  had  tunnel  infections  due  to  the  double  cuffs.       If  any  bug  entered the  tunnel the, the  double  cuffs  prevented  it  from  entering  INSIDE.

 

[Alisa]

Could you explain in more detail what a double cuff is?

[Marina]

Could you explain in more detail what a double cuff is?

http://www.pdiconnect.com/cgi/reprint/27/5/554.pdf

http://www.ncbi.nlm.nih.gov/pubmed/20103501

[Atooraya]

Mine is well below my belt line. Works well Ican tuck everything away and tape it up. I wear the same pants as before PD.