PD catheters - 3 strikes and they're out!

[MaryD]

Just home from my third bout of peritonitis - recurrent.  Next step is the removal of the catheter.  OUCH.  Then I get rested for a week or so and we have another go.  My adequacy is still thought to be very good.  Doing a 24 hour collection tomorrow to see how much kidney function is left.  It is hoped I can get by with great care till the catheter is replaced.  I expect I'll have to change my diet, too.

Anyone been there?

[MooseMom]

Wait a minute...are you saying you won't be having any dialysis for about a week?  And that your docs think you have enough residual function to get you through that time?  That's really interesting!  I hope someone on PD will post an answer to your question, and I hope you will let us know the results of your 24 hr collection.

[jeannea]

It is true that if your 24 hr collection shows enough clearance, you can probably be ok for a little while without dialysis. You should be careful about what you eat and drink.

I'd be more interested in why you have the peritonitis. Do you just never get rid of the same infection? I would want to know how to keep from having that problem again.

[deniferfer]

I had the same problem, where I kept getting peritonitis a lot in a very short period of time and my Dr told me the infection was in the catheter . She never stopped D with me probably for the reason that I don't urinate at all and would have no way to clean my blood. So I ended up having to go thru surgery to replace the catheter. After that the infections stop. Good luck and I hope it all works out for you.   

[Jean]

Wow, Mary 3 times!!! That is 2 times too many. Hope they get it straightened out for you promptly.   

[MaryD]

Of course I had to get my latest bout of peritonitis at the beginning of a long weekend.  Catheter removal discussions start tomorrow.

My first lot struck on 30th March and was followed by two weeks of antibiotics in my 7.5% bags at night.  Second dose got me on 30th April - three weeks of antibiotics.  Last one - 9th June.  It seems to be the same bug.  I'm supposed to have a very good preparation and hookup technique (the ex-nurse in me coming out), so I still don't know how the original infection started.

Every time each day started out with me feeling really good, with clear drain bags.  By lunchtime I had a mild windy stomach ache, and by 4 - 5 pm it was on for young and old.  I caught it early each time so it was not as painful as I had been led to expect.  I am not lining up for a fourth bout though, if I can avoid it.

I have a feeling my non-dialysis time might be longer than one week.  It sounds as though it depends on the surgeons.  If the worst comes to the worst I will have to have emergency HD.  My veins are too crappy for a fistula.  I will be eating and drinking SOOOO carefully, in an effort to avoid HD.

At least I am on Renagel and Sensipar since I started dialysis so my phosphorous and PTH wont be as hard to control  (I hope)

[billybags]

Mary, I really feel for you and I hope things go well. Have they told you what bug you keep getting. Some times it is not all about hygiene (our nurse would say it is)  it can come from with in, like bowels. They must know what infection you have.

[Grumpy-1]

I had one go around with peritonitis and that was enough.   Thought I was having a heart attack.  So the hospital spent the first day treating a heart attack.  Then they realized (through tests) that is was peritonitis and began treating that.  They pumped me full of antibiotics and even pushed some down the PD tube directly into the PD fluid. All that took care of it after a couple days.   I never did stop PD during that time.   Grumpy

[Joe]

I haven't had those issues Mary, at least not yet (knock on wood). Hope it all comes out ok.

[snlfankevin]

I haven't had a peritonitis yet... and I'm trying to avoid it as much as possible. My nurses tell me it's very painful when I get it, and that it feels like someone's punching me in the stomach. I've only been on dialysis for about a year now.

[WishIKnew]

A little over a year ago i had 4 bouts of peritonitis concurrent and they pulled my cath and I had to go on hemo dialysis for 6 months and then they said I could go back on PD.  I like your plan MUCH better.  Fight to get back on PD!  I wish you the best!!!!!

 

[MaryD]

The Plan - as I understand it!

Surgery to remove catheter within the week.  If my drain fluid seems clear of bacteria (tested shortly) a new catheter could be placed straight away.  If it is I will be off dialysis for a week or so to settle it in.  I heal very quickly, so I hope this will be only a week.  Then dialysis can start using smaller volumes than I use now.

Meanwhile, my extraneal bag at night is being loaded up with antibiotics by Hospital in the Home each day.  Feeling pretty good - may it stay that way.

[bleija]

i had this exact experience this past summer, turned into an absolute nightmare. i would get and infection and do the antibiotics for 2 weeks completely clear up, and not even a full week later the infection would return, although the second 2 times i caught it early so not much pain. my nurse and the nephrologist on call decided it would be best to remove the catheter for about they said about 4 to 6 weeks, and during this time i would do incenter hemo, had a cath in my chest and hated every minute of it. i had a lot of issues trying to get bnack on pd, ive posted about that in other thread. i really hope u have smooth transitions both ways.
and the pain of peritonitis, is like somebody taking knifes and slashing away at ur insides, and laying down does not let it release. 

[MaryD]

I've just had 12 hours notice that I am to be down at the hospital in the morning at 7.  Sounds as though I will have to wait for a new catheter to be installed.  Bummer!  Keep your fingers crossed.

[brenda seal]

Fingers are crossed for you Mary . Hope it all goes well for you !

[billybags]

MaryD, How did things go? Good I hope. Thinking about you.

[MaryD]

CATASTROPHE!!  My jeans are now too large.

Just back from hospital sans catheter and with a flatter belly.  Apparently the bug I had acquired had managed to work up a resistance to the antibiotics I was taking.  Stayed overnight in hospital mainly because I live by myself, and because they were working out which new antibiotic would be best.

A new catheter will go in in 4 - 6 weeks.  Meanwhile I eat carefully and go down to the home care clinic every week instead of every 6 weeks.

My son also is getting married in 6 weeks - what a busy life I will be leading.

I feel very good at the moment.  I can't praise too highly the staff at the hospital - the surgeons, anaesthetists, renal doctors and nurses and ward staff were all wonderful.  Ward 2 East is becoming like a second home for me, which is probably not all good.

It's good to be home.

[billybags]

So glad you are home Mary, have you started doing hemo yet, and how are you finding it. Four to six weeks will go quickly and then you will be back in control with your new catheter. Take care..

[MaryD]

Billybags

I'm hoping to get through the 4 - 6 weeks without haemo.  I've only been on PD for 6 months.  My kidney function decline was quite slow.  My eGFR figures sank quite gently.  From 23 to 17 took 3 years.  17 to 13 another 18 months, then I bobbed up and down between 13 and 9 for six months before PD was started.  I was always careful with what I ate, so everything except my PTH levels and creatinin was reasonably under control.

I have my first post PD blood test next Tuesday.  I will be very interested in the results - hoping they show I might last without PD.  I have been told that it's instant haemo if things go pear shaped.

Fingers crossed!

[komomai]

Mary, hope all goes well sounds like your really careful with the diet which is super good.

I've had one bout of peritonitis, the Japanese hospital told me to come in for a week so they could hook me up to the antibiotics.  I also use the Baxter UV machine to hook up so I don't physically touch the end of the catheter.  Works great, hang in there.

[MaryD]

First test results back five days after catheter removal.

All numbers are Aussie numbers.

Potassium up from 3.8 to 4.2: phosphates 1.56 to 1.54: creatinine 405 to 391.  Not a lot of change except for the potassium.

Amazing turn up though - my foggy thinking returned four days after dialysis stopped.  While I was in hospital I was reading a gripping novel (a murder, political intrigue, international espionage etc etc).  I got 3/4 of the way through it in three days. On day four I tried to finish it off.  I could not make sense of any of it.  I struggled to finish it - had trouble remembering the names of the characters - had to read paragraphs again and again to understand what was happening.

I also had trouble driving to the supermarket - had to think hard to recall the way.  Foggy brain is back with a vengeance!

When I started PD several people told me I would not notice any real difference in the way I felt for 4 to 6 weeks.  On day four I was suddenly and unexpectedly ALERT.  That has just as suddenly and very disappointingly reversed.

Overall, I still feel pretty good.

[travbug]

Glad you are feeling good except for foggy brain.  Keep us up to date.

[brenda seal]

Hi Mary , Just a quick Hello and sending you good wishes . I hope you continue to do OK without dialysis . Foggy brain  hopefully will not last long . Stay warm .
Brenda

[MaryD]

Amost two weeks out and I'm still doing fine.

My eGFR has actually jumped from 9 to 11.  My diet (self imposed) is a little boring though.  I realised a few days ago that it was practically all grain-based - couscous, rice, porridge, pumpernickel, with very little protein and/or vegetables.  I am not at all tempted though.  The thought of emergency HD keeps me on the straight and narrow.  I figure if people in Africa can live on a maize-based diet their entire lives (short though their lives might be) I wont starve in six weeks.

Along with foggy brain, the pre-D constant low-grade headaches have returned.  Otherwise I feel OK.  I also have Sensipar and Renagel working for me, too.

[MaryD]

Still hanging in there three weeks out.  My numbers are still OKish, and I'm game enough to be a little more adventurous with my diet.  I'm having minor fluid retention problems.  Doubling the dose of Frusemide seems to holding that at bay.  More pre-D complaints are returning and some things are happening which hadn't happened since starting PD but which I hadn't realised might be connected to ESRD.  I'll be very interested to see if they disappear when I'm back on D.

With a little luck my new catheter goes in 24th July, and if my numbers are still hanging in there, the catheter might get a couple of weeks to settle in.