Pre-sternal PD Access

[Rainy]

I spoke to a surgeon who is recommending a Pre-sternal PD Access instead of the Abdominal Access.  I would like to know if anyone has had any experience with this type of access and how they like it. 

[Charlie B53]

Pre-sternal, is that just to one side of the sternum, like mine?

It will be 3 years near the end of April.  I couldn't tell you the difference as this is the only one I have.  But if you 'belly up' to things like I usually have, it is much better as it doesn't get bumped or rubbed up against things.

It is more easily seen to check the site and bandage.

While I do have a couple of the PD Belts to hold the hose I wind it in about a two inch curl, single wrap, and tape it down with the bandage.  This gives far more support to the hose so it doesn't 'pull' against the site.  The remainder of the hose I tape against the top of my belly, or poke it through a hole I've made behind the pocket of my T-shirt.  Stick it through the hole and leave it lay in a curl inside the pocket.

[Rainy]

Thank you for the reply.  Since I haven't received any other replies I was wondering if there is another name for this type of access or is it that there aren't very many people using it?  I know, if possible I don't want to do hemo but having the PD access in my chest seems less attractive to me (and I don't mean physically) than having it in the abdomen.   I am thin; am I going to be able to see the outline of the tubing and feel the solution when filling and draining?  I know this  probably should be the least of my worries, but right now it's the one that may help me decide between the two.  I do think I would be less likely to bump/rub the site if in the chest and the doctor seems to think the chest area is a cleaner area than the abdomen.  Thanks again.

[Charlie B53]

Sorry for the very long response.  There is just so much to say, so many factors that people don't know, or what to consider in making a decision.  About the time I thought I said enough I remembered even more that I think everyone needs to know and consider.  It was very easy for my.  I'm a Guy, sorta old, retired, so I have a lot of freedoms that many others do not yet have.


I'm 6' Guy, or used to be.  Age has taken an inch and a half of as the spine 'settles'.  ,Aged enough my chin is grey. Weighed 220 most of my life, until I hurt my back in 97, started gaining 5 lbs a year till the kidneys decided they didn't want to play so well, then ballooned to 310.  Lost 100 over the last 2 years so I'm just under 220 again!

The cath is tunneled fairly deep under the skin from the site to its entrance into the top of the abdomen.   I can NOT see a line or ridge but I can feel it if I poke and slide my fingers across it.

It is NOT a problem.   Yes, it is a much easier area to keep clean and bandaged.  Having it this high on the body I am far less likely to 'bump' or rub it against anything like the table edge, or leaning over a fender, counter, or any other type of chores.

Slim females can still wear a short top without having it show.  For some Ladies I don't doubt they could be mortified at the thought of having to hide their bellies from sight forever.  With the chest cath it can very easily be concealed within a bra, T-shirt pocket, or using the Cath band which is worn just like the lower bra strap.  I don't care so much for mine that I seldom use it.  Just a bit of tape.

I've been on PD almost three years and one major complaint younger females have about a belly cath is their feeling of their less desirability because of the cath sticking out.   IDK, I think it is a self-confidence issue.  Which can be masked by clothing which ever position it is placed.  For me, I believe the chest to be the most logical.  Easier to maintain, easier to carry.

Ask if there are any existing patients in your area that are willing to talk, meet, etc..

Oh, and it is say, mid-point, between the breast bone and the nipple if you were totally flat chested.  Remember, I'm a guy, so I wouldn't know how else to explain it if the boob protrudes.  You Surgeon should be able to tell you EXACTLY the spot on you.  The actual procedure is very short.  In, knocked out, woke up, done.  But mine liked to keep me overnight so I couldn't drive within 24 hours of heavy meds.

It really isn't that tough, I highly recommend the chest.     Many never got a choice.  The Dr's have finally realized the higher placement is far better.   Especially in the case of an infection of the cath site.  The abdominal cath has a VERY SHORT path, with hardy NO TIME for treatment before it can get very bad.  Where the chest chat has a much much longer tunnel/path making it far longer for any infection to work its way down and into the peritoneal cavity.  For that reason alone it is well worth the placement.

Good luck deciding.

Take Care,

Charlie B53

[Hopeful1]

I do have another thing to add to your decision.  A nurse once told me one problem with it being placed high is that it is actually two connected tubes and one could (not likely) come undone and you would need to go back into surgery to get it fixed.  But the good news would be that you can hide it under your bra and it not be noticeable.  I would think that the lower abdomen area would be easier to get bacteria being close to the lower regions. (if you know what I mean) I am not in that position yet but I personally would think the upper area would be a good place to have it placed.  There is also another region you can have it put in.  You can have in put into your midsection.  I would thing the midsection or lower would be in the way of carrying things or even wearing certain types of pants. I hope you can come to an easy decision.

[kickingandscreaming]

I was never offered the option to place my PD catheter higher up. I have my PD catheter in my belly, to the right of my navel and below the belt line. Let's face it. No matter where it is, it is not a thing of beauty and sex appeal. It is simply a way to get fluids in and out of your peritoneum.  Because i'm used to having this alien object sticking out of my stomach, it is hard to imagine it much higher up. I think the "cleanliness" issue is a red herring.  There's just as much "dirt" in the upper regions of the body as in the nether ones.  I think the issue is more being seen from the point of view of the heath practitioners who have to deal with the catheter--for flushing, training, etc. Maybe they feel more comfortable reaching into your bra than into your underpants. 

As someone who has had a running issue with difficult drainage, I would imagine that draining out PD fluid going against gravity would be even harder than going with gravity. From an esthetic perspective, the PD belly isn't a real turn on.  No matter how nice your midrif and belly were to begin with, there is the classic PD belly look. I have spoken to several women who chose Hemo and a fistula (also not a thing of great beauty!) because they wanted to still have an attractive belly.  I'm a 74 year old widow and I don't expect to ever be in the relationship marketplace again.  So it's all moot at my stage of life.  But if I were younger, I might  make a different decision.

[Charlie B53]

You have a couple of years on me.  And I am still learning.  Pretty much the same with many things in life, it is what we make of it.  Accept it and move on, or try to rebel, have a poor attitude, and be continually unhappy.   I prefer the former.

I am glad to see that you also have that good attitude.