How to Secure a PD Catheter at Night

[Marilee]

My hubby has been doing PD for a little over 2 years now, and has had problems with the machine waking him several times at night due to "slow flow". We've had several machine replacements and even another surgery to reposition the end of the catheter in his body. Yet, still, he was getting a lot of slow flow problems.

Recently, he noticed that the titanium connection (the bit that connects the Transfer Set to the Catheter) is so heavy - or perhaps the catheter tube is so weak/flaccid - that the tube can kink right where they come together. The titanium connector just sort of flops to the side. We guessed that this easily happens in the night when he rolls to one side or another while sleeping.

So, to see if indeed this is the problem, he braced this joint with some electrician's tape. That was about 4 days ago. Since then, the number of alarms has diminished to just one or less per night. A huge improvement!

So, now I'm wondering if he's got a faulty catheter, or if this is how they all are. I'm also not sure that electrician's tape is good for the long haul because I don't know how the adhesive may react with the catheter's plastic. That leads me to wonder if we've missed something as far as securing the catheter at night. He wears a belt during the day, but not at night while connected.

I don't have  a specific question, just looking for any thoughts, insights or similar experiences.

[kickingandscreaming]

Are you talking about the catheter  OR  the transfer set?  The transfer set can and should be replaced every couple of months.

[Kathymac2]

I just checked my PD catheter because I don't remember having this problem. My catheter connection between the catheter and the transfer set does not seem floppy or weak. At night when I am not wearing a PD belt, I just tuck the catheter connection down into my underwear.  I sleep very little during dialysis, so I am mostly always aware of my tubing and therefore rarely get an error message for "patient blocked tubing".

I agree that the electrical tape is probably not a good solution long term. If you have a good nurse at your dialysis center, he/she might be able to come up with a practical solution based on past experience.

Something sterile that can be wrapped around the connection and taped without putting the tape on the connection would work. Alternatively, maybe you need a new transfer set. My center changes the transfer set every six months.

[Marilee]

Here's a picture to help with the description. I'm talking about the area I labeled "Kink area"

It's interesting also to note that the catheter literally cut open at the connector about 2 years ago. They shortened it and put on a new titanium connector and that problem didn't happen again... hmmm...

Kathymac, thanks for letting me know that your catheter doesn't kink. Do you know what brand it is? Ours is from Baxter.

[Marilee]

KickingandScreaming, thanks for the reminder about the transfer set: His was replaced about 3 months ago.

[Kathymac2]

Mine is Fresenius.

There is a "beep-away spring" sold online by Stickman (sorry I don't know how to add the link).  I have no idea if it works, but it looks like it might help your situation.

[Marilee]

Oh, man, Kathymac!!! Thank-you !!!

I found it and am posting the link for others to find, too.

https://kidneystuff.com/products/beep-away-spring?variant=2880582778907

[Kathymac2]

You are welcome. If you try it, please let us know if it helps.

[Marilee]

I've ordered one and we'll see how it goes, and for sure, I'll post an update after a few weeks of use. By looking at the photo, I'm not sure how the spring will stay in place all night, but heck, for $14, it's totally worth a shot.

[louman1961]

I also get my transfer set

[louman1961]

I get my transfer set replaced every 6 months by my home dialysis nurse during my home visit.
I found that the 3M Mepore H tape works pretty good in fastening my catheter to the side of my abdomen, and sticks for the whole night and his hypoallergenic.
https://www.amazon.com/3M-Medipore-H-Soft-Cloth-Surgical/dp/B000O0FBL4

[Kathymac2]

I use the Medipore surgical cloth tape to hold down my exit site dressing. It's the only tape that doesn't cause me to have a skin reaction and I have tried them all (almost literally).  Highly recommend.

[Marilee]

Thanks, Louman1961. Just curious... do you tape down the catheter side as well as the transfer set side?

[louman1961]

Just around  the catheter side. a small strip of tape, it seems to hold the catheter in place and doesn't tug when you walk with your patient line. 

[Marilee]

Ok, yeah, that's the same as my hubby: a small strip of bandage tape a few inches from the exit site on the catheter side. It does a good job of keeping the exit site from feeling a tug.

[Marilee]

OK, so we have used the "Beep-Away" Spring for about 10 days. Just to get familiar with it, we ALSO left the electrician's tape on the catheter. About 3 nights ago, we started to notice an increase in beeps, and last night noticed that the electrician's tape had developed a stress crack, so we replaced the tape and last night was beep-free. So that means that the tape is helping, but the Beep-Away really isn't. If it did, there would not have been an increase in beeps when the tape failed.

One note: To keep the spring up where it needs to be, hubby would 'hook' the end onto the bandage's tape that is used as a stress relief, but even so, the Beep Away allowed the kink that happens when hubby rolls to that side during sleep. The spring needs to be A) Smaller and B) A little more Rigid.

Attached is a picture showing a straw inside the Beep-Away, and I'm simulating rolling over. You can see that the straw is free to kink. I can't really get a decent photo of the actual catheter kinking because it's literally hidden from view .

[Cupcake]

I was on PD for 2 years, my cath was very picky about the position and would only drain if I was laying on my right side. but the tube would only work if I had it taped to the right. so to make it work, I would tape the tube going to the right, then wrap it around my waist (underneath my right side, across my back, then up over my left side) and as long as I was in that position for draining it worked fine. I think it worked for me as I am not boney so the tube didn't collapse. For exit site care I used a split 2 x 2, then covered it with a 4 x 4 piece of medipore tape-love that stuff. only once did I wake up after a restless night and the tube had migrated up and was wrapped around my neck.

[Charlie B53]

I did PD 3 1/2 years before an infection caused my switch to Hemo.

My cath was 'tunneled' up and exit site was midway between my left nipple and breastbone.

I HATED my Stickman PD Belt.  It was hot and scratchy enough so I regularly taped my cath using the 3" stretchy cloth tape Cover-Roll I think it is, that my clinic supplied me with for my site bandaging.

I would curl and tape my cath so during the night no matter how I moved it couldn't pull on the site or kink as before I learn this it would pull terribly on my site, stretching the opening and Nurse would cauterize it at EVERY visit.  That area is numb from nerve damage from my by-pass surgery so I never felt the pull.  It was only during dressing changes that I would see that it was elongated and MAD, red, and then I knew Nurse would be sticking that silver Q-Tip in there and burn it again.  That was never much fun.

Once on the Cycler I didn't drain so well at night, so we set my program to 'Tidal' so it wouldn't have to fully drain.  In the morning it would 'Hold' after the last Drain until I got up and poked the machine to do a 'Manual' drain.  Sitting up I would drain completely, then go on to my last Fill of Ico which stayed in all day.

PD is really neat as your Nurse can walk you through changing the program to tailor it making for a much better individualized treatment program that works well for  you.

When my stand-by manual supplies started getting near expiration we added an extra bag to my program, adjusting the time and number of cycles to use another bag.  Side effect?  My labs improved even better than the good labs I already was having.

Aside from my infection from Hell, my only complaint with PD is the massive amouont of time, daily, as compared to 3X weekly Hemo in-clinic.

Still, I think I am Blessed to be doing well as I am.

Take Care,

C
harlie B53

[Marilee]

Thanks, Charlie and Cupcake. I'm starting to get a better visualization about what's needed.

We showed the electrician's tape jury rig to the dialysis team today and we saw quite a few eyes bug out! Their only concern is that the adhesive might break down the tubing of the catheter. They didn't have any data to support it, just had never seen it done before. But at least the electrician's tape proved that the kinking is worth addressing. The doctor suggested instead using bandage tape and taping it every few inches to his body - effectively using his own body as a splint - and that sounds a bit like what Charlie and Cupcake did. It could be that taping it more toward the center of his torso rather than the side will help, too, because the kinking happens mostly when he rolls to one side, and if the tube just never falls that far to the side - no chance to kink.

Meanwhile, I'm looking at some ideas from McMaster-Carr (a hardware website) - various electrical and tubing sleeving ideas that we could place over the catheter tube and tape just to the titanium to keep it right where the kink is most likely to occur.

I'm really surprised there isn't any solution from Baxter - they supplied the catheter AND all the other supplies. They must have run into this before.

[Charlie B53]

I am well familiar with McMaster-Carr catalog.  Which makes me think of ?? Qwap, I forget the proper name of the stuff.  It is used as wire and tubing protector, looks like plastic pipe that has been cutting a spiral.  Can be bought in long coils and cut to any length you want.  It is wound, spiraled onto wire runs or sections of hose that rub against stuff so as to protect the wire or tube from chaffing.  Available in different sizes, diameters, even colors.  A section of the appropriate size could be used on a cath to provide strength to prevent kinking.

Talk a bout plastic tape and staff rolling their eyes.   I adopted a batch of kittens, raised them and adopted them all out.  Well..... Kittens can be a bit  rowdy.  And I kept them in my bedroom where I did PD.  I never let Nurse know about them,   Until I had a problem.

One night I woke up with a wet bed.  I discovered a tiny hole in my cath near the transfer set.  I clamped the line on the body side of the pin-hole, disconnected from the machine then used alcohol to clean and dry the hose.  Electrical tape is quite sterile as it is a petroleum product formed from solvents at temperatures.  Between the solvents and temperatures no bacteria could survive so I was certain it wouldn't be a problem.  I taped around the hose making sure I had a perfect seal, reconnected to my cycler and went back to bed.  The next day or so I called Nurse and let her know I had dealt with the leak.  She wasn't impressed.  Had me come in so she could cut/refit my transfer set and did a manual exchange with a bag loaded with antibiotics.   Nurse made me PROMISE to get rid of the kittens.  I did in a week or so when they were old enough to be adopted out.  Hope she never reads this as she knows where I live and could quite possibly come kick my butt.

Hot solvents, like my favorite carb cleaner also works wonderfully.  Burns like fire for a minute or two, but never any infection and they all heal up in record time.

I wouldn't worry about the tape adhesive damaging the hose.  Both are petroleum products.  I had no problem  with any type of tape adhesives other than they can be a serious bitch to clean OFF the hose.  Alcohol wipes take a lot of scrubbing to get it off.  Nurse gave me some special adhesive removal wipes that worked much better but even they required a bit of work to get it all off.

[Marilee]

Thanks for the assurance about the petroleum products, Charlie. That really helps my brain feel less nervousness. Your right about it being hard to get the adhesive OFF, though, and since the tape does break down, we'd have to deal with that too often.

Hubby woke abruptly just like you did one wet morning, Charlie, with a cut in his catheter tube, right where the titanium fitting goes on. "Close, clamp and call" rang through our heads and he ended up back in the hands of the surgeon who removed that end of the catheter, put a new titanium fitting and transfer set on, and then nurse did the antibiotic session just in case. This event is really the reason we're taking the kinking seriously: We know that a kinked hose is a weakened hose - and we don't relish a repeat of that morning. No one could blame kittens here (and our doggies have shown zero interest in the PD equipment - thank goodness!): There's speculation that there had been some kind of stress point made during the original surgery (this happened just one month after surgery), but nobody really knows what happened.

Here's the page at McMaster-Carr: https://www.mcmaster.com/standard-cable-sleeving with the options. I whittled it down to those with an inside diameter of 1/4", so I'm gonna get some "slit corrugated sleeving", some "spark resistant tube sleeving" (we'll have to cut this open to make it work, but we are curious about it) and some "wrap-around sleeving" to try. I was hoping some of the expandable sleeving would work, but it can't quite expand enough to slip over the connector end. We're gonna make little 1" collars of each and tape 'em to just the titanium and see how that goes, one by one. We think that all that's needed is a guard right where the tube meets titanium: That's where the weight of the titanium collapses the tube. It makes me think of the collar on the garden hose outside right where it connects to the spigot.

[Marilee]

Just an update:

The sleeve that we liked best from the selection in the previous post is the "Slit Corrugated Sleeving". We cut off a two-inch piece, popped it around the catheter just below the titanium fitting and used electrician's tape (because it stretches) to tape it closed and tape it to the titanium. So now it has this semi-rigid collar to protect the catheter right there.

Hubby is sleeping better: The machine will beep, but after the draining is about half-done and it's time to roll over - not because the hose is kinked.

Yea!