Help please, I need advice on chest lines/catheters

[rose1999]

My Dad went to the Renal Access Clinic today  to see about having a fistula.  Unfortunately the surgeon says the scan shows his veins and arteries  are too poor for a fistula and he will probably need to stick with the chest tube/line/catheter (sorry I don't know the technical term) that he already has.  There is an alternative but it involves 2 operations, one of 1 hour and one 2 months later of 3 hours and there is no guarantees of success, in fact it is likely to be unsuccessful and leave him with no circulation in his hand.  SO he's wondering how long these chest catheters last.  Does anyone have one that they have had for some time?  Can any one offer words of encouragement for him please? At 79 he's not keen to go through the alternative operation but if everyone says the chest tube won't last then he will have to seriously consider it.

Thanks for any advice or help you can give.

Best wishes
Rose

[boxman55]

Rose, I had mine for 13 months without a problem. I had the fistula surgery that is why I stopped using it. There are some people on this site that swear by it. As long as your Dad keeps it clean and covered during bathing and you get good blood flow it should be just fine but, it is susceptible to infection...Boxman

[MattyBoy100]

Boxman pretty much nailed it on the head there Rose.  Chest catheters can last a long time as long the site is kept clean.  The main issue with chest catheters is that they are more susceptible to infections.  The main problem is that if the area does get infected, the infection can spread more quickly to other vital organs ie the heart and lungs than with a fistula.  As long as every precaution is taken to keep it sterile then it will last a long time.  Once it is inserted, tissue grows around the catheter keeping it in place naturally.

I had to have minor surgery to have mine taken out and the surgeon ended up cutting it into pieces to get it out as it was so firmly embedded in my flesh!

Yes, I did get infected and I only had mine for 9 months before my fistula was ready.  I had to stay in hospital and was put on an antibiotic drip which was not a pleasant experience.

[Rerun]

At 79 he must realize that dialysis is a gift for life each day.  It doesn't matter how long the catheter lasts.  If it is his only option then he better take care of it and keep it dry and clean. 

Just a reality check! 

[Krisna]

I have had many of these catheters in my long time as a kidney patient.  I think the longest I had one was 5 months straight before it was removed due to infection but I was able to have another placed on the opposite side of my chest.  I was actually trained to clean it myself and I would just clean it and change the dressing after bathing.  Anything like that is prone to infection but I think the other who posted before me got it right.  As long as you keep it clean and dry and take every precaution the risk of infection is cut down! 

Just be sure he reports any new redness or tenderness to his doctor as soon as it's noticed because it could be a sign of infection.

[Rerun]

I'v posted this lots of times but.... there is a doctor on dialysis in my unit and he only has a cathater.  He won't get a fistula.  He has been there 2 years as far as I know.

[stauffenberg]

I had my chest catheter, usually called a 'central line access,' from December, 1996 to August, 2005, when I got a transplant.  It became infected only three times during all these years, and each time it was very simply replaced through the same tunnel into the chest via the insertion of a new line over a guide wire -- an entirely painless, quick, easy, and non-stressful procedure.

I think a central line access is far superior to fistuals and grafts, for a number of reasons.  1) There is absolutely no pain when being hooked up to the dialysis machine or taken off it.  2) You have complete freedom of motion of both arms at all times during dialysis.  3) There is no delay before being able to use a new central line for access, as there is for fistuals.  4) All the complications of fistulas, which include narrowing of the fistula over time, painful testing of it to ensure patency, ugly scarring of the body, the danger of infiltration during needling, possible surgical errors in forming it, and the long time and exercise required for it to mature properly, are all avoided with a central line.  5) The central line has much less risk of recirculation than a fistula.  6) Excellent pump speeds can be achieved and maintained with a central line, and mine was a steady 450 rpm from start to finish.

The only downside is the increased risk of infection, which you can minimize in three ways: 1) Keep the area where the catheter is inserted into the body clean.  2) Never let the area where the catheter is inserted into the body get wet.  3) Always wear a mask when being connected to or taken off of the dialysis machine and make sure the person connecting or disconnecting you does the same.

[livecam]

A little about chest catheters.  I had Tessio catheters for about 9 1/2 months when I first started dialysis.  They were in so long because the first fistula attempt that was made failed and the second was allowed to develop for many months before we started using it.  The Tessio's worked just fine.  Although they hang from the upper chest I would just tape them up and go about my business with no problems.  I was doing a fair amount of heavy lifting in those days at work (schleping tape machines) and climbing (at remote sites and on EJ trucks) and found that the catheters didn't get in the way of that.  The only real drawbacks to catheter use are that dialysis flow rates can't be as great (because of catheter and vein diameter) compared to flow rates with a fistula and the fact that a tech isn't allowed to put a catheter patient on and take them off.  Health regulations require that a nurse handle the put ons and take offs.  Other than those two fairly minor drawbacks catheters work great.  Chest catheters are much much nicer to have than the neck variety so if they want to continue your dad on the chest variety he should be in good shape.

[rose1999]

Thanks everyone for everything. Rerun I completely agree with your reality check and Dad does appreciate that the catheter may well outlast him anyway!      He was just feeling insecure after seeing the consultant, he'd gone in expecting a fistula and come out hearing that if he has one it involves a major op that may not be successful and may cause even more problems, he's recently (4 months ago) had major bypass surgery on his leg (femoral-distal bypass) and that really knocked him about - what you have all said will help him feel more settled. 

You're a great bunch, always so willing to give your time to support others, so glad I found you. 
Rose xx

[aharris2]

Hi Rose, we're just piling on here. Rolando has had his chest catheter for almost 3 years now, with no problems so far. We are careful to keep it covered and dry. They talk about him getting a fistula or graft and he nods politely, but my guess is that he will happily use this catheter until there's a problem and then get it replaced concurrently with graft/fistula surgery. "Cap and Go" is nice and we never have to worry about him bleeding after leaving the unit.

Livecam, I'm not sure what type catheter it is, but our favorite charge nurse researched it at our request and apparently it can be run at up to a pump speed of 500. However, Rolando usually runs between 400 and 450 because of A/V pressure.

Rose, here's hoping that your dad will get the same 8 1/2 years out of his that Stauffenberg did...or more!