I Hate Dialysis Message Board
Dialysis Discussion => Dialysis: General Discussion => Topic started by: chuckt67 on July 11, 2013, 05:09:11 PM
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A year ago my mother's PD cycler had an overfill. It took 2 days for the new one to come out. Her kidneys weren't supposed to be that bad (no day fills) so we were always told she could go a day or two without if necessary. She immediatelly got ill and confused. I took her to ER. The next day her Nephrologist told me she was no longer responding to treatment and that i should take her home and prepare for the end. I asked mom's Primary why we weren't being offered Hemo. He talked to the Nephrollogist and then called me and told me the Nephrologist said my mom would not have an adequate access. I asked if there were tests showing this. He said no, it was just the Nephrologists professional opinion. I asked the Primary to schedule an ultrasound and they found one spot on the upper right arm. So the put a catheter in her chest to get her started on July 3. The catheter clotted and was replaced 5 times. On the fourth time they finaly put the graft in late September. They also took the PD catheter out at that time (yes, the PD catherter was unused and unflushed for two and a half months). When the Hemo catheter clotted the fifth time a few weeks later, they started to use the graft. It clotted in one week. She had surgery to unclot it but came out with a C-MRAS infection succesfully treated with Vancomyacin. The graft clotted 3 more times after that. Shortly before New Year, I found in her records a 'Disorder of Peritoneal Dialysis Catheter' diagnosis on the same day the removed the PD catheter. That's right. It was all a mistake. I couldn't trust her Medicare Senior Advantage Provider anymore and I had to put her on Original Medicare at 20% our cost. There are only 3 reasons Medicare will allow another provider to take you if you already have ESRD and leave your existing Senior Advantage Proveder, and suprisingly, Physician incompetence is not one of them. So takes a look at her graft and says the it is no longer an option. The artery was damaged from the first sufgery and is irrepairable. So stuck with the chest catheter for the rest of her life, it took 6 months to talk mom into trying PD again. We did manual exchanges once a week for a few weeks. Last Wednesday we did the first cycler exchange and took the machine home to start on Friday. That night she wakes up with dry heaves, abdominal and backpains. I took her to ER at 5 am. They gave her drew blood and fluid from the PD catheter for Labs and cultures. And to be safe they gave her Vancomyacin and Ceftazidime IV drip (with a little morphine) and a Rx for Keflex. The pain went away and we went home around 6pm. We started PD the next night. The Davita nurse came by to get a sample. The first night we got 24UFs, the second was -47, the third night was 49, the fifth wasn 789 and last night was -53. Her first week 3 years ago, she got over 800 every night for the first week and didn't have a negative for the first 2 months. I'd been checking with the hospital and they reported not growth everyday. Then today the Davita nurse calls and says no growth in the PD sample, but,.....there was a very abnormal elevation of WBC Neutrophils, almost 100%. So I just did a manual drain and about a quarter of a bag came out. None of the 'pink' or 'white' strings but there is a very white glob that looks like something someone coughe up. It's about the size of a dime.
My first concern is this is something ralated to the way the PD treatment failed a year ago. Anyone have any ideas or heard of anything similar to the Neutrophils issue or the 'clam' floating around in the drain bag?
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Could it be that there was a minor blockage in the PD catheter?
I have rarely had signs of fibrin. After I was off PD for a fortnight recently (hernia repair) a flush produced something about 10 cms long which looked like a caterpillar - it had legs. Fascinating! Obviously things had settled into the holes in the catheter (TMI?) Second flush produced what looked like a puff of cotton wool - the size of my thumb.
Maybe the catheter is still clearing itself out. I wouldn't stake more than an eyelash on this theory though. Hope your mother's problems are sorted soon.
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yeah.. sounds like fibrin of some sort.. perhaps a day exchange with a bit of heparin in it to clear things out? Would ask the nurse first, though.
I was never able to see fibrin, except for the first couple of exchanges when I first started. At those times, it looked like chunks of wood coming out into the drain bag. I always had my mom check my drain bags to make sure there was nothing in them.
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It sounds like fibrin. Consult the PD nurse.
I'm sorry but I can't follow your background. I can't tell what was a mistake and why you had to change doctors. I can't figure out why her primary was involved. I really can't tell what you did with the insurance. Are you paying 20% of dialysis costs? That sounds impossible.
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It sounds like fibrin which can be dealt with by the adfition of heparin into the bag prior to fill. Have they explained the elevated neutrophil count?