YEA, The Cathater Is Finally Out

[BigSky]

stauffenberg,

I use the word temporary because they are all temporary.  They are not meant for long term use in hemodialysis.  By all standards a fistula is the "Gold Standard" for a access.

CMS, AAKD, NKF all recognize catheters as being only temporary in long term hemodialysis

Among reasons they list.
    a greater likelihood to become infected, clotted or fail
    a slower blood flow so dialysis may not clean the blood as thoroughly as with a fistula or graft
    inferior access for long-term hemodialysis

[thegrammalady]

what fun, i apparently started.....well i'll be nice and won't say, what i will say (actually say again) ya'all remember the 300 pound gorilla in the corner of the room that i ignore, stauffenberg apparently spends his time chasing him around the room trying to make him leave. but it does make for interesting commentary. stauffenberg is entitled to his thoughts and feelings, no matter how many of us there are that disagree with him. i find his dissertations interesting, no matter how much i disagree with him. after more than 2 years of catheters, here are my main reasons for being glad mine is finally gone.

1 - it showed with almost everything i wore.
2 - i couldn't (not that i really want to) wear a bra with it.
3 - it itched continually
4 - when i drove the seat belt rubbed against it.
5 - it was the cause of the pulmonary embolism that landed me in the hospital.

now as to the scar from the fistula, WHO CARES. if someone sees it and comments, in fact i wish they would, it gives me the opportunity to climb on my soap box and educate a mostly unknowing population about kidney disease, dialysis and the need for living transplant donors.

sorry i'm just a fiesty red head with a big mouth and i use it. continue on, i'm enjoying this thread immensely.

[spacezombie]

1 - it showed with almost everything i wore.
2 - i couldn't (not that i really want to) wear a bra with it.
3 - it itched continually
4 - when i drove the seat belt rubbed against it.
5 - it was the cause of the pulmonary embolism that landed me in the hospital.

I agree with most of your reasons for not liking catheters... only apply them to my PD catheter. At least it does seem that a PD catheter is safer than one for Hemo (just in terms of causing things like pulmonary embolisms). I think that while catheters do not bother some people, for me they are really annoying. Always itchy, always in my way. Any time I can feel just a little bit more "normal" is a day to celebrate. So congrats again on getting your cath out!

[willieandwinnie]

stauffenberg, I have one question for you, are you truly that miserable of a person? I feel sorry for you if deep in your heart you believe what you post.

[stauffenberg]

Bigsky: "Temporary catheters," also called "Neck Lines," and "Permanent Catheters," also called "Permcaths," are technical distinctions between physically different designs of catheter.  The first type cannot safely be used for longer than 10 or 12 days; the second type can be used for many years.  You may want to characterize the second type of catheter as temporary because of various objections to them, but they are not 'temporary' in the same, technical sense of the first.

Bill: There is no way different rates of catheter use can account for the observed difference in death rates between the US and other developed countries, which is, on average, 24% per year in the US and 10% per year in the rest of the developed world.  Catheter use is not sufficiently widespread to account for a 14% difference.  The usual explanation offered is that at for-profit centers patients are confined to shorter treatment times, while in not-for-profit systems, there is no pressure to reduce patient treatment tiimes.  In fact at US non-profit dialysis centers, where no doubt the catheter use is similar to that at private centers, the death rate is comparable to that in the non-profit dialysis centers in the rest of the world.

Petey: Almost all the comments on this message board are critical of renal failure and its various treatments, which INDIRECTLY characterize LARGE NUMBERS of people on this message board.  We criticize sleep difficulties, exhaustion, anemia, hemodialysis, peritoneal dialysis, transplant medications, waiting times, transplant operations, and fistulas.  While these phenomena are regarded as NEGATIVE, and these negative things INDIRECTLY characterize the patients and thus indirectly say something negative about them, they are not PERSONAL, INDIVIDUAL attacks on them, as were those against me.  To say something negative about a particular individual's personality is uncivilized in any context, and outside the bounds of what is acceptable on this message board.  I hope the distinction between your comments and everyone else's is clear to you.

[Bill Peckham]

If you'd take a look at the data I think you'd find it more compelling than your four country personal survey
http://www.kidney.org/professionals/KLS/pdf/BestPracticeMar05.pdf

I was on a panel earlier this month that reacted to a presentation at the NKF Spring meeting, by Lawrence Spergel, MD, Clinical Chair, Fistula First Initiative who was presenting data to refute the idea that Fistula First increased the use of Catheters - which we believe we've seen here in Seattle - but Spergel had compelling data to show that this wasn't the case. I can send you the slides if you'd like but not much has changed since the 2005 data was reported - the above link provides a nice summary.

The difference in mortality is almost entirely due to catheter use (there are other factors but the vast majority of the difference can be seen flowing from catheter use, particularly prolonged catheter use) and I know it must be very tempting to bolster your argument by exaggerating the mortality difference but it is only in Japan - where the fistula rate is above 90% - where the mortality rate is below 10%. Outside the US and Japan mortality rates are mostly in the upper teens.

[BigSky]

Bigsky: "Temporary catheters," also called "Neck Lines," and "Permanent Catheters," also called "Permcaths," are technical distinctions between physically different designs of catheter.  The first type cannot safely be used for longer than 10 or 12 days; the second type can be used for many years.  You may want to characterize the second type of catheter as temporary because of various objections to them, but they are not 'temporary' in the same, technical sense of the first.

Technical distinctions mean nothing in terms of long term dialysis and the complications that arise from the use of such devices.

[petey]

Petey: Almost all the comments on this message board are critical of renal failure and its various treatments, which INDIRECTLY characterize LARGE NUMBERS of people on this message board. We criticize sleep difficulties, exhaustion, anemia, hemodialysis, peritoneal dialysis, transplant medications, waiting times, transplant operations, and fistulas. While these phenomena are regarded as NEGATIVE, and these negative things INDIRECTLY characterize the patients and thus indirectly say something negative about them, they are not PERSONAL, INDIVIDUAL attacks on them, as were those against me. To say something negative about a particular individual's personality is uncivilized in any context, and outside the bounds of what is acceptable on this message board. I hope the distinction between your comments and everyone else's is clear to you.

stauffenberg -- There's a difference between commiserating with others about the negativity of renal failure, sleep difficulties, exhaustion, dialysis, etc. and coming right out and describing how horrible and inferior one type of access is compared to another.  As far as I'm concerned, you started the personal attacks when you used those awful, hateful words about -- and your distorted descriptions of -- a fistula.   You weren't "INDIRECTLY" characterizing a patient with a fistula; oh, no, you came right out and directly stated that fistulas were horrible, freaky, creepy, sausage, etc.  There was nothing indirect about your comments.

See, almost all of the posts on this site are supportive -- even if someone here is going through something awful, the rest of us try to encourage them to "hang in there" or to "keep going."   We say things like "I know what you mean..." or "I've been through that, and here's what worked for me...."  Your posts, however, don't have that same inference or tone.  I think it is YOU who needs to look at the distinction between your comments and everyone else's.

I am usually an up-beat, positive, encouraging, supportive person.  You just bring out the "ugly" side of me for some reason.

And, I agree with willieandwinnie...

stauffenberg, I have one question for you, are you truly that miserable of a person? I feel sorry for you if deep in your heart you believe what you post.

...if you believe what you post, it can't be healthy for YOU.

[kitkatz]

Let us stay on topic.  The catheter topic is great. I like the give and take in it.  Interesting information about the mortality rates here in the US and Japan.



Have you showered yet?  I loved my first shower after everything was healed!

[thegrammalady]

Have you showered yet?  I loved my first shower after everything was healed!

of course 

[annabanana]

Congratulations on your shower, thegrammalady! And thank you for starting one of the most informative threads I have read here!

[Zach]

sorry i'm just a fiesty red head with a big mouth and i use it. continue on, i'm enjoying this thread immensely.

 

[stauffenberg]

Bill:  There are so many confounding variables with the comparison of fistulas and central line permcaths that it is dificult to draw any reliable conclusions from the statistics.  Because catheter rather than fistula use is significantly correlated with the patient being extremely sick from factors having nothing to do with catheter use, the higher death rate for catheter users is the result of these other factors, not from the catheters themselves.  Thus fistula access is highly significantly correlated with patients 1) of younger age; 2) who are not diabetic; 3) who have no peripheral vascular disease; and 4) who have no angina.  The first two correlations alone comprise the major causes of the difference in mortality among all dialysis patients, so these alone could wipe out the significance of the catheter-fistula difference.  Also, catheter use was significantly associated with 1) the patient not having seen a nephrologist before the start of dialysis, which correlates well with patients who don't have access to healthcare, are not attentive to their health, or who are poor and live in medically under-serviced areas; and 2) with nephrology centers which are so poorly run that they don't bother preparing patients for dialysis until two weeks or less prior to starting dialysis,.  Both of these factors constitute independent factors for increased death risk, having nothing to do with the difference between catheters and fistulas. (See R.L. Pison, et al, "Vascular Access Use in Europe and the United States," KIDNEY INTERNATIONAL, vol. 61, no. 1 (2002) pp. 305-316.)

Septicemia, which results from careless technique and thus can be prevented, is the real source of increased risk of mortality with catheters, but even that occurs only at a rate of 9 instances per 1000 dialysis days.  The evidence of vascular stenosis from catheter use is, in contrast, only anecdotal, and the study by S. Evro, et al, "Implantation of Permanent Catheters in Patients on Regular Dialysis Treatment: The Results of Ten Years' Experience," JOURNAL OF VASCULAR ACCESS, vol. 2, no. 2 (2001) pp. 68-72, found no evidence of it in the group he studied, referring to it only as anecdotal, i.e., as "recent reports of permanent catheter venous stenosis."

Every year I go for prophylactic CT scanning and, after 8 years with a permcath for dialysis access, there is no evidence of vascular stenosis.

[stauffenberg]

Petey:  Since I made absolutely no reference to any negative perception of the patients who, through no fault of their own, have to endure the modes of dialysis I criticized, any negative implications about those patients are based purely on inferences YOU YOURSELF have drawn.  If you feel that you have the right to impute invented ideas to other people and then subject them to cruel and vicious personal attacks on the basis of what you have imagined they must be implying by what they are saying, then you might perhaps want to question your own motives.

In other contexts I have often found that when I have alarmed people in their cherished assumptions by radical ideas I have put forward, people have sometimes reacted by criticizing me, simply because they can think of no other way to defend their assumptions from the unsettling thoughts my purely theoretical point have aroused in their mind.  I hope that is not the case here.

[LightLizard]

we are not our long-held, cherished beliefs. nor are we the parts or process of dialysis, even though we rely on them to survive.
offensive people are easily offended.