Catheter Vs. Graft

[greeneyesinva]

My 85-year-old dad is on hemodialysis and has been using a chest catheter for nearly 2-1/2 years minus a fistula in his arm for 5 of those months; the fistula failed and now the surgeon is advocating for a graft to be done. My dad has some reservations about having this surgery due to a low platelet level and the fact that the catheter is working fine. Can anyone share opinions/experience with this?

Thank you!!

[sullidog]

A graft is under the skin and while it's more prone to infections then a fistula which is hardly prone to infections, the chances of getting one is much less then a catheter. I would deffinatly get a graft if he can get one. I didn't want an access either, but I had two catheters get infected and I prefer an under the skin access then a catheter, but it's up to him what he wants to do if he wants to stay with a catheter then that should be his choice but a graft is better for anyone.

[greeneyesinva]

Thank you for your reply...my dad was reading in the plethora of information that he has been collecting over the past 4 years on dialysis that there is a 50% chance of infection with a catheter and a 50% chance with a graft as well. He has had no infection with the catheter--just had to have TPA administered to clear catheter and 2 replacement catheters; all done on an outpatient basis. The low platelet level started and has persisted since 6 months after starting on HD--am wondering if that is a possible result of HD...

[mcclane]

I have a central line (or catheter) and a fistula.  While I've not had any issues with the catheter, all the nurses/doctors tell me that the risk of infection/clot with a catheter outweighs the benefits.

[greeneyesinva]

That's what my dad has been told as well, but the statistics don't seem to bear that opinion out...I feel as though the "if it's not broke, don't fix it" approach  is applicable in his situation, particularly due to his age. The final decision will be his; we are just trying to feel people out and gain more knowledge before he actually has this done...the surgeon is pushing and not asking my dad for what he wants, and that is frustrating.

[MooseMom]

I certainly understand the "if it's not broke, don't fix it" mindset, but the problem is that with a catheter, if it "breaks", it's awfully hard to fix.  An infection with a catheter can be catastrophic because the thing is in his HEART! 

Considering his age, I'm not sure there is a "correct answer".  I'd think twice about having any sort of surgery at that age.  My elderly mother had a cath for 18 months while they were working on her fistula.  She took very good care of her cath and didn't have any problems, so as long as you believe your father is capable of the extraordinary care demanded by having a cath, then I'd be more comfortable letting him keep it.  The surgeon shouldn't be pushing your father.

[greeneyesinva]

Well, my dad decided to put off the graft surgery until after the first of the year; he said that he would rather have it done after the holidays. After further discussion with his nurse practitioner, he asked her to let the surgeon know; she told him that she would be denied the cancellation if she called the surgeon's office and that he should call them instead...I thought that sounded a little odd, but he made the call. So he has postponed the procedure for now.