Need answers.. Which dialysis access now?

[jo]

My mother has survived a cardiac arrest lately and is being treated on 2 different antibiotics for 2 different staph infections. Since she has a foreign object and a stent inside her arm, the doctors would like to get rid of the fistula in order to prevent recurring staph infections (the same bug grew on her for the 2nd time so the doctors decided to remove the fistula which has the foreign object and the stent). The vascular surgeon gave us a few options to choose from. Please advise what would be best for her in this situation:

Option 1: Keep the current fistula until it stops working (nobody knows how long the fistula would work) and putting my mother on 1 year of continuous antibiotics so that the staph doesn't grow in her bloodstream and doesn't affect the foreign body and the stent in the fistula. If the fistula stops working, then the surgeon would lock the fistula and put a catheter line in.

Option 2: As being on antibiotics for 1 year is not a good idea, get rid of the current fistula immediately and dialyze with a catheter line in.

Option 3: Make a new fistula in the other arm but that would require two different surgeries, one to create the fistula and an other surgery to move the fistula to a different location. This is a very stressful and complicated procedure as it involves a very big incision and the surgeon wouldn't recommend this due to fear of my mother who had a cardiac arrest.

Option 4: Put a biological graft on the other arm and once it is ready to use, get rid of the current fistula. But if the graft stops working in about 6 months to a year, go back to the catheter.

Option 5: Live with just a catheter line until it works.

Option 6: Peritoneal dialysis which my mom doesn't prefer.

Everything has risks so we are not sure what decision to make. Can someone please advise?

[Michael Murphy]

I think it is a risk analysis problem, while a catheter is not recommended it is a viable option for patients whom a fistula doesn't work.  I went to dialysis for several years with a tiny women with a catheter who was fine and never had a problem, she was careful with it.  She has moved on to a better place now, she moved to Delaware from New Jersey.  You need to balance the risks and choose the option that gives your mother the best quality of life, doctors won't help with this but if asked if it's their mother what would they do they often then will give a honest answer,  also remember this is not a lifetime commitment if it doesn't turn out you can always choose another option.

[kickingandscreaming]

I'm no expert on access.  But I have had a neck catheter and it worked fine for about 4 months after which I switched to PD. The only issue with them is that it's a challenge to wash your hair and shower as you mustn't get it wet (korshield.com) I would get rid of the fistula that is causing the infection, ASAP.  The catheter will buy her time to make a better decision for the long term.  PD is certainly worth a second thought.

[Charlie B53]

I agree with KickingandScreaming.  The neck cath can be put in and immediately used.

Remove the possible source of infection.  After a course of antibiotics to ensure the infections are gone then repair of have a new access created.  Once that access has matured well enough to use remove the neck cath.

Your Mother needs to deal with the source of infection.  This is THE most major problem.

The neck cath can be used immediately so she will not have to miss any Dialysis treatments.

This course of action also is the least invasive surgically.  The least harm and shock to her body.

I was on PD for 3 1/2 years until an reoccuring infection caused the removal of my PD cath and I now an using a neck cath.  Patiently waiting the time I can have another PD cath placed, heal, and return to my former treatment.

I firmly believe this to be the best choice for your Mother but I am not a Dr.  But does make solid sense.

Take Care,

Charlie B53

[nursey66]

My husband had a central line " neck catheter " for a full year a long time ago , had no issues but it's not recommended for a long time due to if an infection developed , it has a straight shot to the heart ❤️ since those lines go into a blood vessel near the heart.  The only nice thing is no stick for dialysis, just uncap and hook up .