central venous catheter

[jenb]

Can you live with a central venous catheter if that is your request?

[UkrainianTracksuit]

Short answer is yes, but it comes with a bunch of "buts."

I had a catheter for awhile only because it was difficult to create a working fistula or graft and yes, I preferred it a lot. It was great. Had I the option, my preference would have chosen to continue to use it. It only needed some alteplase in two instances.

You find reliable and safe methods of bathing and sleeping. The key though is safety as infections commonly occur and when they do, they have a speedy highway right into the bloodstream. So, you really to keep it dry, as not submerged in water or anything that saturates the bandaging (like Tegederm). Side point: the Tegederm is typically non-problematic, but it can itch horribly and if they only change cath-bandaging once per week at your clinic, the plastic film can get disheveled, thus causing another point of infection.

The other factor is that CVC don't offer optimal filtration, but if you are a smaller person, this doesn't cause too much problems (as I was advised).

Another point to consider is age. I was advised more than once that I wanted to save accesses for CVC for when I'm older or need to quickly create an access. CVC need to be replaced (some last longer than others, so I won't say how long one would last. I went 2 years without a change). Naturally, I was pushed for a "more permanent" solution (fistula).

So, yes, you can reasonably live with a CVC, but there are just a lot of considerations and a prioritization on keeping the area untouched/clean due to the higher risk of infection. I won't come down hard with the hammer and say "no way" as some people really have no other option, like senior citizens, who only have CVC as an option to do HD. Hopefully someone will come with better advice.

[jenb]

Thank you.

[enginist]

Why is it the only option for the elderly?  Is it because their veins have collapsed from age, or from excessive puncturing during previous hospital stays?

[cassandra]

Hi, I think I read somewhere that: yes their veins are fragile etc through age with some, and that the fistula doesn’t mature at all in many cases.

[UkrainianTracksuit]

Yes, cassandra is right on. Fragile veins and fistula not maturing at all. Don't get me wrong, there are seniors that have fistulas or grafts (I guess those with better vein quality at that age), but for others in otherwise decent health, a CVC is their only option. It's a mix: at my last clinic, some in the 80+ category on HD for 2 years managed to have a decent fistula while a handful of others were left with the cath option. (They were still spry but their veins didn't cooperate.)

[enginist]

I think my veins are tapped out.  I've been poked too many times.