Fistula not maturing

[jambo101]

 Seems my veins dont have enough elasticity to make for a successful fistula, they are going to try an angioplasty to save it but failing that its time to think about a catheter, what would be the pros and cons of a catheter?

[Charlie B53]

My fistula was very slow to mature.  Dr had to angio the whole length. 
That still didn't help much at all.  Dr went back in, raised it closer to the surface and while in there found a narrowing near the beginning and took that out.  The first third of it finally developed a bit.

Went in for a second angio with another Dr.  He found another narrowing also near the beginning, angio'd that and told me if it fails to flow enough he may have to place a stent there as it was right at the bend in my elbow.

After that the last third of my fistula matured enough we are now using it.

The middle third still isn't good enough to stick, either to draw or return.  So we stick the first third to draw and the last third to return.  It has been working now 9 months.

Dr tells me next time I'm in he will angio that middle third again.  For now it is working well enough not to mess with it.

[kristina]

Hello and welcome to IHD,
I could not say anything negative about my (chest-cath) Tesio-line which has served me well for around ~ three years and nine months without any problems ... and touch wood it hopefully continues like that ...
The most important point about a Tesio-line is, that taking a shower is only possible with a movable shower-head and you can't really shower above your hip and the rest of the body has to be very carefully cleaned with a flannel. Please bear in mind that no water is ever allowed near your Tesio-line. No compromise there.
Apart from this I am very happy with my Tesio-line and fortunately I had no problems with it and touch wood it hopefully continues like that ... It really depends what you like to do ... For me a Tesio-line is important, because it leaves my arms and fingers free without impediment. I love playing the piano whenever I am not too tired because of dialysis and over the years I have heard of some people having problems moving their hands and/or fingers because of their fistula and hearing about it made the mind up for me to decide on a Tesio-line.
Best wishes and good luck from Kristina.

[lulu836]

I had six different tries for a fistula...…….3 in each arm.  Then a graft which also failed.  The "surgeon' butchered my arms so badly I cannot raise them more than chest high and have seriously impaired circulation.  I've had a catheter for 3 years and other than having to have a couple of cath-washes it is very successful.  I shower 3 times a week using a special shower shirt and have a sponge bath on other days.  My access is totally covered with waterproof Tagederm.

[kristina]

I had six different tries for a fistula...…….3 in each arm.  Then a graft which also failed.  The "surgeon' butchered my arms so badly I cannot raise them more than chest high and have seriously impaired circulation.  I've had a catheter for 3 years and other than having to have a couple of cath-washes it is very successful.  I shower 3 times a week using a special shower shirt and have a sponge bath on other days.  My access is totally covered with waterproof Tagederm.

...I was told by different medics not to get tempted and try to cover my cath for a full shower and/or bath because water could "silently seep" through any cover - according to the medics... And because of these warnings I have decided not try any of it but keep my hopes up and wait for my transplant to come along and take a shower and/or a full bath then ...

[lulu836]

I had six different tries for a fistula...…….3 in each arm.  Then a graft which also failed.  The "surgeon' butchered my arms so badly I cannot raise them more than chest high and have seriously impaired circulation.  I've had a catheter for 3 years and other than having to have a couple of cath-washes it is very successful.  I shower 3 times a week using a special shower shirt and have a sponge bath on other days.  My access is totally covered with waterproof Tagederm.

...I was told by different medics not to get tempted and try to cover my cath for a full shower and/or bath because water could "silently seep" through any cover - according to the medics... And because of these warnings I have decided not try any of it but keep my hopes up and wait for my transplant to come along and take a shower and/or a full bath then ...

I know we have this discussion every time anyone posts about catheters.  I'm only going to say that Tegederm is absolutely  waterproof.  Not to try to sway anyone's opinion..........just sayin'.  You do have to put waterproof protection around the lumens but that is it.  Perhaps your catheter is not covered with waterproof "bandage".  When I visited Gatlinburg, TN the Davita clinic I went to used some monstrosity made of a 2x2 covered in white silk tape. 

[PrimeTimer]

Early on when my husband's fistula was just a few months old, they implanted a small flexible stent in the venous section. It is above the area where they "stick him" at dialysis. The stent was placed during an angioplasty. It helps to keep that part of his fistula "open and running". I don't believe it is the same thing as a graft. His fistula is located on his upper left arm, just above the elbow. You can feel the stent by touching his arm and it shows up on the security monitor (aka Xray machine) at airports but it otherwise does not bother him. He has had his fistula for 5 years now and almost like clockwork, needs an angioplasty every few months or so. These angioplasties are helping to keep is fistula alive so we are both grateful to his vascular surgeon. Hopefully your surgeon has a good plan for yours.

[jambo101]

I see my vascular surgeon tomorrow to discus the fistula and see what my next course of action will be.

[kristina]

I had six different tries for a fistula...…….3 in each arm.  Then a graft which also failed.  The "surgeon' butchered my arms so badly I cannot raise them more than chest high and have seriously impaired circulation.  I've had a catheter for 3 years and other than having to have a couple of cath-washes it is very successful.  I shower 3 times a week using a special shower shirt and have a sponge bath on other days.  My access is totally covered with waterproof Tagederm.

...I was told by different medics not to get tempted and try to cover my cath for a full shower and/or bath because water could "silently seep" through any cover - according to the medics... And because of these warnings I have decided not try any of it but keep my hopes up and wait for my transplant to come along and take a shower and/or a full bath then ...

I know we have this discussion every time anyone posts about catheters.  I'm only going to say that Tegederm is absolutely  waterproof.  Not to try to sway anyone's opinion..........just sayin'.  You do have to put waterproof protection around the lumens but that is it.  Perhaps your catheter is not covered with waterproof "bandage".  When I visited Gatlinburg, TN the Davita clinic I went to used some monstrosity made of a 2x2 covered in white silk tape.

Hello Lulu, it is true, we seem to differ with our opinions on this ...  but ... I just feel obliged to mention here what I was taught by medics. I also feel that medics know much more about this than I could and ... and I am just a patient who tries to make as sure as is possible to be given a fair chance to survive on dialysis with my Tesio-line for as long as is possible...
P.S. I have no idea what could be right or what could be wrong about this and since I am not medical, I really don't know and because of this I feel I can only go on my instincts  ...
All the best wishes from Kristina

Hello jambo, I wish you good luck at your meeting with the vascular surgeon tomorrow.
Best wishes from Kristina.

[Charlie B53]

Different clinics teach slightly different methods.

My PD Clinic was adamant about keeping my cath site dry and I was told under NO Circumstances was I allowed to get the valve/fitting connection wet bathing, but I could wet and wash the exit site itself.  PITA wrapping that fitting with Press and Seal in order to get in the shower so most days I simply used the sink.

Then I met somebody from another clinic and we got totalking about showering.  She told me that her clinic let her just shower without taking any precautions.

I was speechless.

I can undersstand the importancce of infection prevention as even a small infection can easily grow to become a serious problem in a very short time, tunneling alongside any cath deep into the body.  A blood cath far more critical as the blood stream instantly spreads to the whole body and all organs where the PD cath infection remains pretty much contained within the peritoneal cavity, giving Dr's more time to treat it.

There are a couple of products available to 'seal' a chest cath from water contamination and allow the person to shower.  Even using these covers it is critical that they be used correctly and the user remain careful during bathing.

If you are in doubt then I would recommend that you stay with bathing in the sink.

[kristina]

Different clinics teach slightly different methods.

My PD Clinic was adamant about keeping my cath site dry and I was told under NO Circumstances was I allowed to get the valve/fitting connection wet bathing, but I could wet and wash the exit site itself.  PITA wrapping that fitting with Press and Seal in order to get in the shower so most days I simply used the sink.

Then I met somebody from another clinic and we got totalking about showering.  She told me that her clinic let her just shower without taking any precautions.

I was speechless.

I can undersstand the importancce of infection prevention as even a small infection can easily grow to become a serious problem in a very short time, tunneling alongside any cath deep into the body.  A blood cath far more critical as the blood stream instantly spreads to the whole body and all organs where the PD cath infection remains pretty much contained within the peritoneal cavity, giving Dr's more time to treat it.

There are a couple of products available to 'seal' a chest cath from water contamination and allow the person to shower.  Even using these covers it is critical that they be used correctly and the user remain careful during bathing.

If you are in doubt then I would recommend that you stay with bathing in the sink.

Hello Charlie and many thanks for sharing your observations, what you were told and your honest opinion, it is very much appreciated.
Kind regards and thanks again from Kristina.

[jambo101]

Hello jambo, I wish you good luck at your meeting with the vascular surgeon tomorrow.
Best wishes from Kristina.
[/quote] Unfortunately the dopplar imaging technician is out sick so my consult with vascular surgeon is now postponed a week.

[PrimeTimer]

Hello jambo, I wish you good luck at your meeting with the vascular surgeon tomorrow.
Best wishes from Kristina.

Unfortunately the dopplar imaging technician is out sick so my consult with vascular surgeon is now postponed a week.
[/quote]

Suspense is a killer. Verrry stressful. But nothing can be done about it except the way we choose to deal with it. The weekend is here, try doing something you enjoy to keep your mind off of it or a chore or task that you've been putting off. Work off the nervous energy. Either way, the surgeon will come up with a plan and then you take it from there. 

[jambo101]

 Saw the vascular surgeon,did the dpppler imaging and next course of action is another attempted fistula further up the arm, not looking forward to the procedure as its rather traumatizing followed by a boring 24 hours in a hospital room.

[kristina]

Saw the vascular surgeon,did the dpppler imaging and next course of action is another attempted fistula further up the arm, not looking forward to the procedure as its rather traumatizing followed by a boring 24 hours in a hospital room.

Good luck with the procedure of another fistula and all the best wishes from Kristina.

[PrimeTimer]

Saw the vascular surgeon,did the dpppler imaging and next course of action is another attempted fistula further up the arm, not looking forward to the procedure as its rather traumatizing followed by a boring 24 hours in a hospital room.

Hopefully the placement further up the arm will bring the needed results. Maybe the higher up the stronger the flow will be and likely keep things moving better. Don't know but maybe it would also result in better clearance (labs) too. It's early on so don't despair. 

[jambo101]

Second fistula also turning out to be a dud, next step a catheter to the jugglar vein 

[UkrainianTracksuit]

Hey Jambo!

I had similar issues like you in that fistulas just didn't mature. The ones that worked konked out and weren't able to be saved. An AV graft as well. Vascular surgeon suggested an upper arm fistula and the circulation didn't provide the blood flow needed to keep it chugging. So, had a chest catheter. Worked well, had no problems, no infections. Like lulu said, I used Tegederm and it was good even if I got water droplets on it. My one hospital said no bathing... but another just wrapped the lumens, put on some saran wrap over the Tegederm, and showered me (I was sick..), so it's different strokes for different folks. Follow the advice of your vascular access team on caring for your cath and you'll be fine.