Perma cathe.

[JayO]

Hey everyone,

I'm JayO, I've posted on the introduce yourself section about helping my mom get started on Dialysis. she goes in tomorrow for surgery to get her access for PD and a temp hemo access in the neck. I spoke to a friend of a friend this morning who is a dialysis nurse and she mentioned that at her clinic the doctors recommend a perma Cathe in the chest be used instead of a neck Cathe when first starting, to be employed until the pd Cathe  or fistula is ready. She says it can be used for a long period of time and that many patients (mostly elderly) only use this type. How do the people who really matter feel about this type of access? At this point I probably could not change the type used and still keep the surgery appointment. All opinions would be welcome. JayO.

[Sara]

I wouldn't know which one is better, and my husband is the one on dialysis, but I do know that he had the cath in the neck and currently has one in the chest, and the chest one is a whole heck of a lot easier to keep covered and somewhat clean/dry.  They are both uncomfortable (for him anyway).

Weren't you struggling to get your mom on PD?  I guess the doctors finally agreed with you?

[Epoman]

Hey everyone,

I'm JayO, I've posted on the introduce yourself section about helping my mom get started on Dialysis. she goes in tomorrow for surgery to get her access for PD and a temp hemo access in the neck. I spoke to a friend of a friend this morning who is a dialysis nurse and she mentioned that at her clinic the doctors recommend a perma Cathe in the chest be used instead of a neck Cathe when first starting, to be employed until the pd Cathe  or fistula is ready. She says it can be used for a long period of time and that many patients (mostly elderly) only use this type. How do the people who really matter feel about this type of access? At this point I probably could not change the type used and still keep the surgery appointment. All opinions would be welcome. JayO.

Of course you can just request a chest cath. As I had mentioned to you before it's a bedside procedure not a surgery it literally takes less than 5 minutes. Then they xray to make sure it's placed properly then it's ready to use. I would NOT let them put one in the neck if I were you. A chest cath is MUCH better than a neck cath. STAND YOUR GROUND and DEMAND a chest cath. BOTTOMLINE.

- Epoman

[Rerun]

I've had both.  Both worked fine.  I had the neck for 9 months and the chest one for 6 months.  Both required surgery to insert because the chest one they put an "anchor" up under the skin above the tube.  I guess I would have to say the "chest" one is better.  Like Sara said it is easer to keep dry and clean.  Number 1... you can't see the one in your neck without a mirror.  The chest one I could keep an eye on.

I read your other post about your doctor not wanting to go with PD.  I would be insulted that he "doesn't think you can do it." 
Children do it!  Does he think you aren't "clean" and will get infections?  Again... I would be insulted!  There is a doctor that sits by me at dialysis and he got an infection twice on PD.  It happens!  I never got an infection while on PD......but was only on for 3 months before I received "The Gift of Life."

[Epoman]

I've had both.  Both worked fine.  I had the neck for 9 months and the chest one for 6 months.  Both required surgery to insert because the chest one they put an "anchor" up under the skin above the tube.  I guess I would have to say the "chest" one is better.  Like Sara said it is easer to keep dry and clean.  Number 1... you can't see the one in your neck without a mirror.  The chest one I could keep an eye on.

I read your other post about your doctor not wanting to go with PD.  I would be insulted that he "doesn't think you can do it." 
Children do it!  Does he think you aren't "clean" and will get infections?  Again... I would be insulted!  There is a doctor that sits by me at dialysis and he got an infection twice on PD.  It happens!  I never got an infection while on PD......but was only on for 3 months before I received "The Gift of Life."

Really? All they did for both of mine was stitch it to my skin and both times they did it at my hospital bedside. I had just a local applied to the area and that was it. I was awake the whole time and it literally took 5 minutes or less.

[JayO]

Man, I tell you I just can't believe the B.S. in the medical field!
I thought the battle for PD was finished and onward to treatment. Wrong. Got intouch with the home nurse at the referred clinic to make sure they received the paper work only to find out that now we have to go thru their doctors so they can evaluate my mom, doesn't matter that she has now been seen by two nephr's who didn't find any physical reason she should not do PD, then the home nurse has to give her O.K, then she has to inspect the home for "suitability", then she can have the pd Cathe put in. So now at the second opinion this afternoon the new nephrologist says "she should do just fine I'll get her in" Nope, couldn't do it. The procedure is tomorrow morning at 7. The surgeon thinks he's doing a perma Cathe and a pd Cathe. Nope. the plan now is only a perma Cathe until she is accepted into the Pd program or until I can work something out with another clinic. This is amazing. I will tell the surgeon personally not to do the PD Cathe. I probably should write "NO PD CATHE TODAY" on her belly. I guess if the PD thing doesn't work out we start looking towards Nxstage at home. Might as well start looking into it closer. Keep all options open. Thanks everyone for replying so quickly. JayO.

[Epoman]

Man, I tell you I just can't believe the B.S. in the medical field!
I thought the battle for PD was finished and onward to treatment. Wrong. Got intouch with the home nurse at the referred clinic to make sure they received the paper work only to find out that now we have to go thru their doctors so they can evaluate my mom, doesn't matter that she has now been seen by two nephr's who didn't find any physical reason she should not do PD, then the home nurse has to give her O.K, then she has to inspect the home for "suitability", then she can have the pd Cathe put in. So now at the second opinion this afternoon the new nephrologist says "she should do just fine I'll get her in" Nope, couldn't do it. The procedure is tomorrow morning at 7. The surgeon thinks he's doing a perma Cathe and a pd Cathe. Nope. the plan now is only a perma Cathe until she is accepted into the Pd program or until I can work something out with another clinic. This is amazing. I will tell the surgeon personally not to do the PD Cathe. I probably should write "NO PD CATHE TODAY" on her belly. I guess if the PD thing doesn't work out we start looking towards Nxstage at home. Might as well start looking into it closer. Keep all options open. Thanks everyone for replying so quickly. JayO.

Yeap the entire medical system in the USA is screwed up big time. But I glad your mom has someone to FIGHT for her. Imagine if she was alone.  keep doing what your doing it's a pain in the ass but what other choice do you have. There is so much red-tape bullshit it's amazing. You have been doing this for a few weeks now, think how I feel I've been fighting this nonsense for almost 13 years now.

- Epoman

P.S.
Stay strong, hold your ground, and tell them this:

"I came here today to chew bubble gum and kick some ass, and I'm all out of bubble gum" 

[Black]

...I would be insulted that he "doesn't think you can do it."  Children do it!  Does he think you aren't "clean" and will get infections?  Again... I would be insulted! ...

LOL, you should have heard the tone of voice the dialysis nurse used at the Fresenius clinic orientation class when I asked about home hemo.  She didn't come out and say so, but the general tone was most people aren't smart enough to home hemo.  The ignorance and arrogance of the medical professionals we deal with is almost unbelievable.

[Rerun]

I would put a STOP to the surgery if it were me!  Bull-Shit putting your Mom through 2 surgeries.  She won't "die" if you wait until things get straightened out.  Maybe if you put a stop to the surgery, your surgeon will come to bat for you! 

Putting her through 2 anesthesia is ridiculous and dangerous.  Have him go a head and insert the PD cath...... then they have to recognize that she wants to use it.

(just my opinion)

[JayO]

Hello everyone,

Mom got her perma Cathe placed yesterday. We were at the hospital from 6:30 till 2:00. The procedure only took about 1/2 hr. but the pre-op   and the post op was much longer. They wanted to give mom a transfusion because her hematocrit level is at 27 but she refused. It turns out the surgeon and the main anesthesia guy said it was low but since we didn't want the pd Cathe or fistula it would not be necessary I spent the rest of the day finding a clinic for her. Found one she might like,visited, spoke with the admin lady and took a tour. I met some of the staff. I set her up for her first dialysis on Saturday. They called the new doc and his office faxed over her records while I was there. The head nurse checked the hematocrit and said she may need blood and they can give it there. Mom isn't going to let the do it. So today I will track down some epo (the auth. should come thru today) and have someone give it to her. Does anyone know if it will help her if she gets the shot a day before  dialysis? I have another clinic to visit  today, if I like it she goes there. I don't want to screw clinics around but it's all about mom.
Oh, check this out, the guy next to mom got a pd Cathe placed because his perma Cathe kept getting clogged and he had mentioned to his doc. that he wanted to try pd. He's been on dialysis for two years, He's 73. I was standing within ear shot when the doctor told him in recovery he would have to spend the night because they needed to flush the Cathe. He was totally shocked, didn't even know they were giving him a pd Cathe today, as far as he knew they were only supposed to replace the perma Cathe! I wonder if he got moms. Anyway I'm off to see what I can get accomplished for her today. JayO.

[Epoman]

Hello everyone,

Mom got her perma Cathe placed yesterday. We were at the hospital from 6:30 till 2:00. The procedure only took about 1/2 hr. but the pre-op   and the post op was much longer. They wanted to give mom a transfusion because her hematocrit level is at 27 but she refused. It turns out the surgeon and the main anesthesia guy said it was low but since we didn't want the pd Cathe or fistula it would not be necessary I spent the rest of the day finding a clinic for her. Found one she might like,visited, spoke with the admin lady and took a tour. I met some of the staff. I set her up for her first dialysis on Saturday. They called the new doc and his office faxed over her records while I was there. The head nurse checked the hematocrit and said she may need blood and they can give it there. Mom isn't going to let the do it. So today I will track down some epo (the auth. should come thru today) and have someone give it to her. Does anyone know if it will help her if she gets the shot a day before  dialysis? I have another clinic to visit  today, if I like it she goes there. I don't want to screw clinics around but it's all about mom.
Oh, check this out, the guy next to mom got a pd Cathe placed because his perma Cathe kept getting clogged and he had mentioned to his doc. that he wanted to try pd. He's been on dialysis for two years, He's 73. I was standing within ear shot when the doctor told him in recovery he would have to spend the night because they needed to flush the Cathe. He was totally shocked, didn't even know they were giving him a pd Cathe today, as far as he knew they were only supposed to replace the perma Cathe! I wonder if he got moms. Anyway I'm off to see what I can get accomplished for her today. JayO.

No, her getting a Epogen shot will not help her that fast. It literally takes a few weeks of continuous Epogen injections (either in her arm or through her cath) to actually start working and raising her crit. Also if I were you I'd save my mom the discomfort and have them give her Epogen through her cath. They may tell you it won't work as well but that's bullshit. I have been getting mine through dialysis (the last 10 minutes of treatment) for EVER now and my crit hit 40+ this week.

[JayO]

Hey everyone,

Just got back from moms first dialysis session. Went smooth I guess, mom was nervous as was I and my sister. We stayed there the whole time keeping her spirits up. I asked the nurses alot of questions and they were very willing to teach us anything we wanted to know. Mom got two epo shots about one hour into the two hour treatment (by IV). They were going for one kilo of weight reduction and achieved .8 total. I am concerned because her bp started at 179 and climbed to 216 at the end. Her last bp pill was taken at 3pm the day before. As soon as she finished her treatment I gave her a pill. One hour later it was down to 167. Does any one have any idea what caused the rise in pressure? Is this a normal occurrence for dialysis? I noticed the lady next to my mothers pressure climbed to 188 when she was disconnected. I think I will have mom start taking her pill at bedtime so only 14 hrs. have past by the time she gets to dialysis. This might help. She said she didn't feel tired or sleepy, I guess it's because they kept this first session really conservative. Next time they will bump up to 3hrs. Should she feel any different tomorrow? (i.e. stronger, more energy.) So far she has been a real trooper about this whole ordeal and I'm really proud of her. A million thank-you's to everyone for helping me get her to this point. I don't think I could have done it with out all the support and guidance. JayO.

[Epoman]

Hey everyone,

Just got back from moms first dialysis session. Went smooth I guess, mom was nervous as was I and my sister. We stayed there the whole time keeping her spirits up. I asked the nurses alot of questions and they were very willing to teach us anything we wanted to know. Mom got two epo shots about one hour into the two hour treatment (by IV). They were going for one kilo of weight reduction and achieved .8 total. I am concerned because her bp started at 179 and climbed to 216 at the end. Her last bp pill was taken at 3pm the day before. As soon as she finished her treatment I gave her a pill. One hour later it was down to 167. Does any one have any idea what caused the rise in pressure? Is this a normal occurrence for dialysis? I noticed the lady next to my mothers pressure climbed to 188 when she was disconnected. I think I will have mom start taking her pill at bedtime so only 14 hrs. have past by the time she gets to dialysis. This might help. She said she didn't feel tired or sleepy, I guess it's because they kept this first session really conservative. Next time they will bump up to 3hrs. Should she feel any different tomorrow? (i.e. stronger, more energy.) So far she has been a real trooper about this whole ordeal and I'm really proud of her. A million thank-you's to everyone for helping me get her to this point. I don't think I could have done it with out all the support and guidance. JayO.

Well glad to see all went well. About the Epogen shots you say she got two shots but really it was just one, you see Epogen comes in these little vials and they are not supposed to stick a needle in a vial that they already drew from another vial. They usually use the small 10cc syringes. And depending on your dose (number of units) they may need to use more than 1 syringe. About her blood pressure how about giving her blood pressure med in the morning as soon as she wakes up?. About her feeling stronger, well that varies from patient to patient. Some patients start feeling better right away while others it takes several months for them to get used to dialysis and start feeling better. As long as they do not need to remove more than a couple kilos a treatment she will be fine. But if they start needing to remove 3,4, or 5 kilos in 3 hours then she may feel bad afterwards. Also once the Epogen starts to kick in she will start gaining her energy back. You need to tell us her numbers, for example:

Anemia/Energy Level:
What is her HGBX3 or Hematocrit?
How many units of EPO is she getting?

Adequacy of dialysis/How well she is dialyzed:
What is her KT/V?
What is her URR?
What is her BUN Pre AND Post?

Also learn what her Calcium, Phosphorus, Potassium Results are. If you know all these results it will help you monitor your mother better and be able to be her advocate. Find out those lab results (and how many units of EPO) and I'll tell you what they should be.

DO NOT DEPEND on the nurses to watch those numbers. YOU DO IT!!!!

And finally your welcome, this is what this site is all about helping people like your mother and yourself. Also a million thank yous to YOU for being there for your mother and being her advocate. I have seen many older people not have someone fighting for them and it is sad they way they get treated.

- Epoman