Question:
Hi Folks, My Mom is new to dialysis. She recently had the access catheter taken out of her neck. They tried to create access (shunts) in her arms, but the surgeon was unable to find veins that were large enough. Today she had the access catheter put in her right chest area, and when I visted her tonight in the hospital, there was quite a bit of blood coming from the area. The doctor said this is normal for about the first three weeks until the area heals completely. Does anyone else here have the access in their chest, and is there any special problems we should watch out for? I try to get answers from the surgeon, but it is next to impossible to get a hold of him, much less have a conversation. Thanks in advance, Paul
Response:
I find that you just have to keep it clean. I speak for myself in that I shower just before diaylisis. They change the dressing anyways so I find that it doesn’t matter if it get’s a little wet. Talk to your doctor not the surgeon. I don’t know how old your mother is. But the neck is the easy place to put a temp. cath. But if they ever have to replace it your mother has the right to choose where she wants it placed. Don’t let then bully you into believing otherwise. The neck is just that a pain in the …..I find that the cath. diaylisis is not as good a direct exchange. Long term effects sometime catch up with older people, Mostly fatigue. Has something to do with blood flow. The greater the better 300-350 min. 400-500 optimum for a good treatment. I find that having a snack a newspaper a book or magazine a cup of coffee and a TV makes a treatment easier. I am buying a laptop soon to take with me. I wish your mom well I hope she’s young enough for a transplant. Tell her not to worry it’s a piece of cake if your attitudes rightI started Nov 13th 1995. I am pretty lucky that I’m only 51 and was pretty strong before my kidneys failed. Mine went with hypertention. I suspect your mother’s went with either lupus or diabeties. Most women lose there kidneys that way.All my best to you and your mother. *** to you I wish for your mother that you not pity her or treat her any different than you did before. She’s sick that’s all, It’s like a bad cold if she follows the diet and takes care of herself there is no reason she can’t lead a normal life.
Response:
Dear Paul, I am sorry to hear that your mother is having such difficulty getting a fistula. Is she a diabetic? Very often diabetics and patients who have undergone chemotherapy have compromised peripheral veins. You did not indicate your mother’s age but if she is younger than 65, I think it is going to be problematic to rely on a permcath. They do not allow for good dialysis because the blood flow rate is limited. To compensate, the nephrologist will probably extend her treatment time. In any case, I would suggest that you seek a second opinion about the condition of her veins. Did the surgeon do a venogram to assess the veins? So often, vascular surgeons make judgements based on what is "average" when the patient is diabetic, overweight, female, etc. I had a similar experience after two grafts failed. My vascular surgeon, at the time, was convinced that there was nothing else he could do. Fortunately, I had talked to several other patients who had experienced problems with their access but were able to keep it working despite clotting and revisions. The one thing they had in common was a very dedicated and competent surgeon. I have been with this surgeon for the past two years and have maintained a working access!! In the meanwhile, it is vitally important that special care be taken with the permcath. In the dialysis center, universal precautions must be observed to protect against infections. When the nurse changes the dressing she should always wear a mask and give your mother one as well. The betadine that is used to disinfect the site should be allowed to dry otherwise it doesn’t kill the bacteria. I would recommend baths rather than showers since it is not a good idea to get the dressings wet. Best of luck. Jackie
Response:
His folks, I’m sorry, I should have put in my orginal message that my Mom is indeed a diabetic, insulin dependant for 21 years. She is 72 years old. Thanks for all the info. There is so much to learn, and I want to get it right so I can understand and help her. Thanks goodness for the kindeness of others here and at her clinic. They have help greatly. Paul
Response:
Has your mothers nephrologist ever suggested peritoneal dialysis. It is a dialysis treatment done with a catheter in the abdomen into which dialysate is instilled and dwelled. It is done at home by the patient after considerable training. Exchanges of fluid need to be done either 4 times a day (takes about 30 minutes each time) or exchanges are done by a cycler machine at night while she sleeps. This kind of dialysis is done daily as it is a slower form of dialysis. I would suggest you can get information on it from the nurses or even the internet. If all hemo accesses fail this may be an option.
Response:
On 17 Sep 1998 03:25:29 GMT, redwing…@aol.com (Redwing386) wrote: – Hide quoted text — Show quoted text ->Hi Folks, >My Mom is new to dialysis. She recently had the access catheter taken out of >her neck. They tried to create access (shunts) in her arms, but the surgeon was >unable to find veins that were large enough. Today she had the access catheter >put in her right chest area, and when I visted her tonight in the hospital, >there was quite a bit of blood coming from the area. The doctor said this is >normal for about the first three weeks until the area heals completely. >Does anyone else here have the access in their chest, and is there any special >problems we should watch out for? I try to get answers from the surgeon, but it >is next to impossible to get a hold of him, much less have a conversation. >Thanks in advance, >Paul
They’ve put the catheter into the subclavian artery. Our doctors told us that it could potentially caused problems with the arm, something about blood flow. However, for a temporary site, it’s probably the best for the patient, since it’s easily covered with clothing, and is not as obvious or uncomfortable as an access in the neck.
Response:
- Hide quoted text — Show quoted text ->On 17 Sep 1998 03:25:29 GMT, redwing…@aol.com (Redwing386) wrote: >>Hi Folks, >>My Mom is new to dialysis. She recently had the access catheter taken out of >>her neck. They tried to create access (shunts) in her arms, but the surgeon was >>unable to find veins that were large enough. Today she had the access catheter >>put in her right chest area, and when I visted her tonight in the hospital, >>there was quite a bit of blood coming from the area. The doctor said this is >>normal for about the first three weeks until the area heals completely. >>Does anyone else here have the access in their chest, and is there any special >>problems we should watch out for? I try to get answers from the surgeon, but it >>is next to impossible to get a hold of him, much less have a conversation. >>Thanks in advance, >>Paul >They’ve put the catheter into the subclavian artery. Our doctors told >us that it could potentially caused problems with the arm, something >about blood flow. However, for a temporary site, it’s probably the >best for the patient, since it’s easily covered with clothing, and is >not as obvious or uncomfortable as an access in the neck.
There is one thing to pay very much attention though. My wife had a subclavian cathether at first before the shunt was put into operation. However one thing they warned us for and it became sadly true is that the subclavian cathether is very infection prone. After every dialysis the cathether should be properly cleared and checked. Also be on the lookout for red areas around the cathether. On the whole the subclavian cathether did its work very good. Good luck to Pauls’ mom Marten Boonstra
Response:
hi paul my name is mike i am from rhode island i was on dialysis for 3 years i too had a catheter in my left chest for one year —but i never had blood from that area, what part of the country do you live in?i also had a transplant two and a half years ago and everything is going fine so far. so get back to me maybe we can point you in the right direction email me at PUFFE…@AOL.COM thanks
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