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Transplant Athlete
Wednesday, November 26, 2008
  Jim Poses A Good Question

Jim said...

I have a question.

Why would you not prefer the catheter to the shunt in your arm. With the shunt you have to pierce the skin for each treatment. With he catheter you just hook up and go. I know there is a potential for problems wiht a catheter but your BLOG seamed to indicate it was really bugging you even without any problems.

I'm working in the field, developing new dialysis equipment and wanted to understand your thoughts on catheters.

Thanks,
Jim

Getting stuck three times a week with very large needles isn't my idea of fun, so why would I prefer it to a catheter?

When I first decided to go on dialysis, I asked myself this same question. All the doctors and nurses were telling me that an AV Fistula was the "Gold Standard" for access. I had serious issues with the limitations that an AV Fistula would present. The short answer is...I'm deathly afraid of the catheter. When they first placed it, they said don't get it wet, that's the same thing they said about Gizmo and look what happened there.

Seriously, they said if it gets wet, it will get infected, and the infection will follow the catheter straight to my heart. It definitely makes showering a challenge. I've been on immuno-suppressants for 8 years and had more than my fair share of infections; even though I've recently discontinued the immuno-suppressants, I still carry the fear of getting infected. I suppose if I hadn't had a compromised immune system for so long, I probably wouldn't be as afraid of the catheter.

Jim's right, the catheter is faster, and more convenient. I drop into the chair and they hook me up. The catheter is about 10 minutes faster than getting stuck in the fistula. That would save me 30 minutes a week or about a day a year.

I have a 9 month old girl and she tends to grab the catheter as she's climbing all over me (it's hidden under my shirt, but she seems to grab it at least once a day). I think I was told that they used a suture to keep the catheter in place, but mine has pulled out. My catheter is definitely hanging lower and at some point it will be so far out, that they will need to place a new one(if I still need one).

My dialysis times have been pretty consistent at 3.5 hours each time. The catheter is at a lower flow rate (250 versus 350 for 16 ga.) which means I'm getting more dialysis in the same time with the fistula, I suppose they could shorten my dialyzing times if they wanted because of the higher flow rates. According to one website I found, using a catheter for more than three months presented a risk of "excessive morbidity". I don't know about anybody else, but I make it a rule to avoid excessive morbidity...

The fistula has its own risks; clotting, infection. But, I feel that the risk of infection is lower with the fistula and the consequences of an infection through the fistula are lower than the catheter leading straight to my heart.

I'm not a doctor, so I probably have some of this wrong, but this is my understanding of the situation. Also, as I've stated, my background/fear colors my judgement in choosing an access method. Yes, it makes me think about getting another transplant post haste.

I hope that answers your question Jim.

 

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I've gone through kidney failure twice. The first time in 2000, my mother donated a kidney; and again in 2008, I'm on dialysis waiting for a breakthrough in immuno-suppression medicines before seeking a new kidney.

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