catheter

[petra]

Hello all,

My mother ran out of acces options (fistula, graft). Surgeons are now now trying to implant a catheter, but this also is getting difficult. If this is the only possibility left, which type catheter will suit best?
And is it true that catheters sometimes do not function well the first time they are used and the 2nd time this work better?


kind regards,
Petra Zingel (Netherlands)

[Beth Witten MSW ACSW]

I'm sorry to hear that your mother is having such a hard time with dialysis access. Has her doctor talked with her about peritoneal dialysis? This can be a good option if someone has a problem with his/her hemodialysis access. PD has a less limited diet and allows more flexible scheduling.

Studies show that a catheter is more likely to get infected than a graft or fistula. Catheters can irritate the blood vessel leading to narrowing. Catheters don't allow as fast blood flow so dialysis may not be as effective at removing wastes. The National Kidney Foundation developed guidelines to help doctors and other healthcare team members know what experts recommend about vascular accesses. You can read these guidelines at http://www.kidney.org/professionals/kdoqi/guidelines_updates/doqiupva_i.html#doqiupva5).

I found a presentation for doctors that was posted on HDCN, a website for kidney professionals, at http://www.hdcn.com. The doctor that gave this speech on catheters recommended:

1) Choose a catheter that has a large enough diameter tube and is as short as possible to fit the patient's anatomy.
2) Catheters should be tunneled.
3) The best place to put a catheter is in the right internal jugular vein. However, sometimes this won't work so the next choices in order are
- the left internal jugular vein
- inferior vena cava (femoral or translumbar)
- subclavian vein (last choice)
4) Use an ultrasound test to know where to place the catheter.
5) Use fluoroscopy (a kind of x-ray) to check to be sure that the tip of the catheter is where it should be (in the atrium of the heart).
6) The doctor should check for good blood flow before sending the patient home.

I've never heard that catheters flow better the second time they're used. However, it is possible for the tip of the catheter to be up against the wall of the atrium or a catheter can be kinked. Either of these will make the blood flow less. If a doctor does a fluoroscope exam, it should show if the catheter is kinked or the tip is against the wall.

I hope that your mother's situation improves. She's lucky to have you looking out for her.