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  • Permcath or Fistula?

    I have had a per catch for about a month and a half. Unfortunately it had to be taken out today due to an infection. My neph, nurses and the surgeon are recommending that I get a fistula. I am completely freaked out about the prospect of getting a fistula. The main reason being that they can be ... Not so nice to look at. I also don't like the prospect of needles every other day but seriously, my biggest issue is the way it looks!

    I have surgery to get a new per catch placed on Thursday for immediate dialysis but was asked to consider the fistula. Can anyone share what made you choose to get or not get a fistula?

    Are there any products available to cover the fistula (or would the extra pressure on the fistula be bad)?

    Any help anyone could provide would be great. Thanks!

  • #2
    I would recommend a fistula because as you've found out the hard way, a permacath is at higher risk for infections.
    Keep in mind that a fistula does take a few months to mature (be ready for dialysis).

    If you're concerned about the "looks" of it, you can always use long sleeves, or a medium length sleeve (depending on where your fistula is located).
    You never want to wear anything tight on it because this will cut the circulation and damage your fistula.
    You also want to protect it from any other type of pressure on it.

    When I had my fistula done, the vascular surgeon came to see me in recovery, an hour before discharge. His exact words were "Do not baby your arm, but do protect it from any type of pressure directly on it." Those were the only restrictions besides not sleeping on it.

    I know we often worry about our image and what others are going to think, but in this case you have to set your priorities straight.
    Fortunately for me, the only thing I worried about was 'LIVING" so the image aspect of it was not a deciding factor for me.

    You'll have to decide what to do. I completely agree with the medical personnel who suggested the fistula.
    I received the GIFT OF LIFE on Nov 9, 2010 thanks to my wonderful donor Laura and her family!

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    • #3
      Here are your choices:
      1) Get fistula, go on hemo.
      2) Get catheter, go on PD
      3) Remain on heart catheter, and die within 1 year.

      Comment


      • #4
        Originally posted by CaBauer View Post
        I have had a per catch for about a month and a half. Unfortunately it had to be taken out today due to an infection. My neph, nurses and the surgeon are recommending that I get a fistula. I am completely freaked out about the prospect of getting a fistula. The main reason being that they can be ... Not so nice to look at. I also don't like the prospect of needles every other day but seriously, my biggest issue is the way it looks!

        I have surgery to get a new per catch placed on Thursday for immediate dialysis but was asked to consider the fistula. Can anyone share what made you choose to get or not get a fistula?

        Are there any products available to cover the fistula (or would the extra pressure on the fistula be bad)?

        Any help anyone could provide would be great. Thanks!
        I'm the Vascular Access Manager for my clinic and I say...FISTULA PLEASE it's much better than a perm cath. Much easier on your body and most importantly the morbidity rate for patients that have a cath (be it permanent or temporary) are greatly higher than patients with an AVF (Arterial Venous Fistula). + you can take showers, go swimming, change clothes without having to worry about ports catching on anything, in the summer you can go to the beach and not worry about things hanging out of your body...there are a plethora of reasons but most importantly is the infection rate. It would be much more beneficial for you to get a fistula.

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        • #5
          Great advice Marina!

          Also, the site of the access, if it's on the arm,should be on the that is not dominant. Mine is a lower arm access right above my right wrist. If I knew then what I know now, I would have asked for upper arm as it's less trouble to move during dialysis and less visible. But if it's a lower arm or upper arm, you can get an access cover from www.dialysisArmBands.com
          Fistula - March 2008
          Began Dialysis - August 2008
          Fistula Revision - Feb 2011

          Dialysis Patient Citizens, Patient Ambassador
          NW14 ESRD Network, Patient Advisory Committee Member
          CDC Infections Control Discussion Panel Member
          National Kidney Foundation Peer-to-Peer Mentor

          Blog: www.DevonTexas.com

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          • #6
            I didn't know that a permanent catheter was an option. I know my husband hates needles and is dreading using the fistula, he prefers the catheter. It's constantly explained to him that the fistula is the safest way to go. I also did not know about the access cover, great idea. My husband's fistula is on his upper arm, kinda on the inner arm so it may not be quite as noticeable, but it's nice to know there is a way to make him more comfortable if he needs it. Thanks for the info.

            Comment


            • #7
              Health > looks

              Not all fistulas form large aneurisms also.

              I've had mine for almost 7 years and yes it is very noticeable. In that time I can count maybe 3 times when someone asked about it and I think two of those times were from kids who were just curious.

              Being afaid of needles disappears quickly once you start feeling better after treatment. Benefit > cost

              At first the needles will hurt till scar tissue forms at the site. Once the scar tissue forms I can say from my experience that I really don't feel it. If it is that uncomfortable your nephrologist can prescribe a skin freezing spray like Gebauer's. Another option is buttonholes which is a cannulation technique which forms tracks into the fistula which once formed reduces bleeding, pain and trauma at the site.

              All in all, you get over it. There are much more important things in life to worry about.

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              • #8
                So I did end up getting the fistula. After three failed catheters and lots of time telling myself that my life is more important than a slightly "different" looking arm, I took the plunge! My first fistula did fail before I ever got to use it due to clots, but fistula number two is great.

                I use numbing cream on the site about 30 minutes prior to treatment and even feel very little pain from the needle sticks. In the end, this is the best access for me as much as I hate to admit it. My dialysis clinic even presented me with an "I love my Fistula" shirt shortly after I got my fistula placed.

                Comment


                • #9
                  Originally posted by dac0214 View Post
                  Here are your choices:
                  1) Get fistula, go on hemo.
                  2) Get catheter, go on PD
                  3) Remain on heart catheter, and die within 1 year.
                  I think you are wrong. My husband has had his catheter for a year and it is working perfectly on home dialysis. I am very careful about my sterile technique. Another member of the forum knows a person who has had a catheter for 10 years with no problems. This week we went to a vascular surgeon who wondered why we wanted a fistula since the catheter was working so well. He is considered the best in our area and was recommended by our nephrologist. Sure makes me wonder........

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                  • #10
                    Yes there is something to cover your fistula, I was given one from my hospital nurse, I was having surgery, it's lit weigh, come in different colors. I have seen Robbin on GMA with one on

                    Comment


                    • #11
                      Also there is the NoNoSleve from www.nonosleeve.com/. I wear that one when I go into the hospital or day surgery center. It's bright red and warns of nay BP or IV's into that arm. I instructed my sons to put it on if I am incapacitated for any reason. I wear an armband from www.DialysisArmbands.com the rest of the time. They come in various colors and match my shirt.
                      Fistula - March 2008
                      Began Dialysis - August 2008
                      Fistula Revision - Feb 2011

                      Dialysis Patient Citizens, Patient Ambassador
                      NW14 ESRD Network, Patient Advisory Committee Member
                      CDC Infections Control Discussion Panel Member
                      National Kidney Foundation Peer-to-Peer Mentor

                      Blog: www.DevonTexas.com

                      Comment


                      • #12
                        I've had a fistula since October 2011. The AVF is billed as the "gold standard" of arterial access, and I'm inclined to agree. Even though my forearm fistula was able to "mature" for 9 months prior to use in HHD training and the commencement of dialysis, my skilled HHD clinic staff experienced chronic infiltrations on the venous portion. A fistullogram revealed an 80% stenosis at the anastomosis, which was remedied with balloon venoplasty(?). The balloon venoplasty caused the clotting off of the venous portion of the original fistula but produced an assortment of "run off" vessels, one of which was on the top side of the forearm and featured at least one decent straight run. Cannulating and treating successively with 17 ga, 16 ga and 15 ga sharp needles in the same sites during the training permitted the use of 15 ga blunt needles in the buttonhole sites after about three weeks. On short order I was able to cannulate these sites and begin home hemodialysis with my care partner/wife.

                        As far as appearances go, I have always had very skinny and veiny arms. I've got some veins on my dominant non fistula arm that look like they could be used - but I know differently. Because of the lack of stark visual differences, even a trained dialysis nurse would be challenged to recognize my fistula. The only area that is quite pronounced is near the wrist and not far from my arterial access. As far as mobility goes, when I am hooked up, with the blood lines doing a U turn at my wrist and back up my forearm and upper arm - secured with three velcro elastic armbands and a plastic scissor clamp to the front of my chest, I can do anything with my fistula arn that I could do when not hooked up. While an upper arm access would give me more "line", I like the ability to lay the arm on my "over bed" hospital table with all my supplies and prep, cannulate, hook up, unhook up, pull needles and hold pressue with great vision and manual dexterity.

                        Regardless of your choice of AVF access location, the almost daily repetition of HHD will breed confidence and competence. I've only been at it since July 2012 and I've already developed a third button hole access in a challenging portion of the vessel and will develop another as my original venous buttonhole fistula flap is now "out of reach" of the the 1" long 15 ga blunt dialysis needle after nearly 9 months of development and movement relative to the original buttonhole tract. I've done it before and I'll do it again.

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