Hello everyone this is Headbandgrrl (I forgot my password!)
I recently moved from Phila to MD. I have had three blood staph infections since Feb. I am on nocturnal dialysis 4x week…
I never had a problem like this before moving to MD- I have had 2 quinton (sp?) and two/three perm caths placed because I keep on having staph infections and they have to this point believed I was contaminating the catheter (not so, as my technique has not changed)-
I am wondering is- it possible that the water in my apartment complex…pre RO… is extremely high in bacteria, and the RO is not cleaning the water properly?
There is one other possibility- I have had bladder infections- and in the past I have had staph infections because my bladder infection has gone mutant. This is what I believe is actually happening- the bladder infection is going mutant- and being pulled by the slow nocturnal dialysis into my blood stream…I was in center in Feb and I didn’t notice any issues then… then I went home and Yikes!
I need to get this cleared up because I have just found out I am positive yet again, and I can’t go back to my home treatments until everything is ok.
If anyone has any suggestions, I surely will take them. I am scared I won’t be able to go back home…and quite honestly I do not tolerate 4 hour treatments well. :?:
You gave me lots to think about. I have about 3 old grafts in my left arm that have all clotted, and it seem reasonable that I could have a lingering infection…
I am wondering is- it possible that the water in my apartment complex…pre RO… is extremely high in bacteria, and the RO is not cleaning the water properly?
It’s possible, but can be ruled out by water and dialysate cultures which should be done routinely. Also, some machines (Fresenius 2008K, for example) have optional bacteria filters (Fresenius is called a Diasafe filter) which offer further protection.
[/i]We perform monthly water cultures and last month we disinfected three times. The water cultures have come back positive for gram negative rods. So we can’t rule out the water source yet.[i]
There is one other possibility- I have had bladder infections- and in the past I have had staph infections because my bladder infection has gone mutant. This is what I believe is actually happening- the bladder infection is going mutant- and being pulled by the slow nocturnal dialysis into my blood stream…I was in center in Feb and I didn’t notice any issues then… then I went home and Yikes!
A latent infection is a very real possibility. My wife had her cuffed catheter replaced three times before it was discovered that she had an infection in an old, clotted bovine graft in her arm that was the source of her blood stream infections. My impression is that catheters are always the first suspect, but with proper care in insertion and maintenance give relatively little trouble and the problem lies elsewhere A white cell scan is a common way that infection sites anywhere in the body can be detected.
[/i]Thank You! I am going to request a white cell scan!
One further idea if you are getting positive culture reports. Our center decided they were getting too many positive culture reports from their home patiens R/Os so they installed UV disinfectant lamps on the R/O water line. They also moved up the R/O membrane replacement schedule. I have had no positive water, dialysate or LAL reports since they took these steps although I can’t be sure it is cause and effect.
I neglected to mention that the best way to determine if your catheter is your infection source causing your bacteremia is to take simultaneous cultures from the catheter and from a vein on the opposite arm. If catheter culture growth first appears an hour or more before opposite arm growth it’s very likely your catheter is the infection source. If culture growth starts from both at about the same time or the catheter culture lags you can conclude the source is not the catheter.
One thing you must watch for is the problem caused by the (appropriate) policy of most hospitals not to permit lab techs or ER or floor nurses to touch a catheter – only dialysis nurses. One consequence is that even though your doctor has written the order for both cultures the lab will draw the arm culture and then wait until a dialysis nurse shows up hours later to draw the one from the catheter – this blows the whole test! I ran into this several times – on one occasion at night there were no dialysis nurses in the hospital, and I insisted I was qualified to draw the catheter culture which was vetoed until I explained the situation to a moonlighting ER doc who let me do it. Sure enough, it proved the catheter was not the problem…
Thanks for the possible solutions…I am working on it. Mel- I got smart about the cultures and when I was in the emergency room last Thursday, I had them do a culture both from the catheter and my arm…alas the cultures were LOST! Ahhh and since then I have had antibiotics, so of course I am infection free.
Unfortunately I am in-center, and will be for the next few weeks. The Biotechs are coming out to my house this week to do disinfections, etc. I just realized that I have been using the same carbon tanks on my RO for the 15 months…Can any of my peers who are using a non-aquaboss RO tell me what your carbon tank change schedule is? I heard from a biotech that there is the remote possibility that bacteria is growing in the second tank because chlorine never reaches the second tank. Now, I don’t know if that is true or not…but it is an fact to be explored.
This is really an unfortunate situation, as I receive two calls for potential kidneys this week and I had to decline because of the infections. Needless to say, I am not very happy. If I do need to continue on dialysis (hoping to actually receive a kidney by the end of summer)- I will consider Nxstage- I do not like the fact that it does not do nocturnal dialysis- I really wanted the therapeutic benefits of ND, and I have also read somewhere (on these boards?) that it does not give great clearance to larger people, which I am.
I’ve been doing hemo at home for 3 months, and I’m still on the same two carbon tanks. I was told the first one would need replacement after about 3 months, but it’s still checking out Ok, at least using the Hi-Sense test kit.
There are a number of short daily and nocturnal hemo patients in my city with the exact same setup as me, and I’ve never heard of a bacteria problem. I would be more concerned with the R/O for that when it sits unused over the off day, but it gets disinfected with a special peroxide once a week. Plus, the reverse osmosis process itself is supposed to reject bacteria. The dialysis machine has a special filter on the back which is similar to a dialyzer. It’s supposed to take care of bacteria too, as far as know.