Inserting a PD catheter for patient comfort

just had an abdominal pd cath placed on 11/19 and it has been a horrific ordeal for me. I feel as if I have really fallen through the cracks at both my surgeon and nephrology practices and am scared and beginning to get a bit frustrated and almost angry. First of all, I was only offered the option of an abdominal cath - never heard of a presternal one until just a few minutes ago. I love baths in the jacuzzi tub of the new house we bought last year and love hot tubs on vacation - just found out that those are part of my past at this poitn as well!!! No one has even told me this yet and I have alreeady been to the PD nurse for the first flush of my cath. The surgeron also told me to take off my badages after 36 hours and that I could shower after 48 - now I found out from the pd nurse that I shouldn’t have done either until she saw me to remove the bandages in a sterile environment!! I am so angry and now have an infection at the site that my nephrologist had to culture and treat me with mega antibiotics for aftter the surgeon’s triage nurse had told me I wouldn’t know what an infection looked like!! Any suggestions other than to pray, which is all anyone in my support system seems to be able to say at this point? Additonally, the surgeon placed my cath exactly where my pants lie on my abdomen so it is very uncomfortable for me. What is the possiblility of having the presternal cath placed at this point?

Dear Lynne

I am sorry to hear you have had such a terrible time. It’s awful when things dont go right … and so often, when one thing goes off course, others follow and it turns into a chain of problems that no-one either expected or anticipated.

Though I am primarily an advisor to HD, we certainly have, in my unit, 20% of all our patients on PD so can give you a brief reponse.

I have to say at the outset that I have no experience with pre-sternal catheters. Thus, to advise you about them is getting out of my field. All our peritoneal catheters are placed, abdominally, using laparascopic surgical placement in theatre by our TC (Tenchkoff catheter) surgeon under general anaesthesia.

Our PD nurses pre-mark the exit site before theatre with the patient standing erect and with careful thought/consideration to clothing and belt-wearing habits … a patient reclining under GA on a theatre table will have a different-shaped tummy to the same patients’ tummy when he/she is standing.

That said, exit site infections are also (sadly) not uncommon after catheter insertion. They can also be quite nasty and even threaten the survival of the catheter though, luckily, most are not. It sounds like you drew the short straw on infection too … but infections do happen - whether we like it or not - and they dont necessarily threaten the longer term function and effectiveness of the catheter.

It sounds like you have had some conflicting comments made between nursing and medical staff - and that tends to be confusing, I agree - but if the catheter is settling down and the infection can be controlled and beaten, dont give up on your catheter yet.

As for presternal catheters … they have problems too - though I have no personal expertise in them at all. Before you go down that track, try to talk it through with your nephrologist. To feel anger when things go wrong is a natural response … but, unconstrained or loosened, anger can lead to even more negative outcomes so, try to look to positive steps to resolve and move forward some of the issues rather than recriminatiing over whats happened. Easily said … difficult to do … but in the interests of a good outcome for your dialysis … essential for you to try to ensure. You need good vibes and good feelings (and good, straight-talking advice … be upfront (but not confronting) about this with your doctor as you go forward … so, even if you feel things weren’t done as well as they could have been - and, lets face it, I can think of squillions of times in my professional career when, looking back, I think 'I could have done it better than that" - go back to see your team for positive steps forward, solutions and options looking forwards, not back.

And, good luck.

John Agar