Peritoneal dialysis catheter block

[Marbella17]

Hi everyone, for those on PD, have you had any catheter complications or blockages and how were they resolved?

My father suddenly started to have his PD fluid drain bloody two weeks ago. We notified the nurse/dr who are both unresponsive and just assumed it’s a burst blood vessel. We requested a sample of the fluid to be tested to rule out infection but they were adamant that blood cannot indicate infection and only cloudy fluid can (deemed false information from multiple resources).

The following week he stopped draining, we notified them again and they said he must be absorbing the fluid due to dehydration, another baseless random guess. We finally got the nurse to come in yesterday and he tried to flush the catheter with saline however it wouldn’t aspirate. He did a heparin dwell directly into the catheter and said he will return next day to see if that opened it up if there was a clot. By the time he comes it’ll be 24 hours it’s in there and based on my research a PDC hep dwell is not supposed to be done for more than 2 hours as it poses several high risk situations such as being absorbed systemically causing risk for bleeding, inflammation/infection in the peritoneum or even degrade the catheter.

Has anyone had a heparin dwell directly into the catheter and how long did it stay inside before the nurse aspirated? Thank you!

[Darlenia]

Yes. When my hubby started PD, he also had a blockage. His nurse gave him heparin via his cath. After a few hours after the heparin, his blockage went away. Like you, we were worried about it since some time had passed between dialysis sessions. But it all resolved okay - no damage done internally, etc. I think that heparin comes in various dosages - my hubby was likely given a high dose. I assume others may be given a lower dose that make take a longer time to work. After that, we kept an eye on his drain bag. If we saw fibrin floating in it, we knew to expect clotting. (Fibrin looks like little threads, in my husband's case.) I don't think my hubby had outright blood in his bag, though. I hope, by the time you get this, your dad's issue is resolved and that it's not an infection.

Interestingly, with PD, one can skip dialysis when necessary. We discovered this after we had a power outage for an extended time due to storm. Our nurse told us that PD is done daily so that missing a session, although not recommended, is acceptable here and there. She noted travelling on planes forces people into that occasionally too.

Crossing my fingers that all is well by now with your dad. He's a lucky man to have you watching over him. Thank you for caring!

[Marbella17 in reply to Darlenia]

Thank you so much Darlenia for your detailed response and as always helpful information! I appreciated hearing about your husband‘s experience and so glad he had a positive outcome. It sounds like he has such amazing care starting with you and also the care team he had while on PD.

I wish I had good news to report about my dad’s situation but unfortunately it didn’t go as hoped for. The nurse tried to aspirate the heparin back out with a syringe and it did not come out… the dose he had administered was 1000 ML. He said that the catheter continues to remain blocked and now needs surgery to correct this. This is not what we wanted to hear of course… it’s quite worrisome as my dad’s condition is not the best, he is frail, has dementia and only mobile with assistance at this point, so another procedure understandably raises concerns.

Yes, it seems that intermittent missing of the PD session is not detrimental thankfully… however dad has not been getting dialysis for two weeks and I believe may be on toxin overload since his last labs showed his creatinine is now in the high 6s. So it’s also concerning that he’s losing his residual kidney function since the demand on his kidneys are higher without the dialysis… ugh I wish this catheter issue would miraculously resolve and we could resume as normal.

If you see this response… can you please share if you recall was the heparin that was directly placed in your husband’s catheter aspirated or did it remain in there? Thank you again for your kindness and care to this community, God bless you and yours!!!

[Darlenia in reply to Marbella17]

Ah...thank you so much for your kind words! I try to help where I can. As caregivers, we take care of each other. With regard to the blockage and heparin, neither of us recall anything additional being done about the heparin other than it worked. We assume any residual heparin simply swooshed out into the drain bag as the clot broke up. At the time, my hubby had some residual kidney function too - like your dad. It's interesting that your dad's creatinine is 6. My hubby waited until his rose to 8 to start dialysis. I wonder if that might be why they're not moving very fast to treat your dad's situation. Yet, it's still not right for them to be pokey -I hope they reach out to you soon and fix his cath. Stay on top of it...asking questions is free! Meanwhile give your dad a hug and kiss for me. I so miss my parents! Love on him as much as you can.

[Marbella17 in reply to Darlenia]

Exactly, we must, only caregivers can relate and truly support one another as those who are not in that role really don’t understand what it’s like. Yes, it does seem like your husband’s remaining heparin may have just came out with the exchange since the clot cleared. It’s so complicated and intricate this whole thing and not having a very helpful team makes it harder. I’m going to take him for a CT scan today as when I messaged the surgeon about this he suggested he needs one to show detailed what’s happening inside (I had an order from before because it seems like he has a hernia that developed post PD that we wanted assessed)… I’m just not thrilled about the radiation exposure being that he’s so frail as it is and has a blood condition on top of all which that’s not good for. As far as the creatinine not being too high, the Nephro had said you should start PD when the GFR gets to 10. Hope your husband is doing well now and everything is stable!

Aww thank you so much for your kind words! I really wish I could give him a hug and kiss ASAP but because of exposure to large crowds and many places I’m being careful, hopefully I can be in the clear these few days so that I can do exactly that (darn virus scares). Thank you lots for your words of wisdom… it’s evident you’re not only an exemplary wife, caregiver but also child to your parents… it’s so hard when you love them lots. Sending my best, take good care!🙏🏼😊

[Darlenia]

Yes, thank heavens, my hubby is stable and well at the moment. Hopefully, you and your father will be get there too. One step at a time. Hang in there!

[Marbella17 in reply to Darlenia]

I’m so glad to hear he is doing well and stable! I sure hope I will have positive news to report back as well!