Thursday, 20 February 2014

Haemodialysis Access Catheter Dressing and Stopper – the good, the bad and the ugly

Wednesday 2014-02-19

Last week I’ve had the best dressing ever, which lasted a whole week without being retouched for six days, and can really be said waterproof. For the entire week it stayed snug along the contour of shoulder, chest and armpit. In the past 5 months I must had about 30 changes, none of which stayed in shape or in position for long. The quality of dressing material has the following different types and the skill of users varies, the chance of having a good dressing is to land in the hospital with good dressing and a capable nurse, in my case is 30 to 1.

Material wise for the dressing, hospital M has the best one, sturdy, strong, and smart, a transparent plastic with the inside loop lined with net ventilating adhesive fibre. Together a blue paper covered sponge button lined with antibiotics is used underneath the dressing circling the catheter entrance covering the flesh. When it is used properly should be waterproof, but due to my queer catheter position perfection is rarely achieved and hence need retouching after getting home on dress changing day.

Another type which is also commonly used in some hospitals is also made of plastic without the accompanying blue button, the looping fabric is not sealed with plastic, the single layer adhesive soft fibre doesn’t stick fast enough, with moisture especially in summer when one often sweat, it is likely to unstuck and the seal opens easily.

The third commonly used in other hospitals is the worst of them all, a plain, sandwich rapper like plastic with adhesive edges which curls and rolls back up easily, and before one gets home the dressing is already shrunk in size. When this one is used with the button proofs to be even more problematic. Underneath the dressing is airtight, the plastic clings to the skin, if one perspires the sponge button sucks up all moisture, fattens up and moves away, left the blue paper on top sucked to the catheter entrance point to the flesh. The sucking power looks so strong to me, when such things happen I often fear that this little piece of paper could be sucked into my flesh, however, this has not yet happened so far, but scary nonetheless.

With all the dressing having adhesive issues, I always keep rolls of sticky tapes handy, the strong ones are most preferable, even though when peeling them off often left the skin pink and raw with blood spot visible, part of the flesh could literarily torn off, one need to rotate sticking position to avoid repeated injure.

One other thing needs a mention is the catheter stopper. There are two types are in use, a short one and a long one. The short one is simple, tooth paste cap like flat top screw up stopper, 1cm in diameter, 0.8cm in length with vertical ribs of 0.3cm apart, easy to use and wearer friendly.


The long one, 1cm in both diameter and in length with vertical ribs of 0.1cm apart, the tip end stretches on to a thinner rod  of 0.8cm in length and 0.7cm in diameter with one single screw line at the tip which when touching the skin felt rough and scratchy, and its length proof to be cumbersome. The wearer can’t sustain a close or bear hug which would be dangerous when the rough edges is pressed against flesh. The closed ribs on the stopper are not friendly to the fingers when screwing it on. The short one is not flawless either, the reason today I had both a short and a long one on was because the other short one rolled away on holiday.

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