drainage problems on APD

[Mike]

Hi Everyone,

I got my homechoice pro machine and have been using it now for 5 days but I have been having some problems with the initial drain.

Since my hernia op I was originally was doing 1500ml for each exchange but this was changed on friday to tidal 1800ml overnight and I carry 1000ml during the day. For the last 2 nights I have had a problem with low drain volume on the initial drain so the machine alarms and I have to bypass it. I only drained out 379ml on sat night and slightly better last night but still only 601ml.

I had spoken to the unit and the PD nurse there said it was probably because there wasn't enough pressure but I feel that I am reabsorbing it. Is that a lot of fluid to reabsorb and should I be concerned about it?

I also find that it leaves me so dry in the morning and I can't drink enough fluid to counteract it even though I have been drinking 5 or 6 pints overnight! Plus as I still wee a lot I'm disconnecting and running to the toilet 2 or 3 times a night!

All in all I'm not getting a very good nights sleep what with the alarms a couple of times a night, having to disconnect to go to the toilet plus the noise of the machine is making it hard to get to sleep in the first place!

I must admit that it is better than PD and the only other problem I am finding is what to do with myself during the day as it seems strange now not to do any exchanges.

Also it looks to me like my hernia op didn't work as I am pretty convinced that itn is still there but the doctor just tell me I have to wait 6 weeks in case it is a blood clot! I think I can tell the difference between a hernia and a clood clot. It would have to be one very big blood clot that just happened to be in exactly the same place, size and feel the same as the hernia!

any advice would be gratefully received.

Mike

[Hal]

Hi Mike,

You say that you are still going to the toilet a lot, so if you are still passing a lot of urine, its very possible to absorb the fluid during the day.

What kind of bag do you have in during the day? Low?

The main way to check things are OK are to weigh yourself when you get up in the morning evey day, before you get dressed and have breakfast.

If your weight is staying steady then you are balanced overall and I would say absorbing the fluid is nothing to worry about. I presume maybe you are doing this already as you say you are dry in the morning.

5 or 6 pints is a very large amount! What bags are you using on the machine? If you are passing so much urine you should definitely be on all low bags (Yellow 1.36% on Baxter).

A main cause of drainage problems on PD is constipation, so you need to ensure you are regular. This was a big problem for me when I first started PD.

I don't pass any urine so I don't have the disconnection problem, but I was advised to use bottles if possible to avoid disconnecting too often. I know this isn't particularly pleasent but it reduces the chance of infection and avoids the nuisance of having to disconnect with an OptiCap, wash your hands and connect again.

I also had difficulty with the noise of the machine. A good tip is to put the machine on a towel on your table and this tends to reduce the noise from vibrations. However, it is still noisy and I just found with time I got used to it, although it is still very rarely I sleep a whole night through (for whatever reason).

Good luck,

Hal.

[Mike]

Hi Hal,

I have a supply of yellow and orange bags but I only use the Yellow (1.36%) ones. I do pass a lot of urine considering my low function for instance the last 24 collection I did was about a month ago and I had no problem filling a 2 ltr container.

My Ultrafiltration is around 800-850ml and I believe that when your function is reduced that your kidneys produce more urine overnight. I did find this problem when I first started PD but it seemed to reduce over time and I assumed it was maybe my body adjusting so maybe it will get better in a few weeks?

I do weigh myself every morning but I feel very dehydrated in the morning.

I've only had a problem with constipation a couple of times but that was before I started PD and one of the times was straight after the PD tube op and was due to the drugs. I take docusate sodium every day to prevent it and I try to make sure I have enough fibre everyday.

I was concerned about the risk of infection from having to disconnect so much so I have been trying to drink in smaller but more frequent amounts particularly more during the day rather than at night in the hope that it is passed throught the peritoneum before my kidneys get to it but I dont know if that will work?

Anyway I'll see how it goes over the next few days.

Thanks

Mike

[Julie]

Mike,

Sounds to me like you may need a switch to Extraneal during the day so you don't absorb - Extraneal will always take off more fluid than you have put in.

Yellow 1.36L bags when kept in for a long time, i.e. over 4 hours, will always tend to absorb, so we were told.

Worth chatting to your PD nurses about.

Hope you get it sorted out soon.

Lots of love,
Julie
x

[Mike]

It was much better last night the initial drain was about 850ml and there were no alarms all night plus I managed to sleep through to the morning without waking up at all

I think that I have not been drinking enough so I have been very dry during the day and that is why I am tending to absorb a lot of the fluid.

[Hal]

Sounds good Mike.

Mention the Extraneal, but I doubt they will give you it because its intended for patients who don't pass a lot of urine as it tends to pull off a lot of fluid (its also very expensive!)

I seem to be very "leaky" myself at the moment and have to drink about 2 litres a day to keep myself from getting too dry.

Hal.

[Mike]

I doubt they would give it to me as well, I think I've more than used up my portion of the NHS renal budget over the last few weeks what with my op, new homechoice machine and I've been on 2000units of epo 3 times a week for the last 2 months which has resulted in my hemoglobin shooting up from 9 to 17.4 !! Plus I'm going to have to have another hernia op soon as the other one didn't work.

[Hal]

I wouldn't worry about using a portion of a budget, take everything you need!!!

[amanda in CA]

I have found that my UF fluctuates. Being female, I have found that this tends to be cyclical and I think that it is the effect of hormones. I also find that when my UF is low I too get very thirsty. As Hal has said, if your weight is reasonably constant, I wouldn't worry too much. You may be making up for any fluid that you missed out on when you had your op. and your body is just 'saying' that it needs a bit extra. I wouldn't stress too much about disconnecting, after what is the difference from disconnecting and re-connecting 4 -5 times per day when you are doing CAPD? Clearly you want to minimise the risk of infection, but when you are trained for dialysis the nurses have to inform you of the 'perfect' way of doing things. I have found, unfortunately, that this doesn't really take into account the practicalities of living with dialysis. I must admit that I disconnect most evenings just so that I can go and do other things while I'm on the dwell cycle. I've been on dialysis for two years now and have not had any infection issues. As long as you understand the principles that are taught to you, i.e. non-touch technique for the sterile parts then you should be ok. Amanda