I Hate Dialysis Message Board
Dialysis Discussion => Dialysis: Home Dialysis => Topic started by: Charlie B53 on August 11, 2016, 05:27:13 AM
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I had to ask my Team at Clinic the other day about how slow drains can have an effect on 'adequacy'. My thought is because I have noticed the dwell time of many of my last cycles many mornings are only 5 minutes, sometimes Zero minutes. What? How can a dwell be that short? The Cycler calculates the dwell periods depending on the remaining treatment time left on its clock. Once set to run for a period of time, if it takes far too long to drain, it automatically recalculates the remaining dwell, shortening it so to end treatment at the correct time. Sounds so simple. My problem with that is all those nights that I drain slow. The machine cuts the dwell time and I do NOT get the treatment, the solution is not in long enough to have much exchange occur.
So I had to ask questions. And they don't have answers. We, well they, had me do another set of 'collection. But that will only show an AVERAGE exchange for the nights treatment. Because each exchange is all combined into the two big bags, it is all a mix. There is no way, yet, to determine what, or if, any one exchange had more time, had more 'exchange' than another. And can't, until, or unless I change collection bags at every exchange, just as we do when doing manual exchanges.
God I HATE this laptop! I bump the *&^%'n touchpads, not noticing it, and WIPE OUT the whole last paragraph that I had just typed in!!!!! Grrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrr.
Try again.
Other news. I have a new PD Nurse, again. My Clinic is growing, fast. They say I am a pretty good patient, do what they want, complete my log, yada yada.......
So I get the new Lady as she doesn't need to do much but draw my labs and check off the boxes on the paper work and I'm out of there.
This new Nurse, Carla isn't really new at all. She transferred in from another Clinic where she has been a Hemo Nurse for the last SEVENTEEN years. She is pretty new to PD but she seems very smart. We had quite the conversation during my clinic visit.
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Are your slow drains affecting your blood work? If so, then maybe your prescription needs a tweak. Maybe fewer exchanges would be better. Or maybe some supplementary manual exchanges. If your blood work is OK, then why worry about it?
On the other hand, do you have any idea WHY you are having such slow drains? Is this a new feature? Does it have to do with position? Might you need the occasional heparin (I do) to make sure the flow is free?
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So... I've actually figured out that when I have nights where I have a really slow drain and a short final dwell, it's because I've slept through an alarm for a bit. My mom actually pointed it out when I was home for a visit. I've cranked the volume up a bit and so far so good.
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I wish i was such a sound sleeper!
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I wish i was such a sound sleeper!
DITTO!
Even with the volume turned down as low as possible it bounces me right out of the bed!
Most times it gives a three beep warning, I am awake by the second beep and turned from my back onto my right side by the third. But there are nights that I swear this has happened a LOT of times as by morning I don't feel like I had slept much.
First thing PD Nurse asked was if I have been constipated. NOPE! I eat my vegetables, daily. If I have a sandwich you can bet there is an inch of lettuce on it, and a very healthy slice of tomato. Drippy enough I usually have to hold over the sink so not to make a mess anywhere.
VA Appts this afternoon, one for X-rays to check cath position. Doubt if they will tell me anything. I won't find out till Dr gets the report and tells my PD Nurse. I don't expect her to call til at least mid next week.
Still waiting for Tuesdays Lab report to come back, should be today.
Most likely everything will still be within range and I'm just overly cautious about seeing the ending cycle short dwells. I just have so much fear of the thought of needing to switch to hemo I makes me crazy.
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I just have so much fear of the thought of needing to switch to hemo I makes me crazy.
I feel your pain. The threat is like a ticking time bomb.
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3 years and 2 months on PD. So far, so good. I think I am very fortunate that I haven't even had an infection, yet.
And I Pray that I haven't just cursed myself bragging about it.
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I may have inadvertently solved my 'Slow Drain' problem.
My Cycler stopped pumping this morning. When I Bypassed to the 'Last Fill' just as I do every day, after a few minutes I started getting alarms 'Check Patient Line'
Of course I found nothing wrong. Stopped the alarm and Started again. Few minutes later alarm again. This went on to a number of times. I was getting quite frustrated. I hit the down arrow to see how far into my fill I was 5ML That's hardly any! I disconnected, pointed the hose to the drain and restarted, expecting to see some low flow. NONE. And after a couple of minutes the alarm went off.
It was only then I realized the normal sounds of the machine weren't quite the same. I could still hear the whirring of something like an air compressor, but I did NOT hear the rhythmic pulsing of the pumping chambers, the diaphragms that are supposed to be moving back and forth making the cassette chambers pump.
Maybe my Cycler has been dying for a while and I only THOUGHT that my cath was slow flowing?
Baxter is sending me another machine. Said to listen for the phone, they will call with an appt time. And be ready to carry out the old one.
Can do. I even wrote a note and taped it to it so whatever Tech looks at it will have an idea what's wrong.
As I retired mechanic/machinist I sure would like to take it apart and look inside!
sp mod Cas
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Wonderful Charlie 853 I hope you found your problem. Yes I am not a mechanic but a curious person who understands the basic way that things function and have dismantle a FEW things in my life. My machine went bad the 3 week after I started CCPD And the urge to look was hard :bandance; :lol;
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Let us know if that fixes the slow drain. My Baxter machine is being replaced because it is very loud. I have also been experiencing slow drain that came on suddenly. I used to get between 10-20 minutes lost dwell from the way I sleep. All of a sudden it started going over an hour of lost dwell. The one thing that I noticed is that it did not seem to be pumping like it should during drains. When I first started PD if the drain slowed down I would get an alarm right away. Now I can watch just a few ml of fluid flow on each pump of the machine. If I do not move this will go on for a long time. I hope that the new machine is not as noisy and also takes care of the drain problem.
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No phine call, no new Cycler yesterday. Hopefully today. They asked to be sure I had manual bags, I do. But my heating pad died long ago. I never bothered to replace it. Never thought I'd need it. Wrong again.
PD Nurse said she will make SURE that I get a new heating pad at Clinic next Monday. I'm thinking I can just skip a night, maybe two, without any serious problem. I can just use both greens for a couple of days to pull off the water I gain. The hot humid weather I haven't reduced my ice water intake very much. Today I will be in the truck with the air on half the day, that should help curb my thirst a bit. Since I will be out running errands I can almost BET Baxter will call to make the delivery. I think I will leave the old Cycler on the porch so I may not have to be there.
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Came home to find my new Cycler sitting on the chair where I left the old one. Connected now. What a difference! I can hardly hear this one at all! So much quiter than my old Cycler. I forgot to turn the alarm volume down. I will do that in the morning as it is already going and I don't want to risk messing anything up trying to change anything. I had written down everything in the program so it was farly simple to scroll through and set all the values.
I will see what my average dwell time is in the morning. Hopefully it is back to near an hour.
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QWAP! Not even 10 minutes and got my first alarm. LOUDLY. Low Drain Volume. I forgot, I am dry cause the old Cycler failed on the last fill, and I didn't bother to use manuals. D'oh. Maybe this is why they make 'By-Pass' possible?
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Only the one 'Low Drain Volume' alarm all night. And this mornings #'s show an average dwell back to 58 minutes!
I think it's cured!
That's a lot off my mind, I was thinking something was going wrong with me or my cath, NOT!
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:2thumbsup; :2thumbsup; :yahoo;
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I received my new machine two nights ago and the noise is hardly noticeable. I took me a while to ask for a new machine because I thought it would be a hassle. All it took was one phone call and no hassles.
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Gosh... I'm about to chuck my machine out a window. I wish they would just send me a new one. I keep getting yellow bar sensor alarms and "slow drain" alarms in addition to just RIDICULOUSLY slow drain times (and not draining at all in some cases). I've called twice now, and they insist since it's not a red bar, that I should be able to fix it. Or that it's my cath (it's not... scans are perfect).
I'm just waiting for it to go off again with the darn alarms so I can call in and see if they'll finally believe me.
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Or that it's my cath (it's not... scans are perfect).
I think you are on the Fresenius cycler, so I don't recognize the yellow or red bar. But... your catheter could be perfect and you could have fibrin that is slowing down your drain. I found a smalll piece of fibrin in my drain tubing and that was enough to totally shut down draining until I had to abort treatment. Have you checked for that during a slow drain?
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I didn't notice how long the fill and drain time were. What I noticed was the short 'Dwell' times as the machine adjusted the dwell so to end treatment within the prescribed time setting.
I never noticed fiberin out of the very rare string, if that. Cath X-Ray proved normal. My Cycler had always made a certain amount of sound. I didn't notice any change in sound.
I was getting 'Low Volume' and 'Check Patient Line' alarms which most often were only a three beep warning, rarely a real alarm needing a 'Stop' and restart to continue. It was only when it totally failed top pump on that last fill that I finally know there was something wrong with the machine.
Oh, twice I had an error during the set-up Prime and had to reload the cassette. And just within this last week it started showing a 'Low Battery' during its start up. I did call Baxter and found out about battery charging. I posted a thread about that.
It does sound like your Fresenius cycler is dying. How long until it actually stops is anyones guess. Perhaps daily calls to tech to complain of the repeated problems can lead to a replacement machine?
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I finally got a new machine!!! Was on the phone with them at 5:30am near tears and they finally agreed that it needed replacing. Even better, I got SAME DAY delivery! Last night was a perfect cycle, no slow drains! Fingers crossed it keeps it up.
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GREAT News!
I didn't get mine until the second day. Oh Well, it was still new, and SOOOOOO much quiter than my old machine. I'm beginning to think my original was very old. Who knew? Doesn't matter now.
I still have nights of slow drains but not near as many as before. Most nights the morning report is around 50 minutes for my dwells which is fine.
Glad you have gotten a new one and it works well for you!
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Two nights down and so far it's perfect. I think this machine is technically older than my other one, oddly. It's an older OS at least... and this has the "refurbished" sticker where as the other did not.
Oh well. Don't care! It's working beautifully for now!
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May you spend many quiet nights together. :bestwishes;
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Sticker? My new machine looks identical to the old one, just the serial # is different, but that is just the sticker on top. I've no idea if there is any way to tell them apart otherwise.
I did tape a note to the old on describing the sounds and the lack of the old pulsing sound. I was hoping it would clue a tech into what may have gone wrong.
As a Retired Mechanic I am well used to asking customers questions about their machines. Cars, trucks, tractors, boats, motorcycles, lawn and garden engines, most anything that burns fuel. Very often asking the right questions I could know what I was going to be looking into without tearing the whole thing apart. Saved me massive amounts of time and work. So I try to extend that same courtesy to other Techs. It might make their day a bit easier.
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Last night was another slow drain. Grrrr... I'll be asking about fibrin on Friday.
Still so much better than what it was though...
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I drain into a bucket and have to empty it daily. This way I can SEE if, or how much fiberin I pass. Dangers of using a bucket, SP
ILLS, not sercuring the drain hose well enough. That will make a mess. Forgetting to empty the bucket. DEFINITE mess.
This wasn't me original intention when starting PD, I just didn't want to run the drain all the way down the hall to the bathroom.
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I've thought about it... but I have my own bathroom and it's really not a huge problem to run the hose.
I'm assuming it's fibrin and not a cath problem. Given that I can do manuals just fine for the most part and that I don't slow drain every night, I kinda think it must not be the cath.
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I use heparin every third night. I just inject it into the medicine port on the bag. It's just on more thing....
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My body position makes a huge difference in how well I drain. Vertical, sitting or stand is best, but I lay down to sleep connected to my Cycler. Sometimes even sitting here using this laptop or reading a book I tend to 'slouch', leaning forwards a bit. And I can tell when my Cycler is about to give me that 3 beep warning of a slow flow, it's like I can hear it taking a deep breath before screaming out the BEEPs. If I straighten up soon enough it may only beep once.
I don't doubt much the same thing is happening during my sleep. Most of the time when it gives those three beeps I am laying flat on my back. I go to sleep on my right side but once asleep, I don't know how soon, I roll onto my back. I am told this is normal, that most people do roll onto their back to sleep. All I know is somehow this restricts flow enough that it takes longer to drain AND fill. This time causes the machine to recalibrate cycle time so to end treatment within the prescribed time programmed. If it didn't, who knows how long we would have to stay connected before all the exchanges finished. Being retired, no job, that may not be a problem. But for those few that do still work, or have kids and got to get up to take care of business, this could be a major problem.
Perhaps a larger diameter catheter would help, but that would require larger fittings perhaps, at leat another surgery to change out the existing cath. That would be a PITA.
The heperin may help, but until proven I don't think many Dr's would prescribe it.
As long as my labs stay well within range it isn't a real problem, at least not for my PD Team, only messes with my head. A puzzl;e that I wold like to solve.
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The last cycle dwell this morning was only 9 minutes instead of the hour programmed. I must have been real slow draining during the night again. Called PD Nurse to let her know my suspicions. She called me back a little later, told me Dr thinks we should try dosing my bags with heperin.
Since I have a Clinic appt tomorrow for repeat labs they will have heperin for me to take home. I will be given a crash course on dosing bags as I haven't had to do that since my initial training 3 1/2 years ago. Shouldn't be to tough, just got to be sure to do it correctly so as not to contaminate anything. It may be days before the total effect occurs. You can bet I will be watching my dwell times to see any difference.
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Appointment with my nephrologist yesterday. I brought up my slow drains. She actually mentioned to me that when your blood pressure is on the lower end, as mine has been lately, sometimes what happens is that because your body is lower on fluids it retains more of the dialysis fluid. Basically it's the reverse osmosis of pulling the water out of your body but instead you're pulling the water out of the dialysis solution.
Don't know if that could apply to your situation or not, but it certainly makes sense in mine because I've been pulling myself slightly dry lately.
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My Clinic appt Thursday Nurse gave me everything I needed so I started dosing my bags with heperin. Hopefully this will make a difference.
I never saw much in my drain, but if it is large enough to cause a restriction then maybe I won't see it until it gets small enough to pass through the cath.
Will find out.
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How frequently are you supposed to use the heparin? I started daily and have tapered it to once every third day and that seems to work.
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I asked that very question as I had seen your posting. Nuse doesn't know yet. Told me to dose every bag every day until I see if it makes a positive difference in my dwell times.
I also asked if this is the same stuff they inject into my jelly roll (belly fat) while in-patient in the hospital to prevent blood clots in the legs. Nurse says it is. So I then asked if or how much dosing the bags can affect blood clotting. Nurse tells me hardly any effect as the heperin in the bags is not absorbed into the blood hardly at all, it merely helps desolve existing fiberin.
Oh. Three nights done so far. Dwells have recorded in the 50's. Far better than the 30's that I have occasionally been seeing.
Monday is my regular Clinic with Dr. I imagine we will talk about this and maybe come up with a schedule.