I've been on PD for over 5 years now and am currently using a Fresenius cycler and dialysing at night. As far as proper draining is concerned, the level of the machine in comparison to your bed is very important. If the bed and machine are too close in height, the fill just won't work well. And if the bed is too low, then drainage can become a problem. That's one of the reasons why I like the Fresenius cycler is that it comes with it's own stand, which can be adjusted in order to obtain the correct height. We just got a new feather bed mattress cover for our bed which added about two inches in height and I was concerned that I might have a problem with filling and draining properly but luckily no problem. I'm not sure what your mother's machine looks like but perhaps you can find a way to raise it to make the draining easier.
Here's a link to several pictures of my home setup:
http://ihatedialysis.com/forum/index.php?topic=375.msg53617#msg53617There are quite a few pictures of people's home setups in that thread that might give you some ideas on how others have made adjustments.
The thing about doing manual exchanges is that you expose yourself more often to the potential of catching some sort of bug. So a very clean environment and good technique when setting up the machine and connecting the patient is a must. When I first went on PD, I found myself dealing with several cases of cloudy fluid. These were minor enough that I was able to treat myself at home using antibiotics provided by my nephs. I just added the antibiotic to my solution bags each night for a week or so along with taking some oral antibiotic. We think we traced the source to an overhead fan that we had in our bedroom. We had always just left it on but after turning it off while setting up and hooking up, my problem was solved. My one major bout with peritonitis that landed me in the hospital for 5 days and then on home IV treatments for another 2 weeks was traced back to (believe it or not) constipation. The bug I had developed was finally diagnosed as Pseudomonas Putida. That episode was almost 2 years ago and since then I take a daily stool softener which also contains a mild laxative. I've had absolutely no problems with peritonitis since that time (knock on wood!). I guess what I'm trying to tell you is to look around where your mom is dialysing and just think about what might be a potential hazard. It could be something very simple (like my fan) or it could mean a slight change in medication or even a minor change in technique. It takes so very little to get an infection but it could also take just a little to prevent it too.
There are some people here at IHD who have had their catheters removed because of peritonitis but I haven't had to do so since I started back on PD 5 years ago. In any of my cases of peritonitis, my catheter and exit site did not become infected so there was no reason to remove it. My neph will only remove a catheter if he feels it's become infected also.
I'm not sure if I've been able to help much but maybe I've given you some ideas to think about. Many times I've found answers here at IHD that I couldn't get from my PD nurse because she has so few PD patients (only about 12) and therefore hasn't experienced some of the things that can go wrong. I wish you and your mom lots of luck. I'm like your mother, Hemo is just not for me and I will do PD as long as I possibly can.
Take care and be sure and continue to ask lots of questions. It's the only way to make sure things will get better!
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