Low initial drain on APD

[Newtothis1234]

Hi,

My husband has just started APD. He is on day 7 on 1 yellow bag, 1 green and 1x2L Extraneal.
We have been plagued with low drainage alarms since day 1 which the PD nurses cant explain but the main problem is that his initial drain is only ever 200-300mls which has everyone confused as he has been carrying 2L of fluid all day.
Last night his initial drain was 200mls but his total UF was 2500mls. he spoke to the PD unit about it and all they say is that shouldn't be happening and that the total UF doesn't count if the initial drain is so low.

Has anyone else experienced this? What did you do about it?

He is definitely not constipated

Thanks very much xx

[Newtothis1234]

Hi,

My husband has just started APD. He is on day 7 on 1 yellow bag, 1 green and 1x2L Extraneal.
We have been plagued with low drainage alarms since day 1 which the PD nurses cant explain but the main problem is that his initial drain is only ever 200-300mls which has everyone confused as he has been carrying 2L of fluid all day.
Last night his initial drain was 200mls but his total UF was 2500mls. he spoke to the PD unit about it and all they say is that shouldn't be happening and that the total UF doesn't count if the initial drain is so low.

Has anyone else experienced this? What did you do about it?

He is definitely not constipated

Thanks very much xx

[kickingandscreaming]

I have no experience with this particular problem, but if it were me, I would call Baxter tech support for troubleshooting.  Maybe the cycler is defective.

[cassandra]

Or maybe his position is different while having his first drain?

[solid98]

Could be fibrin. Have you been using heparin? I find I have to dose up with heparin every time or I will have some drain problems. It's also positioning for me, I have to be on my right side to have consistent drains. If I roll onto my left side, even without the line being kinked, I will often get a drain alarm.

[Charlie B53]

Recently changed to Hemo but I had been on PD for the last 3 1/2 years.  I have noticed body position can made a huge difference in how well I drained.  I always drained better vertical, at least sitting or better yet standing, I would drain far more than if I lay down.

Laying onmy back I wouldn't drain near as well as laying on my right side.

This caused my Dr and Nurse to agree to change my Cycler Program to 'Tidal' and also to set the last drain to 'Hold' so that once I got up in the morning I had to hit the 'Stop' than again hit the 'Start' to restart that last drain.  Only then could I drain completely before that very last fill with the Ico.

I suspect your Husband is connecting and going straight to bed.  I think he needs to stay vertical at least until that first drain is finished.

This can be very important as if he is not draining, then filling on top of that he can get OVER-filled.  This can be dangerous to some people unable to withstand that total volume of fluid pressing against their organs.

This needs to be figured out and dealt with before possibly causing him a problem other than some discomfort.

Please let us know more details, and contact his PD Nurse to confirm my advise.

[Newtothis1234]

Thanks all,
He stood up for his initial drain tonight but only got 7mls off, yes that wasn't a typo I meant SEVEN MLS. So now the machine has pumped another 2litres in and he feels like a beach ball!
We dont know enough about how to program the machine so can't do anything..He is exhausted and sleeping soundly but I'm watching the dwell time ticking down and praying that it all comes out in the first drain!
Don't know what to do

[cassandra]

If he doesn't wake up, it can't be too bad? Try to relax. Has drain already happened?

Love, Cas

[Newtothis1234]

First drain just finished 2757 MLS. There's no fibrin in the bag and the fluid is clear.
I just don't understand why the initial drain just doesn't work!
Thanks for your support

[sahern]

What is sounds like as there is not a minimum number programed in for the initial drain.  If he is carrying fluid during the day it should be required to take off a minimum amount before the first fill takes place.  I run dry during the day but when I first started for the first week I carried 2L during the day.  When I started the machine (Baxter) it would tell the number of ml that had to at least drain before it would start to fill.  You could see this when you pushed go the first or second time.  Hope this helps.

[sahern]

One other thing I was not draining a lot when I carried fluid during the day and was concerned so I called the nurse.  They said my body could have been absorbing a lot of the fluid.

[Newtothis1234]

Thanks all,

The night seemed to go OK, only one low drainage alarm. I had to go to work before he'd finished so don't know what his total UF was.

Is it possible to absorb the extraneal fluid then? That's a bit of a worry if that's happening! I don't think it is as he says he feels very full all day and his tummy looks really distended.

The PD nurse is coming over this morning so I'll message him to ask about setting a minimum drainage on the intitial drain.

Thanks so much for your help xxx

[Charlie B53]

Depending on his hydration level it is possible to absrb SOME fluid during the day.  But I seriously doubt anyone could be so 'dry' as to absrb 2 lliters.  Perhaps 100, give or take a little.

Sahern made the best call.  A setting for what is expected minimum of that initial drain.  I forgot about that.  This was usually a problem every time in the Hospital using their machine as it wasn't fully programed like mine at home.

[Newtothis1234]

Thanks, he's definitely not dry as you can see he is carrying fluid on his legs.

He ended up spending the morning at the hospital in the PD unit so I'm hoping they've sorted him out now.

Thanks again

[jimcorr]

I'm not in APD (yet, but i will be soon) but what i've noticed on CAPD, is that my last exchange of the day drains way better when i go really light on my dinner. If i eat everything that id like too, i get bad drains just like your husband.

[OldKritter]

I’ve been on PD for 2 years.  When I started I had problems with the initial drain alarms.  Seems I absorbed the fluid during the day.  Like some of the others I have to sit up and use the manual drain in the morning to finish off. 

Did you have the PET.  (Peritoneal equilibration test) It tests your peritoneal membrane transport function.  They usually test you when you start PD.  Depending on the results they may increase or shorten your dwell times and number of exchanges.