New PD Nurse Willing to Learn from Patients!

[MOMMADUKES]

Hi Guys!

I am an old dialysis nurse, well experienced I don't think I'm that old.  I was just trained to teach patients PD.  I finished training my first patient last week.  We had 6 training sessions and I think we both did really well.  Now he's home and having trouble draining.  I had him sit in different positions, lie flat and stand up.  After 20 minutes only 1200 out after 2000 ml in on a 1.5% solution.  Any ideas.  Catheter is in place, went for X-Ray yesterday.  No Fibrin in bag or lines.  I'm not sure of what to do next, thinking maybe putting him on a 2.5% soln., but he is still urinating don't want to cramp him up.?? At a loss any suggestions would be appreciated. 

[paul.karen]

Fibrin can get caught inside the cavity where the tube sucks the liquid up.  If it is clogging you may not see it in the lines or bag.  Could be a big ball of it inside him.  Try some heprin cant hurt.  Also the results of his XRAY??  My tube turned itself up (northwords) once and i couldnt drain.

He needs a KT/V he may be absorbing much of the liquid.  He also may have a lower hernia and the liquid would drain into his neather regions.  Is he swollen down there?

Last but not least it could be the machine.  Good luck to you both.
P&K

[M3Riddler]

Hi Guys!

I am an old dialysis nurse, well experienced I don't think I'm that old.  I was just trained to teach patients PD.  I finished training my first patient last week.  We had 6 training sessions and I think we both did really well.  Now he's home and having trouble draining.  I had him sit in different positions, lie flat and stand up.  After 20 minutes only 1200 out after 2000 ml in on a 1.5% solution.  Any ideas.  Catheter is in place, went for X-Ray yesterday.  No Fibrin in bag or lines.  I'm not sure of what to do next, thinking maybe putting him on a 2.5% soln., but he is still urinating don't want to cramp him up.?? At a loss any suggestions would be appreciated.

It sounds as if the patient is doing CAPD with a few exchanges per day with mainly 1.5%  If so, how long are they letting go between each treatment?  If they are letting the fluid dwell longer than 4 or 5 hours, then the body will re absorb some of the fluid.  I would try a 2.5%.  Also, if he is still uriniating, are you including the amount he is putting out?  Perhaps have him measure his fluids for a day and calculate that into the equation to see if that is where the extra fluid is going...

///M3R

[KICKSTART]

Constipation ! Thats very common and can have this effect 

[MOMMADUKES]

Thank you all sooo much!!  I was so happy to log on and find people actually answered me.  After I posted I thought maybe I was invading space I shouldn't have.  Saw my patient today and ended up sending him back to the surgeon for laproscopic intervention.  Hopefully All will be well.  Thank you all again!!  God Bless.

[*kana*]

Constipation ! Thats very common and can have this effect 

FYI.....pooping twice a day still doesn't mean you aren't constipated.  I refused to believe that my problem alarms and drain issues were bowel related.  I started taking stool softeners and problem solved.  I also have a hernia and I lose fluid to that also.

I think you are more then welcome here.  People like to help others help patients.  Coming here will make you a better PD nurse. 

[HouseOfDialysis]

I'm a wickedly fast transporter and I have absorbed 700ml in three hours. It got old quick, too.

[Annig83]

I had the same issue.  They thought fibrin and gave me heparin, didn't work... sent me home with "Go Lightly"- basically, colon-blow for when someone needs a colonscopy- NOT THE PROBLEM!   Went to a surgeon, and there was some fatty tissue hanging down, clamping off the cath.  The surgeon tacked it up, and I haven't had a problem since... a lot of caths. have this problem, for some reason.  Surgery sucks, but it does help.

[tbarrett2533]

I am just wondering how long is he dwelling for? maybe he just absorbs quickly, if so maybe add more exchanges during the day and see if that makes a difference... good luck