Ultra Bag Manual Drains

[Whamo]

   Hi, I'm doing four drains/fills a day with ultra bags instead of 11 hours on the machine.  I like the ultra bags, but have some concerns.  It seems like the drains don't get it all.  I put in 2,000 ml and only take out 1,800 on the green bags, perhaps close to 2,000.  With the one red bag I do overnight, I take off 6 or 700 ml of fluid.  I was staking off 2 liters on the machine.  I've cut back on my fluids to compensate.  Are there any secrets to getting bigger drains on a ultra bag?  It seems like if I give the drain more time I get more off, but that takes up a lot of time.

[amanda100wilson]

May be positional so change position while you drain.

[Joe]

I always gave my drains about 45 minutes to ensure I got everything possible off. It sounds like you are not giving adequate drain time if you go longer and get more off.

[Charlie B53]

Are you sweating during the day?

I've found that being outside in the yard, or puttering around in the barn, the warmer the weather the more I sweat and the less I get during a drain, especially when using the yellow bags.

I've since switched to the cycler and am carrying Ico all day, and here again, I get back far less than I did when manually using Ico for the long overnight dwell.  Where Ico was pulling 300 to 500 overnight it is now absorbing some, I get anywhere from 1680 to just shy of 1900 with it in all day, from 6 a.m. to 7:30 p..m.

I've always been a easy sweating guy, sometimes sweat just standing still on a decent day.  Far worse when it's' in the 90's and humidity well over 70%

I am somewhat surprised to learn you are using the red for an overnight dwell.  My Neph started me on the Ico so as to pull off a lot without risk of damaging the membrane from continued use of the reds.  This may be a good question to ask your Neph, I'm just a patient, what do I know?

Oh, I should mention that I have become diabetic, this could be a contributing factor to my Neph's decision as the Ico does not raise my blood sugar, tho I did have to get an Ultra One-Touch meter as the Ico can cause a false high sugar reading using other brand meters.  This could be dangerous if found unconscious and EMT's hit me with a bunch of insulin in error.  I wear a medical warning tag, just hope they never have to see it.

[Whamo]

I avoid red bags, but my propensity to gain weight, fluids, usually, has my nurse telling me to use them.  I'm not diabetic, but I'm afraid I'll go that way using too many red bags and drinking soda.  I drink the eight ounce sodas, but it's still sugar.  I'll probably settle into using a two greens and a yellow bag once I get things sorted out.  Right now all I have are red bags and ultra bags.  I'm going to my kidney center because there is no way I'm going to make it on ultra bags only, or red bags.

[jcanavera]

We learned early in the process that the Baxter Pro is not infallible in its drain calculations.  From what I have read, it uses a couple of methods to determine when to stop the drain process.  Both are measurements of flow over time.  The problem is that my wife is not a fast drain (we found that out when initially were doing continuous flow).  The cycler when encountering this slow flow was ending its final drain cycles (at the beginning of treatment and prior to the final fill) before she truly was empty.  After talking to the technical support folks from Baxter, we found that we could do manual drains when the cycler finishes those final drain cycles. 

The key is to catch the cycler right as it finishes those drains and prior to starting the next fill.  So what I do is sit with her and watch that first and final drain.  You will see the output slowing and when the screen changes from drain to fill, I hit the stop button.  I scroll down to manual drain and hit enter.  At that point the cycler will go back into a drain mode and you will see more fluid being pumped.  Eventually the flow slows and again the sensors in the cycler stop the drain.  At that point you can scroll down to manual drain hit enter and drain more, or you can hit start and the next fill will begin.

In my wife's case I have her laying in bed and she changes positions from side to side and sitting up.  Each of these changes yields more fluid output.  Typically I can extract anywhere from 100-650 ml of additional UF above what the cycler records in the first and last drain.  What's great is the cycler is keeping track of these manual drains, so the reporting numbers are updated to reflect those.

Additionally we have a Temper-Pedic adjustable bed which allows us to raise her hips, lower her torso, and raise her torso.  This makes the movement process very easy for her.  Since we have done this we are pulling between 700-1,100 UF per nightly session without having to resort to the red bags. 

Bottom line the machine is not perfect and adding manual drains has made her comfort level and output level much more successful.  I can't say enough about the Baxter technical support folks on the time they spent with me on the phone helping me understand the nuances and things I can do with the cycler.  Wish our PD nurse who did the programming was that much help.

Jack

[Charlie B53]

Incomplete drains using the cycler can be a very serious problem causing over-filling and possible life threatening complications.  Baxter recently sent me a letter with a couple pages of addendum's for the cycler manual spelling out those possibilities and suggest the very same 'manual drains' as a means to prevent over-filling.

My Nurse and I had a long talk about this during my cycler training.  I stay up during my initial drain and we have the machine set for 'tidal' fills and drains with the last drain set large so the machine will NOT switch to fill until I get up in the morning, check /restart the drain so I can watch to see when or rather how much more it pulls off since I am then vertical.  Once the drain is completed then I still have to use the 'Override' to get to the final 'fill'.  We decided this was a guaranteed method of ensuring a total final drain and no possibility of an over-fill.

I am an early riser anyway so this isn't a problem, I already up.

Did I ever mention that I love my spell checker?  My posts would never be right without it!

[jcanavera]

What's nice is that final drain minimum UF is a parameter that the patient or care giver can set.  We have ours set at 500 and most days we are short or just short of meeting that goal when the cycler thinks that my wife has finished the final drain.  That allows the cycler to halt with a low UF alarm and gives me a chance to then go into a manual drain mode without jumping to the final fill. 

Typically I can get another 300-500 ml of UF out of her before resuming the final drain.  Works pretty easily.  The Baxter help line is really good about giving you explanations on the workings of the cycler.  It was the call to them about how the cycler knows when you are drained which gave me the knowledge I needed to ask the question as to how to make sure that final drain truly emptied the patient.  These folks are really patient and will spend the time necessary to make you successful with their machine.

Jack

[jcanavera]

One thing to be aware of is that on the initial drain, if you stop the cycler at the begin of the 1st fill to start a manual drain, the internal treatment clock continues to run.  What this means is when you finally finish your manual drains, the cycler will shorten your dwell periods to make sure it completes your treatment within the timeframe originally programmed by your PD nurse.  We ran into this lately when I noticed that my wife's average dwell time had gone down from the high 40 minute period to below 40.  The key if you are slow to drain is to set the minimum drain volume on the initial drain high enough.  What will happen is if you don't make this initial drain minimum, the cycler will stop and alert you.  Then you acknowledge the alarm and hit the go button.  The cycler continues the initial drain but holds the treatment clock.  This means your dwell time will not be reduced and you will get your full treatment time.  Now if you can't make the minimum, you can always do a bypass which will immediately take you to your first fill.

Jack