Advice for adjusting from manual PD to cycler

[kickingandscreaming]

Next week I begin my training--at long last-- for the cycler.  Because I am a high-average transporter, I have been on a bruising schedule of 5 exchanges/day with short 3-hour dwells.  I am almost more tethered to dialysis than I was when doing in-center hemo for a month and a half.  I am looking forward to liberating my days but I'm really not sure what to look forward to and what to avoid.  Once again, because of my transporter status and my high clearance (2.7) I will probably begin with NIPD (nocturnal intermittent PD) with dry days.  I'm really looking forward to dry days as I hate carry around so much fluid.  With a full peritoneum, every day feels like the evening after Thanksgiving dinner when you just feel like groaning with fullness.  And I don't even use the full 2000ml and I still feel like I can't breathe.  So it will be really nice to have a flat-ish belly and not feel like a ton of bricks.

But I hear that some people can't sleep.  And that there are drain problems and alarms that go off in the night. I'm a bit concerned because my catheter exits on my right side, but I sleep either on my back or on my left side.  I doubt, after all these years of habit, that I could switch to sleeping on my right side.  I hope that doesn't mean that I won't be able to drain.

Anyway, I would really appreciate your best tips for a newbie to the world of the cycler. Thanks in advance.

[Charlie B53]

You are very anxious to get started, but that anxiety is also driving your imagination to worry about problems that may NOT occur.   And if any of those do happen they are very easily dealt with.

Most people roll onto their back as they sleep, regardless of the position they were in going to bed.  During training your will actually use your Cycler to do exchanges while laying in bed. You will find out if you have any drain issues.  You need to remember using the Cycler is NOT like doing a manual drain, the machine has a little 'pump' that pulls the fluid out.

The most likely problem affecting draining is constipation.  Always be aware of this, proper diet including plenty of vegetables and fruit goes a long way in preventing any problem.  But there are occasions and having stool softeners and/or fiber supplements at hand may be advisable.

Do not be alarmed if your Cycler program as far different than doing your manuals.   I did 4 hour dwells doing manuals.  My Cycler does 1 hour dwells but twice as many as my manuals, and my Labs are even better than while doing manuals.   Most peoples Labs improve using their Cycler

Fill volume is a simple program setting, set once and done.   Manually watching during fills had to be a chore.  I can imagine hanging the bag from the scale and having to carefully watch the weight decreasing and stopping once it gets to the weight/volume you determined comfortable.   This is NOT going to be a problem.

I suspect that after a couple of nights you will get comfortable with using the machine and relax so much more.

Any you are going to have your days FREE from exchanges!!!!   No having to stop,, clean up, get a heated bag.......... be at home....

What you should be more concerned about is WHERE to stack the additional boxes?  Cycler bags do not have all the hose and the empty drain bag.   You WILL get another delivery of a MONTHS supply.

Where are you going to place your Cycler.  A sturdy table or portable cart conviently located within distance from your bed. The size/number of bags will determine which cassette you will need to use.  Three bags/3 Prong, four bags/4 Prong.   The difference is the length of the hose set for the patient and drain hoses.   I have no idea why they are different, but the 3 prong are at least TWICE the length of the 4 prong set.  Giving you far more freedom of movement about the room. Adding a patient extension hose to the 3 prong set I have access to half of our house.   The drain line is the same length.

Where will you drain?   Basically you have two choices, run the hose to the bathroom and securely tape it to the toilet or securely taped to the lid of a 5 gallon bucket.   I drilled a hole in the lid using a 3 inch holesaw.  This makes it far easier to pour it out.

NOTE:    Using a drain bucket can be convienient but it has two drawbacks.  One, it gets heavy.  10 or 12 liters and it is starting to get close to full.  Water is heavy.      Two,  If you forget to drain the bucket you WILL create a big mess the next night.   Don't ask me how I know.   THREE times.   Emptying the bucket HAS TO BE a regular part of your morning routine without fail, same as everything else such as disconnecting, taking apart the used cassette, keeping your chart completed, etc..

Lastly, remember the Cycler is programmable.   Any problem can be solved.  Most by a simple push of a button, (or nine or ten to make program changes).  LOL

I use an old metal fish tank table frame.  I cut a couple of plywood shelves to fit it so it is very sturdy.  Remember, water is heavy?  This frame used to have one of those long fish tanks on it, they are VERY heavy.    I cover the top shelt with the heavy duty aluminum foils so to have a 'impermeable' surface, drips, anything, can NOT soak into the wood.  I wipe it down with a Clorox wipe and KNOW it is very close to sterile.  If/when I think it funky or anything not perfect, I peel it off and lay on a new sheet.   Standing my IV pole alongside leaves the rest of the table space free for my PD Log, laptop, Blood sugar kit. Blood Pressure cuff.

I keep my open case of cassettes box of patient ext hoses, box of mini-caps, and a box of Ico on the lower shelf.    Everything is right at hand except the two main bags I get from the boxes in the hall right outside the bedroom door.    Handy for me.

As long as I always remember to empty that bucket.    Otherwise I clean the carpet, again.

[kickingandscreaming]

Thank you, Charlie.  I am eager AND anxious to begin.  A little worried about my drain line not quite reaching my bathroom as I think it might do me in to have to haul such heavy load--daily-- from where it's collected to where it's dumped.  I have tried to measure the distance using a string, but that was futile. So I won't really know until I actually have the machine and all the tubing set up.

My pattern in the evening is to retire to my bedroom quite a few hours before going to sleep.  I do a lot of reading at that time and settle down from the day.

Here's a problem I'm trying to pre-figure out (am I a control freak? I plead guilty).  Because I have a dog who spends most of her time in my bedroom, I have been doing my exchanges in my bathroom where it is relatively dog-free.  So I'm trying to adjust the situation to the new technology.

1- I could--several hours before bedtime-- arrange for my dog to be out of the room while I set up the cassettes, etc. and then when it's time to connect the patient line, I could go into the bathroom and hook up there.  Only problem with that is if I have to fully close the bathroom door, then the tube will be crushed by the door.

Or
2- If the patient line with extensions reaches to my front door (I really hope so) I can let my dog out for the last time at night and then run to the bedroom and do the hook up there while she's out. And then let her in and continue with whatever. 

Which of these sounds best to you?

How many hours in advance can the machine be set up-- but not hooked up to?

[Simon Dog]

My comments are in regard to the Fresenius Liberty cycler - I have no experience with others.  The drainline can be cascaded (using multiple drain lines) to get up to something like 40 feet.   Also, there is a cartridge available which puts you on a 20ft leash instead of 10ft.

[kickingandscreaming]

My comments are in regard to the Fresenius Liberty cycler - I have no experience with others.  The drainline can be cascaded (using multiple drain lines) to get up to something like 40 feet.   Also, there is a cartridge available which puts you on a 20ft leash instead of 10ft.

I'll be using a Baxter Home Choice cycler so it's different.  There are 12' extensions for both the patient line and the drain line.  But it's really hard to accurately measure distances in my place-- when I don't have a second pair of hands.  So I don't know how the corners and angles will eat up footage on the way to various places.  I just picked up a couple of the 6000ml bags that have arrived and they weigh a ton!!!! And I'm pretty strong. I think I would do in my back (at the very least) and maybe even my peritoneum if I try to haul a bucket filled with 12000 ml of drainage to the next room and then have to lift it in order to dump it whichever fixture.  I will probably be spending my days dry, so none of the fluid will end up being carried in my body.

[Charlie B53]

If you are onloy using two or three bags the 3 prong cassette will be perfect and it has long hoses.  Adding an ext to the drain I doubt if you will have any problem reaching the bathroom and securely taping it to a fixure.   ALWAYS use at least TWO strips of tape.  In case one fails.

Same with getting to the front door.  The 3 prong gives you a lot of hose, plus a patient ext hose, you have some range to move.

Don't tell your Nurse about the Dog.   They will tell you to always keep the Dog out of your room.  Dog hairs, etc..   My Dog, and Cat, are sitting on the bed next to me, for three years so far.  Used to be three dogs, but old age caught up with two of them.  I will always miss them.

Keep your hands clean, make double sure NOTHING comes into contact with your open transfer set and you should stay fine.

[kickingandscreaming]

Keep your hands clean, make double sure NOTHING comes into contact with your open transfer set and you should stay fine.

I always wear gloves--both as an extra precaution and as a protection for my skin--and I wash and/or sanitize the gloves whenever I touch anything critical (or after I've touched something I shouldn't have touched).  I wipe down the transfer set with Alcavis before I connect and disconnect. And I'm pretty swift in my maneuver.  Do you think that safely removes the danger of any floating hair or dander in the room reaching a critical spot?

[Charlie B53]

I don't think we could ever have our homes 100% safe and sterile.

I am pretty sure you have very well minimized possibilities for infection.

I am not using the gloves or the alcavis, otherwise I think I am doing fine.   Three years so far and no infection, yet.   Can't say I never will, but I hope not to have one.

And our pets have always had free rein, coming and going as they please.

You do know that humans only exist to open doors for cats and dogs.

[kickingandscreaming]

How much earlier can I set up the cycler before I actually begin dialyzing (before hooking up the patient line)?  I don't mean turning it on, just connecting all the tubes and bags, etc.

[Charlie B53]

You can lay the bags out anytime, however the machine once turned On dictates what you do.  The moment the machine comes on the bag heater turns on and heats the bag on the machine.  A temp sensor controls the heat so to maintain body temp.  You have to hit the Start button and the machine telss you to 'Load the Cassette' and unlocks the door.  You cannot move the door latch very easily until the machine tells you this.   Once the cassette is loaded you again hit the Start button and the machine does a 'Self=Test'.   When it finishes and the cassette passes only then will the BEEP and display "Connect the Bags and hoses'.   Here you connect the bags but DO NOT BREAK the seals on the bags.

At this point you can go off and do whatever you wish, leaving the machine turned On.    When you are about ready for treatment come back and break all the bag seals and hit the Start button.   The machine will display "Priming'.  Once all hoses are primed the machine will BEEP that it is ready for treatment and display    ?    Qwap.   I forgot the exact words.   lol


If the power goes out at any time the machine will retain memory of what stage it is at for up to 4 hours.   After that you will have to start all over.

[kickingandscreaming]

So there's no huge consequence to attaching bags and tubes and leaving the machine ON for e.g. 2 hours?  Is it a huge waste of electricity?

[Simon Dog]

The machine will draw a little current to maintain the bag temperature, but I doubt it will make much difference on your bill.

[Fabkiwi06]

I also have my line on the side I like to sleep. What helps so I don't roll on the line and set off an alarm is to take a pillow, put it next to me long-ways, and have the line underneath. That way if you roll, you roll on the pillow, not your tubing.

[kickingandscreaming]

I also have my line on the side I like to sleep. What helps so I don't roll on the line and set off an alarm is to take a pillow, put it next to me long-ways, and have the line underneath. That way if you roll, you roll on the pillow, not your tubing.

I hope that means I won't have an issue because my cycler will be on my right side and I always sleep on my left side (exit site is on right) or on my back if my nose is stuffy.  Sounds like either way it would be hard to roll over on the tubing.

I had my first training session today.  It's went OK.  I do feel a bit of an intermittent twinging during drain time, but it is sort of a dull twinge and I don't think it would wake me up if I were sleeping.  The machine is remarkably quiet--other than when alarming.

[beckums70]

If you wanted to, you could set your machine up in the morning, right after you break it down from the night before.  You could even prime it then if you wanted to.  I've done it before, when I knew I was heading out for a long day and would be coming home late, not wanting to deal with the hassle when I was tired.  If you clamp the patient line after you prime, it will stay full.  Keep all the caps in place and the machine will regulate the temp of the heated bag.  When you're ready for bed, all you have to do is hook up and go to sleep.

I know you've already been doing PD for a few weeks now, but I was reading your concerns about sleeping positions and I wanted to say that I have not had to change the way I sleep at all.  My tube is on my lower left side and I always sleep on my left side.  It has not interfered with draining or filling. 

One thing I do notice is that if I tape the tube too close to one of the connecting pieces of the transfer set, it will bend and pinch off the flow.  I've been on PD for 3 years now and don't usually tape my catheter at night anymore, and that has pretty much eliminated the night time alarms.

Hope this helps.

[kickingandscreaming]

Thank you for your input, Beckums.  As you guessed, I have, by now, established a rhythm with the cycler.  I usually set it up around 5pm and start dialyzing at 9:15.  I just let it sit, primed while I go about  my business.  Doing it earlier than needed gives me the chance to sneak into my bedroom without my dog coming in so I can make the connections safely without having to banish her from the room.  Then at 9:15 I hook myself up and press Go.