Holy Volume, Batman!

[Restorer]

Over the last few weeks, I've been working my fill volume up to try to get my Kt/V within range. Last night I went up to 1940 ml, which with 5 fills is about as much as I can do with my current supply of 5L bags.

Sometimes, for some reason, during the night a drain will not completely drain. I'm not completely sure why it happens - it might be because I'm lying on the line, not enough to trigger an alarm, but enough to make it think I'm empty or nearly empty (the "smart" pump isn't quite smart enough, I guess...).

So this morning, like every morning, I took a look at my drain volumes to see how everything went last night. Apparently, the third and fourth drains came up more than 200 ml short of the fill volume, when they should have been 100 or 200 ml in excess. I was storing fluid in me between exchanges.

The fifth drain was complete, so what I drained then was the amount I was holding in me. To my amazement, it was over 3200 ml. What surprises me even more was that I had no idea - I slept right through that massive overfill, when just a few weeks ago I had trouble with the same situation and a complete drain of 2300 ml.

I guess I'm just happy that it wasn't uncomfortable, because I feel like the more I can hold comfortably, the better dialysis I can get and the better I can feel. Since I'm dry most of the day, and my evening manual dwell stays small at 1500 ml, I don't worry about my clothes not fitting or looking pregnant. Am I wrong? There's really no downside to being able to hold a ton of fluid, as long as it doesn't disrupt my sleep, right?

For my next supply delivery, I'll order a much bigger supply so I can start using three bags at a time - hopefully 6 fills of 2L or more.

 

[george40]

Wow is right. That fluid buildup was probably over a couple of days.  I just switched back to manuals because of the same issue. I put in 2000, however draining goes fine up until 1000 ml range then it will not drain with me laying down. I had to manual drain every morning to get all that fluid off. This caused me to get inadequate dialysis my neph says, so they switched me to manuals. Anyways, Im glad you figured this out.

[Rann]

We go for labs for the first time Monday to see if the cycler is pulling what it needs to be. Wish us luck. I have seen signs of excess fluid and was advised to switch to stronger solutiion bags. Due to drain pain we do the tidal program which has been programmed to leave 300ml each drain and 1000ml for the day. What numbers do I need to be hoping to see when the lab results come back to know that it is working?

[sico]

I used to have similar issues to you Restorer. On a drain cycle one night it said i had ultrafiltrated 1533ml! I do 2200ml fills, so that means i had 3733ml in there! And i slept right through that one. Its working alot better for me now and i rarely get negative UF on a cycle. I am left with 1lt during the day and i hardly know its there.

[Restorer]

The seems to be a little bit of confusion. On my cycler, when you check the details of a particular night's treatment, it will tell you the fill amount, drain amount, and respective times for each exchange - five a night for me right now. For each exchange, I fill 2000 and usually drain about 2200-2300 (ultrafiltration of 200-300 with each exchange). All totalled up at the end, the total UF for the night is 1000-1500 ml.

That means that each night, I pull 1000-1500 ml of water out of my body tissues - mostly the circulatory and lymphatic systems, but also just the spaces between cells. For each exchange, it pulls 200-300 ml of fluid out of my tissues and into my peritoneum. That means, when I drain 2300, I had 2300 ml in my peritoneum. Even though my total UF was 1500, I never had that much extra fluid in my peritoneum at one time.

Anyway, the problem isn't really fluid buildup over a couple days, it's that I don't drain fully sometimes. The cycler stops draining before my peritoneum is empty. It's like the tidal setting, but accidental. So it leaves 300 ml in me, then fills me again with the whole 2000 - meaning I'm now carrying 2300 at the start of the dwell. By the end of the dwell, I've ultrafiltrated a bit more, so now I'm carrying 2600 ml. If that doesn't drain completely, it keeps building up. Fortunately, most of the time, the cycler will try to go extra long to do a complete drain at the very end, so I'm not carrying anything in my peritoneum during the day.

sico, that was just one drain cycle? Wow! I haven't hit that yet, but who knows - I might. My ultrafiltration has been lower recently since I've been hovering around the sweet spot between dehydration and fluid overload - the point between high blood pressure and leg cramps.

[sico]

sico, that was just one drain cycle? Wow! I haven't hit that yet, but who knows - I might. My ultrafiltration has been lower recently since I've been hovering around the sweet spot between dehydration and fluid overload - the point between high blood pressure and leg cramps.

I know what you're talking about and yes that was just 1 drain cycle! But i think the 2 cycles before it were -UF, so just a build up happening. I use a 2.5% on the heater and a 1.5% beside the cycler and my total UF is around 950ml on average (still pass around 750ml). Yeah i was surprised when i worked out i had that much in there, i'm just under 6foot tall and only 63.6kg dry weight at the moment. Would've looked like a had a beer gut! And i'm sure that would be uncomfortable standing up.

[Jie]

Use the Manual Drain on the morning to get out all solutions if staying dry during the day. It is very difficult to do a good drain on a sleep position. During a manual drain, one can sit up and move around the body. I usually get out 200-500 ml by manual drain on the morning. This solution would get absorbed by the body during the day if not draining out. This method can also help reduce weight gain.   

[Restorer]

How do I do a manual drain? Is that just a Baxter option? I haven't seen that on my Fresenius Liberty cycler.

[Hanify]

I don't know either and I've got a Baxter.  If I had to do a manual drain I would just drain into a spare old bag - do you have any around?

[Hanify]

But actually, I don't think you should do anything on advice from here.  I think you should take this advice and ask your renal team about it.  Then do what they say.

[sico]

On the baxter machine you can set up a manual drain, might be in the nurses menu. Just means it waits until your awake to press the go button to start the last drain. But yeah i probably wouldnt change things without talking to your dialysis nurse. I changed my minimum UF target because early on it was giving me fluid!

[Jie]

I am not sure one can program to do manual drain with Baxter cycler. It seems it can, but I have not done it. What I am doing is to press the "enter" when the manual drain option show up on the screen with the Baxter cycler.  On the morning, I press the down/up bottun to check the UF, dwell time, and lost time, and then manual drain option follows.  It is always good to check with a clinic before changing any thing. If one has difficulty to get solutions out when on sleep position, manual drain option is here to help.