Cycler Drainage Problems

[Ken Shelmerdine]

Does anyone have erratic drainage on the Baxter Homechioce cycler? When I first started, those damn bleeps came on during every drain cycle saying 'Low Drain Volume'  and I had to get out of bed and stand up for about a minute to get it going again.My home nurse changed the machine to tidal which means that the cycler leaves about 200ml. in without attempting to get it out which improved things slightly. But the biggest improvement came when I lowered the cycler about a couple of of inches. this has resulted in problem free nights 60% of the time although  low drainage occurs some nights but usually just on one cycle. Is there a limit as to how far you can lower the cycler before the gravity effects can cause problems with the fill volume?

[goofynina]

Hi Ken,  I know they told me that it should be the same height as your bed, thats about all i know,  i dont get as many problems but i do get them, grrrr, lol,   i hope everything works out ok for you soon 

[anja]

Hello, Ken, sorry you are having these problems with your Baxter.  I am also on the Baxter and lowered my initial drain amount so I wouldn't get beeps.  My machine is the same height as my bed.  Do you have your catheter secured to your abdomen with a slight droop for lee-way?  I wear spandex biking shorts to keep the catheter in place( I do not use tape) and have no beeps.  Also, do you watch how much you drink in accordance with how much you sweat?  May have to drink a glass of water at bedtime to offset that fluid loss.  Just a couple ideas for you to consider... Good luck , those beeps can really ruin your feeling of being rested!   Anja

[Ken Shelmerdine]

 :)Goofynina and Anja, thanks for your posts. Had a crap night last night. Machine bleeped on all three drains. That sounds a good idea about letting the tube droop downwards. I think I'll try it. Up to now I've been taping it about horizontal to stay away from my belt-line then curl it round higher and securing it with another piece of tape. My machine is about the same height as the bed but I'm going to take the castors off the table that it's stood on and that should lower it about 3 inches. If that doesn't improve matters I will seriously consider thowing an £8500 machine through the window

[JerseyGirl]

A few ideas...I work with the Fresenius Newton IQ cycler. The ideal height of the bed with that cycler should be about 24".  Also, what kind of transporter are you?  How long are your dwells?  If you are a high transporter you can actually be reabsorbing the fluid if the dwell is too long.  What percent dextrose are you using?  That will affect your UF.  As mentioned previously make sure the cath tubing is downwards and minimal resistance - ie no loops.  Also try repositioning yourself -some people drain better in different positions.  Good luck - keep us posted!

[angieskidney]

I was on the Fresenius Newton IQ cycler but that is completely different than the Baxter Homechioce cycler because it doesn't have scales where as Fresenius does. Am I right?

[Ken Shelmerdine]

I was on the Fresenius Newton IQ cycler but that is completely different than the Baxter Homechioce cycler because it doesn't have scales where as Fresenius does. Am I right?

Angie
 You are right the baxter doesn't have scales. On the cycler you mentioned what do you mean by scales. Is it scales for weight or scales as in charts or tables.? 

[Ken Shelmerdine]

A few ideas...I work with the Fresenius Newton IQ cycler. The ideal height of the bed with that cycler should be about 24".  Also, what kind of transporter are you?  How long are your dwells?  If you are a high transporter you can actually be reabsorbing the fluid if the dwell is too long.  What percent dextrose are you using?  That will affect your UF.  As mentioned previously make sure the cath tubing is downwards and minimal resistance - ie no loops.  Also try repositioning yourself -some people drain better in different positions.  Good luck - keep us posted!

Hi JerseyGirl

My dwell time is about 2hrs 20 minutes with 3 fills per night @ 1.36% and dry during the day. My average UF is always around -125. I think this might be because I still have full fluid output. I've not had a PET test yet but I think I start absorbing after about three hours. I do CAPD at weekends and if I drain after three hours, I get the same out as went in. If I drain after 4 hours I absorb about 200ml. I tried drooping the catheter. Does it have to droop near vertically and when you say no loops, does that mean after the the piece of tape it just hangs loosely? I always
curl it round and upwards ( sounds like I'm bragging about something doesn't it!! lol) after the first piece of tape and then tape it again. The problem is that if I droop it down too vertically it then goes across the waistband of my pants and it worries me that this could eventually damage the tubing. Maybe I'll take off the second piece of tape at night. I'm sorry to have to post such dumb questions but it's all quite new to me and I do value all the advice I get from all of you.
 

[Ginger]

Ken,
Do you do a manual drain at the end of your cycle? I found that I got negative drains more often before I arrowed down at the end of the therapy time to manual drain. (This is on the Baxter HomeChoice)  Sometimes on the manual drain I get more UF than during the total therapy time. You can always try this and see what happens. It works for me. I have to admit that I did not do the manual drains until I read about it on another message board after I had been on dialysis for about 2 months.

[angieskidney]

I was on the Fresenius Newton IQ cycler but that is completely different than the Baxter Homechioce cycler because it doesn't have scales where as Fresenius does. Am I right?

Angie
 You are right the baxter doesn't have scales. On the cycler you mentioned what do you mean by scales. Is it scales for weight or scales as in charts or tables.? 

Fresenius Newton IQ cycler actually has a scale on top and a hook on the bottom attached to reverse scales. This is the way it measures fluid.  Here is a pic. What does yours look like? I have always been curious how the latest Baxter one works since my dialysis unit just switched the CCPD to Baxter.

[JerseyGirl]

Hi there Ken.  Is your exit site low, meaning below the belly button, at the level of the belly button ( correct term umbilicus ) or higher than the BB? I do encourage patients to do what you do, sort of place the catheter in a backwards "C" position and then head down however you can without kinks.  I think I know what you mean about if it is too vertical it will go above the waistline level of your pants and that would sort of counterbalance the fluid drain because of too much upward resistance, not to mention kinks.  Geez, this is hard to put in words...lol...wish I could draw a picture.  Do you use immobilizers or a pd belt to secure the cath while you are asleep?  The level of the exit site would help me alot.   Now to the other issues...you say you still void - about how much daily?  You dialyze for solute removal only, I assume.  I have a patient that still makes 2 L urine daily, and only uses 1.5% on CCPD.  He always ends up negative too and always has a hell of a time draining.  Try to drink in what you void, and alittle more daily. You may be alittle dehydrated.  How is your blood pressure?  Target weight?  What is the drain time set on your cycler?  Make sure you have enough programmed drain time. You could try 4 fills of 2 L instead of 3 fills with a 2 hour dwell.  What are your fill volumes?  Make sure the drain bag is as low as it can get in relation to the height of your bed - this really makes a big difference.  I believe the Baxter cycler operates with a pump.  The Fresenius cycler uses gravity only.  Are you having mid drain alarms or drain alarms?  On the Fresenius cycler a mid drain alarm sounds if less than 50% of the fill hasn't drained in half the programmed drain time - you will get a drain alarm if less than 85% of your fill hasn't drained in your programmed draintime.  Not being too familiar with the Baxter, refer to your operators manual and see if they give you any tips or what parameters the drain alarms go off.  I'd really be interested in your PET.  You sound like an average transporter.  Anyway sorry I am so wordy, keep me posted!

[angieskidney]

Very informative JerseyGirl! 

[Ken Shelmerdine]

I was on the Fresenius Newton IQ cycler but that is completely different than the Baxter Homechioce cycler because it doesn't have scales where as Fresenius does. Am I right?

Angie
 You are right the baxter doesn't have scales. On the cycler you mentioned what do you mean by scales. Is it scales for weight or scales as in charts or tables.? 

Fresenius Newton IQ cycler actually has a scale on top and a hook on the bottom attached to reverse scales. This is the way it measures fluid.  Here is a pic. What does yours look like? I have always been curious how the latest Baxter one works since my dialysis unit just switched the CCPD to Baxter.

Angie
I've been meaning to take some pics and post them to the site and I'll definitely get to it this week-end. The Baxter as far as I can tell does all the calculations internally. After the therapy has ended there's a scroll through facility which displays average dwell time, lost or added dwell time and total UF.

[Ken Shelmerdine]

Hi there Ken.  Is your exit site low, meaning below the belly button, at the level of the belly button ( correct term umbilicus ) or higher than the BB? I do encourage patients to do what you do, sort of place the catheter in a backwards "C" position and then head down however you can without kinks.  I think I know what you mean about if it is too vertical it will go above the waistline level of your pants and that would sort of counterbalance the fluid drain because of too much upward resistance, not to mention kinks.  Geez, this is hard to put in words...lol...wish I could draw a picture.  Do you use immobilizers or a pd belt to secure the cath while you are asleep?  The level of the exit site would help me alot.   Now to the other issues...you say you still void - about how much daily?  You dialyze for solute removal only, I assume.  I have a patient that still makes 2 L urine daily, and only uses 1.5% on CCPD.  He always ends up negative too and always has a hell of a time draining.  Try to drink in what you void, and alittle more daily. You may be alittle dehydrated.  How is your blood pressure?  Target weight?  What is the drain time set on your cycler?  Make sure you have enough programmed drain time. You could try 4 fills of 2 L instead of 3 fills with a 2 hour dwell.  What are your fill volumes?  Make sure the drain bag is as low as it can get in relation to the height of your bed - this really makes a big difference.  I believe the Baxter cycler operates with a pump.  The Fresenius cycler uses gravity only.  Are you having mid drain alarms or drain alarms?  On the Fresenius cycler a mid drain alarm sounds if less than 50% of the fill hasn't drained in half the programmed drain time - you will get a drain alarm if less than 85% of your fill hasn't drained in your programmed draintime.  Not being too familiar with the Baxter, refer to your operators manual and see if they give you any tips or what parameters the drain alarms go off.  I'd really be interested in your PET.  You sound like an average transporter.  Anyway sorry I am so wordy, keep me posted!

Hi Jersey Girl.
I've just done a great big wordy post answering the questions you asked.... and bloody well lost it all and I don't know how to get it back. I'll do it again during my lunch break tomorrow.

[angieskidney]

I was on the Fresenius Newton IQ cycler but that is completely different than the Baxter Homechioce cycler because it doesn't have scales where as Fresenius does. Am I right?

Angie
 You are right the baxter doesn't have scales. On the cycler you mentioned what do you mean by scales. Is it scales for weight or scales as in charts or tables.? 

Fresenius Newton IQ cycler actually has a scale on top and a hook on the bottom attached to reverse scales. This is the way it measures fluid.  Here is a pic. What does yours look like? I have always been curious how the latest Baxter one works since my dialysis unit just switched the CCPD to Baxter.

Angie
I've been meaning to take some pics and post them to the site and I'll definitely get to it this week-end. The Baxter as far as I can tell does all the calculations internally. After the therapy has ended there's a scroll through facility which displays average dwell time, lost or added dwell time and total UF.

Ya the Fresenius one had a screen that showed some of that as well!  Is there any computer card with the Baxter one?

[Ken Shelmerdine]

Hi there Ken.  Is your exit site low, meaning below the belly button, at the level of the belly button ( correct term umbilicus ) or higher than the BB? I do encourage patients to do what you do, sort of place the catheter in a backwards "C" position and then head down however you can without kinks.  I think I know what you mean about if it is too vertical it will go above the waistline level of your pants and that would sort of counterbalance the fluid drain because of too much upward resistance, not to mention kinks.  Geez, this is hard to put in words...lol...wish I could draw a picture.  Do you use immobilizers or a pd belt to secure the cath while you are asleep?  The level of the exit site would help me alot.   Now to the other issues...you say you still void - about how much daily?  You dialyze for solute removal only, I assume.  I have a patient that still makes 2 L urine daily, and only uses 1.5% on CCPD.  He always ends up negative too and always has a hell of a time draining.  Try to drink in what you void, and alittle more daily. You may be alittle dehydrated.  How is your blood pressure?  Target weight?  What is the drain time set on your cycler?  Make sure you have enough programmed drain time. You could try 4 fills of 2 L instead of 3 fills with a 2 hour dwell.  What are your fill volumes?  Make sure the drain bag is as low as it can get in relation to the height of your bed - this really makes a big difference.  I believe the Baxter cycler operates with a pump.  The Fresenius cycler uses gravity only.  Are you having mid drain alarms or drain alarms?  On the Fresenius cycler a mid drain alarm sounds if less than 50% of the fill hasn't drained in half the programmed drain time - you will get a drain alarm if less than 85% of your fill hasn't drained in your programmed draintime.  Not being too familiar with the Baxter, refer to your operators manual and see if they give you any tips or what parameters the drain alarms go off.  I'd really be interested in your PET.  You sound like an average transporter.  Anyway sorry I am so wordy, keep me posted!

Hi Jersey Girl.
Thanks ever so much for your post because what you suggested about taping the cath. down seems to have worked. 4 nights and no drain alarms!  Although the alarms have stopped I am still retaining on the final drain because this morning I thought I'd try a little experiment. I had the usual UF reading of -125 on the cycler
so I connected myself to  a CAPD drain bag and got another 650 ml out but at least now thanks to your advice I'm getting a decent night's sleep.
 
My home sister visited yesterday and suggested I try the 2.27% fluid as she says that even though I am still voiding, the dialysis should still be taking some fluid off. So I tried it and the next morning it was still in minus UF. I'm thinking all kind of things now like is the peritonium membrane working and if its not getting any fluid off, is it also failing to filter out the solutes? I had some bloods done after about 3 weeks and my creatinine had come down from 650 to 580 but they never said at the clinnic whether this is good or not so good. I suppose I shouldn't worry because I feel well enough and I've not got any of the symptoms like tiredness etc.

To answer your questions, My exit site. is level with my belly buton and about 4 inches to the left. What I meant about the cath. being vertical was vertical travelling downward. It then spends time going accross and under  the waistline of my pants all day and I'm worried about causing wear and tear to the cath. You're right something like this is hard to put into words. Hey Epoman, how about a simple drawing programme on this sight? lol

I void about the same as I've always done probably about 2L. and yet I only have 8% kidney function. My BP is typically about 115/80 with meds. 2.5mg Bisoprolol and 2.5mg Diuretic and about 145/100 without medication. My fill volumes are 3x 2L fills @ 1.36% over eight hours.and dry during the day. My target weight is 84kg but during the two months I've been on dialysis I've gained about 1.7 Kg. After I had my cath fitted I didn't have a very good appetite for weeks after so the target weight was based on my weight at the start of dialysis. Since then my appetite has shot through the roof and I think thats the reason for the weight gain. As far as I can tell there's no drain time adjustment on the baxter, but then again baxter never sent a manual with the machine so I might be wrong about that. Going back to drain alarms, you get a 3 alarms for low drainage the first two are 3 bleeps. I guess the first two are mid-drain The third one is continuous bleeps until you press the stop button so maybe thats a drain alarm. Normally if I sit on the side of the bed for about 30 seconds after one of the mid drain alarms and it seems to get it going again and I can go back to sleep. My Pet test is now booked for the first week in January. That's the earliest my home sister can get.

[anja]

Hello, Ken, wish you weren't having so many problems to start with!  I have never heard of not being supplied with operation manuals that go to your cycle!!!  The hospital should have seen to it that you had all that as well as having you watch tapes on PD. from the company before you even began treatment.  Someone sure dropped the ball with you and your training!  I would certainly complain~~LOUDLY!!!

[Ken Shelmerdine]

Hello, Ken, wish you weren't having so many problems to start with!  I have never heard of not being supplied with operation manuals that go to your cycle!!!  The hospital should have seen to it that you had all that as well as having you watch tapes on PD. from the company before you even began treatment.  Someone sure dropped the ball with you and your training!  I would certainly complain~~LOUDLY!!!

Hello Anja
To be fair to the clinnic, this drainage problem didn't occur during training so the need to know about how to adjust drain times etc, didn't arise.
Also I've never mentionedd to Baxters or the clinnic that I didn't have an operation manual because  smart ass me thought I'd got it all sussed , but obviously not. I'll ask Baxters next time they phone me for my order.

[Ken Shelmerdine]

I was on the Fresenius Newton IQ cycler but that is completely different than the Baxter Homechioce cycler because it doesn't have scales where as Fresenius does. Am I right?

Angie
 You are right the baxter doesn't have scales. On the cycler you mentioned what do you mean by scales. Is it scales for weight or scales as in charts or tables.? 

Fresenius Newton IQ cycler actually has a scale on top and a hook on the bottom attached to reverse scales. This is the way it measures fluid.  Here is a pic. What does yours look like? I have always been curious how the latest Baxter one works since my dialysis unit just switched the CCPD to Baxter.

Angie
I've been meaning to take some pics and post them to the site and I'll definitely get to it this week-end. The Baxter as far as I can tell does all the calculations internally. After the therapy has ended there's a scroll through facility which displays average dwell time, lost or added dwell time and total UF.

Ya the Fresenius one had a screen that showed some of that as well!  Is there any computer card with the Baxter one?

Hello Angie
Yes the Baxter does have a slot card which has my therapy programmed in although you can override it by changing the programme manually. If I get to bed later than normal I change it from 8 to 6 hours with a last fill which I then drain later that morning at work.

I've taken a couple of pics of my set-up and after I've read Epoman's instructions on downsizing I'll post them to the home set-up pic site.

[angieskidney]

I've taken a couple of pics of my set-up and after I've read Epoman's instructions on downsizing I'll post them to the home set-up pic site.

Are you gonna post them here? http://ihatedialysis.com/forum/index.php?topic=375.msg23324#msg23324

[Ken Shelmerdine]

I've taken a couple of pics of my set-up and after I've read Epoman's instructions on downsizing I'll post them to the home set-up pic site.

Are you gonna post them here? http://ihatedialysis.com/forum/index.php?topic=375.msg23324#msg23324

Yes
My net connection kept disconnecting last night so I'll try again to-night.

[Ken Shelmerdine]

  Whoopeeeee!!! Another alarm free night. Also did a manual drain at end of therapy and finished up with a plus UF of 245.

[JerseyGirl]

So happy things are working out - the first two weeks of the cycler can be hell until you find out what works for you.  Have been busy!  Actually, currently training someone on the cycler and next week too!  Happy dwells!

[hephziba]

Hi people. sorry Ive not been in touch, I have now been back on the cycler for two weeks,and its a terrible experience, drain alarms and check patient line alarms all night long, and a uf of -699 -500 -  400

on and off since I have started, to stop myself from drowning in retained fluid, I have done sometimes upto too manual bags in the days and each time got off an extra 400 which isn't alot. My bp has been running at 180 over 130 for two weeks now, even though I take many bp tablets.

and you will be glad to know that today I am going to my unit too see what pearls they can offer to my sittuation. I would have gone last week but it was a gloriously sunny week, and my wife and I were to busy enjoying ourselves and the thought of a whole day sat in hospital waiting rooms.....ahhhhhhh
what can I say I am 26 and foolhardy.

I have tried changing positions, every position many times, and now it just gets stupi my highest lost dwell has been 2 hours......

Blessings

Heph

[Wattle]

   I am sorry you seem to be having so many problems with your cycler. All I can advise is too keep trying. I am on the Fresenius sleep safe. After six months of manual exchanges I was soooo grateful to finally receive my cycler. I also do one exchange during the day which helps with the extra retained fluid that may have not come off. The cycler is the way to go. I am sure you will work out the problems.