Total UF is WRONG if you are doing this!!

[tbarrett2533]

I will be the first to admit that PD is a learning experience, but when it comes to MY health I will NOT settle for nothing but THE BEST!! 

if you are on CAPD OR DO ANY MANUAL EXCHANGES and get your supplies from Baxter (b/c that is all I can speak of) PLEASE LISTEN UP:
Here is an example (the best I can think of to describe what I am trying to say)

 If you are priming your lines at the start of your exchanges like you are told to do during training (at least I was anyway) and you prime for at least 5 seconds or 10 seconds that is adding up to anywhere to 100-250 ml of solution in your drain bag..... before you even start your exchange. now you are going to add your drain to that...... then when you are done, you weight the whole bag and record, well if you DON'T SUBTRACT the 100-250ml you are not getting accurate total UF's

SO after you prime your line from now on weigh your bag and subtract that from your drain to get your RIGHT UF. 
I was NEVER told this, but figured it out on my own!!!!

There is ALOT about PD I was NEVER told and figured out on my own, hell I figured pretty much EVERYTHING out about dialysis on my own!!!

I hope this helps someone else
 

[Willis]

I found that I needed to calibrate the spring scale (it has a sliding gauge that can move up and down) by weighing the empty bag and tubing and setting the scale to zero. I suppose you could add a "smidge" to account for the fluid in the lines, but at least my scale isn't accurate enough to account for that difference. When doing manuals I basically just round off to the closest 50ml anyway.

 

[ToddB0130]

I am still pre-D,  but I have to say I totally respect all of you doing home hemo and PD .... all of this seems overwhelming to me.   My new fistula is two weeks old today (HAPPY BIRTHDAY, FISTULA !!) and I'm hoping I don't have to use it anytime soon ..... but I plan on starting my D in center because all of this stuff seems a bit crazy to learn.  I'm sure eventually I'll 'get it' and hopefully get a chance to switch over to home treatment myself .... but I live alone,  so I have that hurtle as well.  YIKES.

Congrats to all of you home dialysizers !!!  GREAT JOB.

[tbarrett2533]

I found that I needed to calibrate the spring scale (it has a sliding gauge that can move up and down) by weighing the empty bag and tubing and setting the scale to zero. I suppose you could add a "smidge" to account for the fluid in the lines, but at least my scale isn't accurate enough to account for that difference. When doing manuals I basically just round off to the closest 50ml anyway.

 

Here is when this becomes a problem......

you see it as a small amount which I totally agree with you, it is!!! 100-250 ml of solution is not a lot so it is a small amount, now most people (such as myself) do 4 exchanges a day I count to 10 when I prime my line so I am loosing about 250 ML at each exchange, now you multiply that by 4 and you get 1000ml, now I think you and I can both agree that is no small amount!!! 

[tbarrett2533]

I am still pre-D,  but I have to say I totally respect all of you doing home hemo and PD .... all of this seems overwhelming to me.   My new fistula is two weeks old today (HAPPY BIRTHDAY, FISTULA !!) and I'm hoping I don't have to use it anytime soon ..... but I plan on starting my D in center because all of this stuff seems a bit crazy to learn.  I'm sure eventually I'll 'get it' and hopefully get a chance to switch over to home treatment myself .... but I live alone,  so I have that hurtle as well.  YIKES.

Congrats to all of you home dialysizers !!!  GREAT JOB.

Hey Todd,

First welcome

 

when you get a minute get on over to my other thread called 'a step by step pd experience'....... read that...........hopefullly it will help you....


I wish you the best of luck in this horrid  sometimes scarry (but very doable  ) dialysis jounrney that you will soon be on
know that we here on IHD are here for you if you need us, please use this website to heal, learn, grow, rant, yell, cry, and whatever I am leaving out re: dialysis....

good luck to you!!!!

 

[Henry P Snicklesnorter]

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[tbarrett2533]

Wow, that's a lot. I use Fresenius and loss is minimal. Less than 20 ml.

I may not be reading your post right, but it reads to me like you are charging your line and wasting into your drain bag, before you start to drain. Is that right?

If so, I don't understand why you would.

I do my drain first, then weigh that, then charge my line (Just a few air bubbles with Fresenius) and then start to fill.

Losses are minimal. I don't do the counting thing, - just watch for air bubbles. I can purge the large ones, start to fill
and if another one appears I flick the switch back momentarily to purge. Great system.

I will try to better explain...... ( the 'counting thing'  actually is done yes to prevent air bubbles but I was also told that it is done to prevent peritonitis too and Baxter actually calls this Priming the lines, some people do this for 5 seconds, I do it for 10.) OK so I get my bag,  hang it on my pole, throw the drain bag on the floor, place a clamp on near the top bag, break my frangible, UNHOOK THE CLAMP, count to ten...... allowing dialysate from my new bag to go into my drain bag, then I clamp off, hook up and proceed with my exchange........

does this make more sense?

its anywhere from 100-250ml of extra dialysate into my drain bag before I even started my drain, like I said in the first post, i can only comment on Baxter CAPD users......... other PD suppliers train/teach and supply their patients differently (with the same concept of course)

FYI: if you prime your line you will NEVER even see an air bubble, I NEVER have EVER seen one!!! 

or maybe I am just one of the lucky ones 

[Henry P Snicklesnorter]

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[JLM]

I do Fresenius here in Texas, but did Baxter in Wisconsin.  With Baxter I would hook up and put a clamp near the connection on the fill bag line, broke the frangible to drain; then opened the valve to start the drain.  Then break the frangible on the fill bag;   When I was drained, I'd close the valve; then switch the clamp from the line from the fill bag to the drain line.  The time it took to switch was enough time to clear the air in the line coming from the fill bag.  I then opened the valve and preceded with the filling.

[Joe]

I use the Baxter system too, but I only count to 3 when I'm priming the line, and that's only if I don't actually see dialysiate flow into the top of the drain bag. As soon as I see anything in the drain bag, I'm primed. Haven't had a problem with that yet.

[tbarrett2533]

I use the Baxter system too, but I only count to 3 when I'm priming the line, and that's only if I don't actually see dialysiate flow into the top of the drain bag. As soon as I see anything in the drain bag, I'm primed. Haven't had a problem with that yet.

next time you do this..... weigh this amount and I am willing to bet you that tiny amount that you see in your drain bag that is so small to your naked eye is at least 100ml now multiply that by however many Manual exchanges you do....... it adds up..... heck even if that's only 50-75ml in each exchange you multiply that by 4 or 5 (depending on the number of exchanges you do, I do 4 a day)  that adds up to anywhere 200-400ml of a difference in our total UF, now if you don't think that is a HUGE difference then I think there is something wrong here..... 

bottom line is....... the smallest amount adds up, and you are not getting an accurate number, and I don't know about you, but I want my numbers right!!!! 

[tbarrett2533]

Ok, I get it, sounds like a pain to me, would be more difficult than Fresenius in the truck/machines etc.

If you look at the first pic, it shows the line, which is packaged pre-charged, so all I have to do is purge the little bit of air in the line (bubbles shown by arrow). Since 50% of that is air, there would be lucky to be 10ml of fluid goes to waste. That is always purged after I finish draining. Its controlled by the rotary dial, which has a close-up in the second pic.
1/.Remove yellow cap and hook up. Release catheter clamp. Drain. Weigh bag.
2/. Rotate dial to next stage, purge air bubbles with small amount of fluid.
3/. Turn dial to fill, (Slow,Medium or Fast). Sometimes a small bubble travels down the tube from where it meets the bag. I watch for this then flick the dial back to purge for a second to get rid of it, then back to fill.
4/. When fill bag is empty, turn to switch off position which also drives a pin into the line connector.
5/. Disconnect and screw safety cap into connector (Pin punctures disinfectant solution.)

I don't have any of that.... with Baxter we get (for CAPD users) two bags that are connected to each other and a pole to put them on......... I will take a pic later and post it to show you..... I have nothing like you have here in these pics at all in fact I am just a little jealous!!! 

[tbarrett2533]

Now this (minus my my cap, & pole) is what you get from Baxter

this is my actual drain.... nice huh?  no fibrin nice and clear 

[Joe]

Good job! But how come you have blue clamps? Mine are red...
And I only do one manual a day, it's typically just a fill. I drain when I go on the cycler at night and am empty all day.
But I will weigh today when I do my setup and report back.

[tbarrett2533]

Good job! But how come you have blue clamps? Mine are red...
And I only do one manual a day, it's typically just a fill. I drain when I go on the cycler at night and am empty all day.
But I will weigh today when I do my setup and report back.

and you better mister!!!! or ELSE.......

 

and how in the heck did you get red? I would rather have red then crappy blue 

[Willis]

OK, I see what you are saying. I do CCPD so the machine handles the "counting." When I do manuals such as when traveling I just open the clamp until I see the fluid pass thru then I clamp it...maybe a second or two.

If you want to be more precise and count to ten then that will certainly make a big difference over a day's cycles. What I'd recommend is dump "10 seconds worth" of fluid into a cup and weigh it on a kitchen scale so you know exactly how much that much liquid weighs...and then you just subtract that from each drain bag's weight. If your count is consistent then the excess fluid weight is going to be a constant value.

 

[Joe]

I did as we discussed and have the following observations:
Baxter does overfill their 2L bags, at least mine are marked that there is approximately 80ml overfill in each bag.
I weighed my drain bag and line before priming, and zeroed my scale with them on, effectively negating the weight of the empty bag and the line.
I connected as usual, and primed the line. To do this, I drop the drain bag on the floor, put my RED clamp the fill bag, break the frangible, open the RED clamp and count to 3 while watching to see when fluid hits the drain bag. (I usually hit 3 the same time fluid hits the drain bag.)
I weighed the drain bag, and the line as it's full now, and came up with less than 50ml.

While I'm not this precise every time I do my manual exchange, I feel it was pretty typical of what I do every day.
That said, I only do one manual exchange a day, so 50ml is pretty negligible in my overall UF. As the majority of my PD is CCPD, like Willis, my machine handles the counting for everything else. The only time I really pay attention to what is in this drain is when I haven't gotten everything off during my last cycle on the machine (but that's another thread.)

If I was still doing my 4 exchanges a day, this would add up to about 200ml a day. While it doesn't appear to be terribly significant, every little bit counts!

And if you'd like some red clamps, shoot me a pm and I'll trade you 3. More than happy to share.

[tbarrett2533]

I did as we discussed and have the following observations:
Baxter does overfill their 2L bags, at least mine are marked that there is approximately 80ml overfill in each bag.
I weighed my drain bag and line before priming, and zeroed my scale with them on, effectively negating the weight of the empty bag and the line.
I connected as usual, and primed the line. To do this, I drop the drain bag on the floor, put my RED clamp the fill bag, break the frangible, open the RED clamp and count to 3 while watching to see when fluid hits the drain bag. (I usually hit 3 the same time fluid hits the drain bag.)
I weighed the drain bag, and the line as it's full now, and came up with less than 50ml.

While I'm not this precise every time I do my manual exchange, I feel it was pretty typical of what I do every day.
That said, I only do one manual exchange a day, so 50ml is pretty negligible in my overall UF. As the majority of my PD is CCPD, like Willis, my machine handles the counting for everything else. The only time I really pay attention to what is in this drain is when I haven't gotten everything off during my last cycle on the machine (but that's another thread.)

If I was still doing my 4 exchanges a day, this would add up to about 200ml a day. While it doesn't appear to be terribly significant, every little bit counts!

And if you'd like some red clamps, shoot me a pm and I'll trade you 3. More than happy to share.

I just love how you made the RED clamps all CAPS in this response, are you trying to say something here?.....  I think I laughed so hard that I almost peed 

I will trade you......... i will shoot you an email over the weekend
thank you very much for the offer
 

[kporter85db]

BAXTER may have the advantage over Fresenius in the cycler machine, but Fresenius certainly has the advantage over Baxter in their manual exchange system with the "Stay Safe" system.

[JLM]

I have done the manual exchange with both systems.  Both are simple to master and stopping to think what you are doing is a must.  I must say, while traveling down the highway @ 70 MPH (my sister was driving) the Baxter was easier.  Only because I didn't have the "Stay-Safe" adapter to fiddle with.  Once, on the way north I threw it in the garbage at a gas station, but realized it and retrieved it before we left the station. WHEW

[kporter85db]

Only because I didn't have the "Stay-Safe" adapter to fiddle with.  Once, on the way north I threw it in the garbage at a gas station, but realized it and retrieved it before we left the station. WHEW

Are you talking about the part that mounts on the pole or the machine? When I had to do a couple of exchanges in the car I didn't put the valve in the adapter. I just used what came attached to the bags.

[Henry P Snicklesnorter]

.

[tbarrett2533]

I must say I (and I can only comment on Baxter b/c that is all I ever used) sorta like that I need nothing but a pole and a few clamps, if I wanna go anywhere and do an exchange its nice...... not much to pack 

[JLM]

Only because I didn't have the "Stay-Safe" adapter to fiddle with.  Once, on the way north I threw it in the garbage at a gas station, but realized it and retrieved it before we left the station. WHEW

Are you talking about the part that mounts on the pole or the machine? When I had to do a couple of exchanges in the car I didn't put the valve in the adapter. I just used what came attached to the bags.

The one on the pole.

[Willis]

When doing manuals I've never used the pole they gave me. I use one of those over-the-door clothes hangers. I've never gone anywhere that didn't have a convenient door I could hang the bag on...