drain and fill issues

[jadey]

I;ve been having drainage issues for the past few days...

It hurts to drain and it is very slow. I checked the drainage and it is super clear..no fibrin. Last night while I was filling, I felt pain in my upper abdomen...

What could it be..??

[MaryD]

I've been doing CAPD for a month now, and I think I have just worked out the best way for me to drain well.

I reckon I always drain about 99% of my fluid in 5 minutes.  After that I would wiggle, jiggle, stand up, walk around, all sorts of weird movements for 15 minutes and get another 100mls out if I was lucky.  I was also gaining weight rather fast (2kg in 3 weeks), so I started weighing my drain bags and found I was often putting 2000ml in and barely getting 2000ml out.  Occasionally I would get 100 - 200 out, but that was infrequently.

Then I had to have an antibiotic put into my bag (I managed an open contamination)  and I did a few exchanges down at the clinic.  One of the PD nurses noticed that when I was lying down I drained like there was no tomorrow.  In a lying down position I couldn't/can't see whether I'm draining or not, so if she hadn't told me I would never have known.  I do the last 5 minutes lying on the couch.

When it hurts to drain out, I close off the end of the catheter, move about a bit, and then open it to drain out again.  Any discomfort disappears as soon as the catheter is shut off, and usually doesn't come back when I open it again.

I haven't had any pain when I've been draining in, but I have been told that some people do have some discomfort when draining in for the first week or so.  Their peritoneum could be a little irritated by the dialysis fluids.

Also have you checked to make sure there isn't a kink in the catheter?  And apparently constipation can slow draining up, too.

I hope your draining problems sort themselves out soon

[JLM]

I put in 2cc Heparin every Tuesday.  Even now that I have been on the cycler for less that 3 weeks..  It's like an insurance policy.

[jadey]

Good idea MaryD, I will try that.

JLM, were you told to do that? I don't know why I feel hesitant on using too much heparin... I'm scared that it will stop being so effective eventually and/or it will be bad for my peritoneum...

I really don't see ANY signs of fibrin in my drain though... it is totally clear...

[kporter85db]

I've been putting 10cc Heparin (divided over two 5000ml bags) in every other day because of Fibrin for the last six months. I rarely actually see any Fibrin but it does give me fits.

Don't follow my example without your nurses' approval though. I think I'm an unusual case

[Joe]

Jadey, MaryD's advice is very good. I had the same issues when I was first doing manual exchanges and found that moving around seemed to do the best for me. As for the 'end of drain pain', clamping off the drain line and wiggling around to reposition it usually takes care of the problem.

Good Luck!

[Grumpy-1]

Jadey

you wrote "Last night while I was filling, I felt pain in my upper abdomen..."  I was told that if there was an air bubble in the fill that there might be a pain in upper abdomen or shoulder area.  I had it a couple of times and it went away after a bit.  Wasn't painfull, just uncomfortable.  You may want to tell your nurse about it though.

[JLM]

When I first started CAPD I had a fibrin and my nurse had me inject the Heparin every week and when I started CCPD I asked about the Heparin and was told to continue.  It seems to work for me.

[highway61]

I;ve been having drainage issues for the past few days...

It hurts to drain and it is very slow. I checked the drainage and it is super clear..no fibrin. Last night while I was filling, I felt pain in my upper abdomen...

What could it be..??

Like others here have, I put in heparin when I have drain issues. Even if I don't see and fibrin. It does seem to help keep things flowing smoothly. I have had the same problems in the short time I have bee doing PD. A little shot heparin never hurts.

[fearless]

When I started PD, on the cycler, i never saw any fibrin or cloudiness in the bag.  But if I pushed my finger into the side of the bag a little and traced a circle (to "stir"the fluid inside) sure enough, the spider webs would form.  The nurse said that since it wasn't excessive i didn't need heparin (I wasn't having any drain problems).  After quite a while, the fibrin didn't form anymore.
When the catheter is new, it stimulates fibrin formation.  When your body desensitizes to it, it may go away.  If you're using heparin regularly, be sure to stop once in a while and check to see if you still need it.  (every time you have to inject it you're risking contamination)

I was only able to drain quickly and completely if I laid on my right side.  Also, I often had to push my fingers into my abdomen and try to massage the catheter around because it would hurt and didn't want to drain (this was required more often when i tried to drain sitting up.)
Find out what position is best for you, and if you have pain, do what others have suggested - close the catheter and try to move around (or move it around)
good luck!

[highway61]

That is good advice fearless. We use alcohol swipes on the needles and stems before pushing the needle into the bottle or stem.

[fearless]

highway61,
Wow!  that is all you have to do?  I always dreaded having to inject anything into my bags because I had to go through this whole big deal of putting a sterilizing solution on the little post on the bag and the drug bottle, then waiting for 2 minutes, then flicking it off without anything touching it, then drawing up the fluid and injecting it UGH!  (you can see why I was happy I didn't have to use heparin) 

cheers!

[jadey]

highway61,
Wow!  that is all you have to do?  I always dreaded having to inject anything into my bags because I had to go through this whole big deal of putting a sterilizing solution on the little post on the bag and the drug bottle, then waiting for 2 minutes, then flicking it off without anything touching it, then drawing up the fluid and injecting it UGH!  (you can see why I was happy I didn't have to use heparin) 

cheers!

I also use alcohol wipes to clean the needle ports on my bags and the opening of the heparin bottle.

[lmunchkin]

Oh Fearless, how I remember those days of "Sterilization" on PD.  It was a bit of a hassel, but I knew, if I did any short cuts, I would compromise something and Whayla, INFECTION!!!!!  The fact is, you have to be extremely careful with PD.  One slip up, is all it takes! 

We really liked PD for the most part! We did CAPD when we went someplace for a few days, and then The Cycler when at home!  I guess the only things I did not like about PD is the constant sterilization and the "HEAVY" bags that I had to lift up!  Man did I have the muscles after that, LOL. But for the most part, it was not a bad modality, and the fact that it kept us at Home!

lmunchkin
 

P.S.  We were trained to swap the ports on bottle and bags with Betadine, then draw meds in syringe and inject after waiting 5 minutes.  That was a nerve racking process, but I did what I was trained to do.

[fearless]

lmunchkin, I remember the betadine too.  We had little packets with betadine swabs in them, and I was supposed to wrap the swab around the top and tape it on there (without touching the top once the wrap was on there) and wait 5 minutes.  Then they said to use the bleach solution - which only took two minutes ad involved no tape! LOL 

So do you find there are less supplies for NxStage compared to PD?  I used two 5L bags per night on PD, which was one heavy box.  Then of course the cassette boxes and other misc. stuff.  I finally got the house all cleaned out a few weeks ago (I'm on in-clinic hemo now)   I was wondering what the supplies might be like for Nxstage?
cheers!

[amanda100wilson]

Drain pain is not uncommon, particularly initially, and sometimes on fill too.  Judt slow down the drain by adjusting the roller clamp on your catheter.  Changing position can help drain.  To the person who mentioned about air.  I doubt this is what you had, if it wasn't painful, as i've done it on a number of occasions and it is excruciating and lasts about a day.  The only thing that relieves it, is lying down, because then the air moves away from the area that causes pain.

[highway61]

I got drain pain more when I first started, the first couple of weeks or so. But it started to get better. At times I changed positions, jumped up and down, and did the PD shuffle till it cleared. Luckily on the cycler I have slept through most of my drains. Only occasionally is one bad enough to wake me any more.