Cycler concern: insufficient drains!

[austinsoul2011]

Hi all,

My Dad's now on the Liberty cycler and I have a huge concern about one thing -- that the cycler's programming thinks 70% drain is sufficient!  That's insane!  See, my Dad doesn't drain well sometimes, and we've managed adequate drains during manual exchanges by shifting him around, extending drain time, and doing that PD shuffle I read about over here.     So it seems the cycler's minimum 70% drain requirement is incredibly inefficient and will pose serious problems.

See, our current cycler prescription is set to 4 fills x 1800 mL and 1 final fill of 1500 mL that stays in him for the day.  We also do one exra 1500 mL midday manual exchange. 

Anyways, so when we begin the cycler at night, the initial drain (drain 0) might stop at the 70% drain requirement -- which means there is remaining dialysate (450 mL) that will stay inside when the first 1500mL fill begins.  That's potentially 1950 mL on his first dwell.

And then throughout the night, he's doing an additional four fills and three 70% drains, plus a final fill of 1500 mL to carry throughout the day.  But you can see with these 70% drains, there's going to be an additive, cumulative effect here that's gonna snowball -- and possibly, after the last "carry" fill, he'll have WAY more than 1500 mL inside him!

I know there's a manual intervention step, called "STAT DRAIN" we can invoke to immediately run a drain at any time (drain/dwell/fill), but does one really want to spend the whole time staring at the screen over 8-10 hrs, wondering when you might need to hit that option?  Has anyone gotten around this problem?   Or perhaps I'm missing something here or misinterpreting the manual's information?

Thanks so much for any feedback.  You guys are so wonderful and supportive here!

Much love,
Steve

[msrosefromms]

I am unfortunately on the Liberty cycler, I was also having trouble with insufficient drains. I got my perscription changed to Tidal. When I set up when it says manual drain. I put in that I did manual drain of 4000, which means 70% is 2800. In your dad's case you could put in 2600 so the machine is looking for 70% of that numberwhich is just over 1800. For my next drains, it is put in that I expect 3250 for the drain volume.  This based on my averages of UF. The only drain I still have the most trouble with is the final drain. It is set for 70% and I have to be awake to try to make it work. Also in the Tidal setup, my drains are set for 40 minutes,

[lmunchkin]

I know when we did PD, we went in a changed the settings on the machine.  Now back then it was the Newton IQ cycler, but I don't know about these Liberty machines they have out now.  But somewhere on that machine, you should be able to program your script, but ask nurse about that.  PD cyclers have changed alot since we did it.  We had very little problems with the old machine.

Check your Instruction Manual on your cycler and see if it tells you how to change settings!

So sorry Steve!  Your Dad is so lucky you are there for him!

God Bless you man,
lmunchkin

[Joe]

I'm using the Baxter system, and it's set for 70% drains too. That is just the point the system will alarm if I don't get that much off. In the 7 months I've been on the cycler, I haven't had a problem with low drains or feeling like I've had too much fluid on. I will add that I had issues with getting everything off when I was doing manuals too, so I do understand your concern. Have your dad pay attention to how he is feeling, if he feels too full you can stop the machine and should be able to go to a manual drain cycle.
Good luck!

[Annig83]

I'm on Liberty as well, but I don't have the insufficient drain issues....although I too am on Tidal now.  According to my neph. and my D nurses, some of the liquid left in during the day passes over the per. membrane and is absorbed in the body anyway?  Is that right?  Anyone know?  In my mind I figure that your father may be getting more than 70% drain because some of the fluid is already absorbed?  Don't quote me, but that's what I've been told.  I do 1800 of 4 cycles.  My final fill is only 100ml throughout the day... and I have NEVER been able to drain anything of that 100ml when I go back to dialyize at night.

[austinsoul2011]

Thanks for the feedback, everyone; we're currently using the default CCPD treatment as prescribed by our clinic, and it does indeed offer the option to enter in the midday exchange at the start, prior to the 4x1800 fills and final 1500 end fill.  So I too was thinking, as msrosefromms suggests, of inputting a 130% value so that the first drain (DRAIN 0) doesn't stop until it reaches at least 70% -- which is exactly where the midday fill should be.  It's just so funky that we need to "trick" the cycler in this way to do something it should naturally do anyways -- which is drain ALL of the midday fill.  I know tech support insists that the cycler will always attempt to drain everything, but so far we're not having much luck.

Thanks Annig83 for the absorption point; yes, it's possible that my dad's body is absorbing back quite a bit of the midday fill throughout the day, so that's something to consider too.  But these DRAIN 0 deficits are huge, so I don't think he's absorbed all of it.  Could be catheter placement too, especially if the catheter gets kinked/lodged up in body parts (bowels).  Or perhaps the catheter's above the internal "water line" and won't pull out more.  Gee, so many potential complications in all this... 

As always, thanks for the kind words, lmunchkin, and yes I'm so glad I can assist my dad.  A strong support system, I've heard, is so critical for families who undergo these medical lifestyle changes.  I'm heading into kidney failure myself so this is as important a learning experience for me as well.  My elderly father is having so much difficulty coming to grips with this condition -- as I'm sure many people here have also had.

I like the suggestions here for "Tidal" -- especially the option of extended drain time.  That just might get my dad to drain more thoroughly and not be rushed off to the next fill.  And I did use the STAT DRAIN option last night, cuz my dad was feeling very bloated during a fill (likely due to an insufficient previous drain).  Sigh, so grateful y'all are experienced users from whom newbies like me can benefit!

Much love to y'all!

[Joe]

austinsoul2011, keep in mind that the 70% is just where the system alarms if you don't get that much off. It's not where the machine stops draining. It will continue to drain until it doesn't get any more out of your dad. That could be at the 100% level, or something between 100 and 70%. Once again, ask dad how he's feeling at the end of the session. If he's not feeling overfilled, he's likely getting everything off he needs to.

[highway61]

austinsoul2011, Joe is right. I have a Liberty cycler and it will stop trying to drain if it is unsuccessful at draining any more in a reasonable amount of time. It may be that he has absorbed some of what was put in leaving less to be pulled out. That is why I try to do some manuals during the day whenever I can since long dwells can lead to more dialysis solution being absorbed.

[austinsoul2011]

Thanks Joe and Highway -- I think you're right on both accounts.  The cycler does seem to quit draining during Drain0, and that might be that there's no more solution left (due to being absorbed by my dad).  I noticed on later drains that the cycler does in fact pull slightly more fluid than what it  put in previously. 

For example, in the morning (8am), the cycler leaves a last fill of 1500mL in my dad .  See, the cycler's set to do 4 x 1800mL fills and a last fill of 1500mL.  I then do a midday (4pm) exchange of 1500mL and the drain typically falls short to give a UF = -400mL (ugh).  Come cycler time, DRAIN0 pulls out only 70-72% of the earlier 1500mL midday fill (UF = -450mL) .  This had me worried, but perhaps all these excesses are all getting sucked up into my dad.  He does complain a bit about bloating, but it hasn't really been too uncomfortable for him.  I guess I'll continue to monitor him and look for any dangerous signs.

The good thing is that it seems most of the other cycler drains (drains 1-4) are more successful and at least pull out the same volume of the preceding fill.  And he does still pass some water during the day, so at least that's something.