Extended dwell time

[paryapta]

Hi

I tried searching if this question was already answered in some other topic but I could not figure out much from the search results for "dwell time".

I do manual PD and I have a dwell time of 4 hours with 2000 ml (1.5%)... my problem is that sometimes I am not able to drain/exchange exactly after four hours if I am outside. So I let the dialysate dwell for 5 or 6 hours. What are the potential risks in this? Please guide me. Is this alright? 

[billybags]

My husband was on PD for over a year, (he is on the cycler now) and there are times when it is was not possible to keep to every 4 hours. We were told as long as you manage to get 4 exchanges a day in with 3 hours in between you are fine. Don't beat your self up about this, remember you dialysis to live, not live to dialysis. Hope this helps. Also ask about an extraneal manual bag. These are good to use now and again if you need to go for a long time say over 6 hours,  traveling, it saves having to stop and do  exchanges.

[highway61]

The biggest problem with keeping the solution inside over the 6 hour period is that it will start being reabsorbed back into your system which defeats the purpose of the dialysis you are doing. It isn't too dangerous other than all the toxins and fluids that you are trying to remove from your system will be slowly be  filtering back in.

[amanda100wilson]

Depends on the speed that your membrane transports salutes across it, determined by your PET.  If you are low average shouldn't be too bad, but not good if you are a rapid transporter.  If you still have residual renal function, effects ofreabsorption will be less of an issue than if you don't.

[wbdoug]

Also ask about an extraneal manual bag. These are good to use now and again if you need to go for a long time say over 6 hours,  traveling, it saves having to stop and do  exchanges.

I use the extraneal every day as my last fill in the morning and that carries me all day until I setup in the evening on the machine. I do not do a midday exchange.
I absorb the 1.5 if I go more than 2 hours.
Bill

[Joe]

There are times when I will dwell longer than my recommended 3 hours. As highway mentioned, the biggest issue of leaving fluid in for a long time is that it will start to be re-absorbed back into your system. Once you reach equilibrium between your dialysalite and the rest of your body, the fluid just kind of shifts back and forth with no cleaning happening. Not the end of the world, but not something you want to do often. Just get it out when you can and move on. That's one of the neat things about PD, you have the flexibility to move schedules around as needed.

[adairpete]

I agree with the other comments. I sometimes dwell too long and know some reabsorption happens but as long as its only once in awhile, its no big deal. My nurse told me dialysis is supposed to fit my life not run it! So if I'm busy or out and about, dialysis can wait a little longer.

[austinsoul2011]

Terrific advice from everyone here.  My dad is a crazy high transporter; his peritoneal membrane runs the sugar/toxin exchanges very fast.  So any dwell lasting longer than 40-60 mins means he'll be reabsorbing fluid.  He does have residual kidney function, so I'm hoping that he does indeed pass out some of the fluid when he goes to the restroom during the day.  I haven't asked our nurses about extraneal (non-absorbing) fluid; that might be an interesting option for long, manual dwells.

Because my dad uses a cycler throughout the night (Liberty), we can control his dwells, but with dwell periods of only 40 mins, it means at least 9-10 exchanges in a 9 hr period.  And he also wakes up during every fill/drain, and so he never gets a full night of sleep.  As a result, he's incredibly moody and sleepy throughout the day.

So as someone suggested earlier, you might want to find out what type of membrane you have, and how long you can dwell before you start reabsorbing the dialysate fluid.  If you're doing manual dwells, it's pretty easy to figure this out.  Record the UF returns you get with different dwell periods.  You should notice that with longer dwells, the UFs will decrease.  You should always, ALWAYS first consult and work with your NURSES to figure out the best way to find out how long a dwell is TOO long...   

[amanda100wilson]

The best way to determine membrane type is for your unit to carry out a PET (perfusion efficiency test).  You can roughly work it out yourself  but the PEt will allow you to get.A baseline for comparison with at further intervals.

[Grumpy-1]

As has been stated here, a dwell over a couple hours will cause fluid to be reabsorbed.  There have been days where I couldn't get an exchange in for 6-7 hours and noticed that.  I would start with 3 liter fill and drain 2 1/2 liters.  The next drain, I would tried to keep around 2 hours and then is seemed to catch up and drain a normal amount, plus the lost amount.  While it won't hurt to do that too often, you don't want to make a habit of it.   Grumpy