PD people: Need help with new cycler program--feeling stupid

[kickingandscreaming]

Until today, I used to do dry days.  But because of poor clearance, my PD prescription was changed today to add an additional fill/dwell right at the end of my usual 5 cycler exchanges/night.

I'm really nervous about how to do it.   I know that a target UF was set (a guestimate of the avg. UF/night).  If I don't drain out that much (e.g. 950ml) then I will get a LOW UF alarm ( in this case a silent alarm).  My nurse told me that I should set my alarm clock for about 1 hour before the therapy is scheduled to end and get up, press STOP and then GO and get in good drain position and try to drain out the rest before the last fill begins.  It's so arbitrary to have to pre-set a UF target when my UFs are all over the map (depending on whether I use 2 greens or a green/yellow) so there's really no way to choose a winning number.

Than she said something about a BYPASS and this confuses me because I don't know what i'm bypassing and why I would want to do that.  I'm really freaked out becuase I'm sure I'm going to screw it all up and be fumbling around half asleep.

i NEED HELP!!!!  Thanks.

[Shaks24]

Which machine do you have?

[kickingandscreaming]

Baxter Home Choice Pro

[Shaks24]

On Liberty Cycler to bypass a mode you push the green ok button in and hold it until the screen displays a bypass option. Then you touch the bypass option on the screen.
It basically takes you into the next cycler mode.
If you are in dwell it will go into drain.
I am empty during the day and my cycler's first mode after set up is a drain cycle. I always bypass it that way cause I am empty at that point.

[Shaks24]

Sorry Kickingandscreaming I just saw your post. I am unfamiliar with Baxter. Can you call the tech hotline?

[sahern]

The Baxter cycler on it final drain has to drain a certain amount or it will not fill.    If you need to bypass on the Baxter you push the stop button than arrow down until it says bypass on the screen.  The manual that comes with the machine is very detailed and simple to follow.   If all else fails call Baxter or your PD nurse.

[kickingandscreaming]

I don't really understand " Bypass" in this case.  I don't know what I'm trying to bypass.

[Shaks24]

Well I would assume that it has to be a fill or a dwell or a drain but that seems strange since they basically want you to add a cycle. Maybe just do your regular program until you can speak to your nurse and clarify what she instructed you to do.

[kickingandscreaming]

I've been talking to her all day and I just get more confused.  She makes it sound very simple, but it really doesn't make sense to me.  I will probably end up calling Baxter hotline in the morning when I wake up to a low drain alarm.  This is not fun.

[Shaks24]

Well good luck. My program is really simple. Just 4 regular exchanges that take about 8 hours. The Liberty cycler has a mini thumb drive that controls the program so changes can be made by taking the thumb drive to the clinic and letting them re program it. Only had this done once when I had a hernia and they reduced my fills for a month or so.

[kickingandscreaming]

My progrqm WAS simple untll tonight.  Now adding an extra fill with a manual drain after dwell..

[sahern]

I have used the bypass a couple of times to get off early.  The bypass gives the option to skip the dwell or drain and move on to the next function. In this case to end the session a little early. If you just push stop button it will start to alarm at you in a little while.  The only step that you can not bypass is the first drain so that you do not overfill if you have not drained all the way. If you are interested you can PM me and I can give you my phone number and I can talk you through it.

[Charlie B53]

The Bypass command is to force the machine to move on to the next function.  In your case that would be to the last Fill.


I used much the same program as I didn't drain well laying in bed.  I would get up, hit the Stop then immediately hit Start again to continue the Drain that had finished and Held while I was asleep.

Once finished with that Drain I very often got a Low UF as we had set that number high enough I wouldn't hit it.  Then I again hit the Stop, used the arrow down until it read Bypass, hit the Enter and the program would advance to that Last Fill.

Does this help make it clearer?

Are you going to start using Ico and have a long dwell for much of the Day?

[kickingandscreaming]

Are you going to start using Ico and have a long dwell for much of the Day?

No Ico.  Just a 2-hour additional regular dwell with my usual fluid.

[Charlie B53]

Curios, what is your Cycler program?  How many hours, how many bags/total volume?  How many cycles?

When I started the Cycler I had just received my manual supplies deliver so I had a months worth of EXTRA bags.  When it got near the expiration date I am such a cheap SOB I asked if I could start adding one 2 liter bag a night to my program.  So we changed the program to add that extra 2 L.  It added one more cycle but shortened the time of each exchange just a little.  No problem.  This took a couple of months and we noticed an improvement in my labs.  So we changed my order from the 5 L bags to the 6L bags.  This way we didn't have to change my program back, just left it at that 12 L a night.

This is why I ask what your current program is.  There are ways to make adjustments to increase Dialysis if needed.

[kickingandscreaming]

what is your Cycler program?  How many hours, how many bags/total volume?  How many cycles?

I have already had my program changed  multiple times.  This is the most recent iteration.

I do 5 short dwells (my peritoneum is high average transport) of 1 hour 36 mins. each. Total program is about 10 hours.  Each fill is 1800ml (I can't hold more than that because when the UF is added, I wake up in the middle of the night not being able to breathe).  And then there is the final fill of 1800 that I hold for 2 hours and then do a manual drain.  Or, I can disconnect and drain into a manual drain bag.

This morning it worked out fine because i easily hit the pre-set UF target.  Tomorrow will be different because tonight I will use a green/yellow which produces less UF (or I don't drain as much initially).  So tomorrow I will run into a low drain alarm before the cycler will move to the final fill.  That's where I have my question.  What do I do then?

[Charlie B53]

If you are already up vertical so to drain fullly, and still get that low drain alarm, then hit the Stop button to both stop the alarm and also stop the program.

Then hit the down arrow until you get to that Bypass, Hit Enter.

Some programs will force you to do this twice.  If yours is it will again show you the Low Drain and possible sound the alarm again.  Hit the Stop again, and again arrow down to the Bypass.  Hit enter and it should go forward to the Fill cycle.

I used to be on a 10 hour program.  I complained of the long time and my Nurse suggested I go to an earlier program with a 'Walk-Off'.  I would come in and connect between 5 or 6 pm, drain and fill and the program would go and sort of  'hold.  I then would disconnect and walk away.  Free for up to 4 hours then come back, connect and go  to bed for a 9 hour run.  Mornings I still had to get up and continue the drain exactly like I described above to make sure I was totally drained before my Ico fill as that Last Fill.

So you can have that extra cyclle either morning or evening, whichever works best for you.

[Tío Riñon]

Can you describe your "Walk-Off" program with more detail?  This sounds like something that would be beneficial for me.  I'm on the cycler 11-12 hours a day and would love to be able to break up the session a bit.  I don't think my nurse is familiar with this option.

Thanks!

[Charlie B53]

I am now on Hemo because of a persistent infection, but they have not picked up my Cycler yet. Perhaps I should turn it on and write down the exact program settings, it does make a difference.  The initial setting  has great effect on the other settings.

Late afternoon I would set up my cycler, connect and drain, then fill and the machine goes on Hold.  I come back about 9 p.m. for bed as I get up by 5:50 or 6.  I have to push the down arrow to bring up the next screen, don't remember what it says, then I have to hit the go button twice, I better be connected as it immediately goes into that Drain. then the rest of my program runs same as usual.

I'll check and write it down tonight, not sure if I will get back here tonight or tomorrow morning.

[SKS]

So much of this is pertinent to what we've been trying to work thru.  Alarms, bypass etc.  The manual for the Baxter Home Choice Pro has become my best friend.  I try to read how to trouble shoot a problem the day after experiencing it and the leave it open to that page.  I'm the caregiver/partner and since he's on a CPAP most times he doesn't even hear the alarm.  We are just one month in and he's a high average transporter (results from the PET confirmed this) I had analysed that anyway because when he had alarms and ended up with shortened dwells the shorter dwells produced higher UF -  when you down arrow thru the stats to put on your report sheets you can hit enter on any item the scroll thru the results from each (dwell/uf/alarm/)

Our biggest problem so far is low drain alarms.  Using Heparin seems to help and out PD nurse plans to do a "power heparin flush"  Today doing an extra intraday a "chunk" of fibrin came out at the end and a lot of smaller amounts - we're thinking that was the reason for so many alarms last night on the 2nd drain and a low uf. 

Wondering if others have had that experience.  Tonight with the PD nurse blessing I'm bypassing drains is they get within 300 of the 2000 that fills - he doesn't tolerate a 2500 fill.

[SKS]

Well I had an entire paragraph typed BUT - dogs needed out, Russ got up,  I tried to resize a .jpg to show AND then it wouldn't post duh

SO after a number of problems with drains, a chunk of fibrin the size of a piece of macaroni, Power Flush that would flush but not drain, at least one conversation a day with PD nurse we seem to have SUCCESS   -

Russ does the PD jiggle (shake stomach and belly roll) when he comes to bed and each bag has heparin 1 to 1 liter and I'm getting sleep.  Clearance is excellent.

Best of all when we go south as snowbirds we won't have to deal with the in-center attitude of the center near us.

[kickingandscreaming]

Congrats! That's a relief.