A month in PD and rapid transporter issues

[hildegard]

Hey All,

My mom is new to pd, but I am Lisa, one of her caregivers.  I've been reading your posts for a month now, but this is my first post to the group. I've learned a lot just from your discussions!!  Thanks

Wow, pd is a lot of work and we are not getting very promising results yet. My mom is a rapid transporter. It seems like as soon as the solution goes in it needs to be exchanged in no more than 3 hours. It seems like she needs the 4.25 solution all of the time as well, or she reabsorbs it, and that high concentration worries me....She is also having problems with hemorrhoids due to the pressure during the day. My mom is 83.

Now we are trying to cycle her every 1:16 minutes at night and leave her "solutionless" during the day. Being "solutionless" seems to have helped her hemorrhoids, but it seems strange not to have fluid in her after almost of month of being full all day and all night.  After being "dry" all day I noticed a few fibers in her drain at night. Any correlation with fibers and no daytime fill?

Any of you experience a similar rapid transporter situation? Is it OK to not have solution in during the day...any common problems that it can cause? How long can it take to find the "magic bullet" in terms of dwell time, # of exchanges, solution concentration...?

ANY feedback would be helpful!!!

Thanks for this forum and for all of you who are regulars and guide us newbies along,
Lisa

[MyssAnne]

I don't go empty, but am on the cycler. My suggestion would be to put some yellow in her during the day, not much, maybe 500MLs?  Just enough to make it 'comfortalbe' She is a VERY fast transporter! I can only imagine how uncomfortable that makes her!  Fibrins come, not from being dry, but from the body, my guess, it's the reds being used all the time. Can she alternate red/green? Is she using two bags or one?

[angela515]

Hey All,

My mom is new to pd, but I am Lisa, one of her caregivers.  I've been reading your posts for a month now, but this is my first post to the group. I've learned a lot just from your discussions!!  Thanks

Wow, pd is a lot of work and we are not getting very promising results yet. My mom is a rapid transporter. It seems like as soon as the solution goes in it needs to be exchanged in no more than 3 hours. It seems like she needs the 4.25 solution all of the time as well, or she reabsorbs it, and that high concentration worries me....She is also having problems with hemorrhoids due to the pressure during the day. My mom is 83.

Now we are trying to cycle her every 1:16 minutes at night and leave her "solutionless" during the day. Being "solutionless" seems to have helped her hemorrhoids, but it seems strange not to have fluid in her after almost of month of being full all day and all night.  After being "dry" all day I noticed a few fibers in her drain at night. Any correlation with fibers and no daytime fill?

Any of you experience a similar rapid transporter situation? Is it OK to not have solution in during the day...any common problems that it can cause? How long can it take to find the "magic bullet" in terms of dwell time, # of exchanges, solution concentration...?

ANY feedback would be helpful!!!

Thanks for this forum and for all of you who are regulars and guide us newbies along,
Lisa

Welcome Lisa.

As for being a high transporter, meaning she needs to dwell short amounts of times... The absorption has nothing to do with the solution being stronger or not, it has to do with how long shes dwelling. Meaning, if she has 2.5% solution in her, and absorbing some of it, she is dwelling too long, it's not because she needs a 4.25% bag. Hope that makes sense. In order for her NOT to absorb it, she needs to dwell for a shorter amount of time than what she is currently dwelling. I was a high transporter also, which is why they put me on the cycler, so for me, 45 minutes dwells were long enough to pull more than enough fluid off, yet not absorb any.

If she needs higher solution, like 4.25%, that means she is taking in too much fluids, and/or too much sodium.  To find the right combination of fills and dwells, you just have to try different prescriptions (with your Dr's approval) and see what works best.

I was also dry during the day, if she has some fibers they usually will put some Heparin in the solution bag and once the fibers are gone (sometimes a few days) you can stop putting it in the bag.

I hope that helped...

Angela

[hildegard]

Hi MyssAnne,

She goes through 2, 5000ml bags each night. Last night we used 2 greens with a 1:16 dwell time of 2000mls, and only got a UF of 150ml. It was the first night with the new no initial drain/5 cycle set up.

Night before last, on the old program of 3 cycles at 2500mls,  we used a red and a green with a last fill of 2000. Yesterday morning, when the nurse decided to reprogram the machine to 5 cycles and to drain her during the day, I got 3100ml off after a 3 hour dwell. (she filled at 6 am and I drained that off at 9am) It's like Christmas when that happens!! Gee all I want for Christmas is a great drain...never thought I'd be saying that!

Tonight we'll use a red and a green and see how it goes.  I hate not getting an initial drain since I have to wait for the fist dwell to finish in order to get a sample to check for peritonitis.

Thanks,
Lisa

[hildegard]

Thanks Angela,

The dwells, and concentrations have never made sense to me...Thanks, your explanation help!!  How many fibrins until we add heparin?

She had 3 in her first drain sample last night.


Lisa

[MyssAnne]

Doesn't matter how much, if she has it, let the nurse know! Angela is good with info, she's been on it longer than I have,
I'd trust her before me!!  Why are you testing for peritonitis? Are you doing that every day? Or are you just looking to see
if the bag is cloudy? That is a good indication, one that worked for me (had it 3 times last year!), was to pay attention to
my gut. If it started hurting and nothing was alleviating it, and I could not drain, THEN it was time to go to the ER. By the way, when you go, TELL THEM she has peritonitis, and is on dialysis. Sometimes it works, and you'll get in right away.

[Chicken Little]

I am a low transporter, but I never saw fibrin until I started the cycler and was going dry during the day.  I don't know if that was the cause, but it's an interesting coincidence.   I was instructed to add Heparin any time I saw fibrin in the bag or if I was having trouble draining.  I hope you find a good set up for your mom soon.

[angela515]

By the way, when you go, TELL THEM she has peritonitis, and is on dialysis. Sometimes it works, and you'll get in right away.

Good point! You would be shocked to find out how little ER doctors and nurses know about dialysis of any kind. You tell them peritonitis right away, they will get you in, start calling your dialysis nurse and she will tell them how to test for it, and then they will get ya the antibiotics... ya don't tell them and you will most likely be in pain alot longer due to them not knowing what the problem is for awhile.

[MiSSis]

Hi Hildegard,

I've been doing Cycler PD for 3 1/2 years now and have always been "dry" during the day.  (I didn't want to have to buy all new clothers for my bigger belly, plus I didn't want to have to carry an additional 5+ lbs around with me every day!)  I occasionally have fibrin but I don't think it has anything to do with being dry.  Our bodies just sometimes manufacture it.  My PD nurse told me that one of her patients adds Heparin to her bags every night because she always has fibrin.  I keep some heparin on hand and add it whenever I start to see it.  When I start to get fibrin, it will clog my drain bags when I try to drain them in the morning so in order to prevent that, I add Heparin as soon as I see it, no matter how much it is. 

I'm considered a slow exchanger because I had a couple of bad cases on Peritonitis when I was first on PD back in the mid-80's.  I do 6-1 hr 15 minute dwells each night.  New patients at my clinic start with only 45 minute dwells.  Just my opinion, but it seems like your Mom is maybe dwelling too long.  You didn't mention (or maybe I just missed it) but it sounds like you're doing manual exchanges.  Has your Mom's doctor or PD nurse mentioned anything about using a cycler machine instead?  Using a cycler certainly makes those nighttime exchanges so much easier to handle.

My total UF for the entire 6 exchanges will usually run in the 600-700 ml range.  I'm using 2 5L 1.5% and 1 2L 2.5% solution bags.  I monitor my weight and blood pressure twice each day (morning and night) and based on how high or low my BP is and how much weight I've put on during the day, I will adjust the concentration of the dextrose solution accordingly.  If I know I've had more sodium than normal or drank a little more, I will use 1-5L 2.5% and 1-5L 1.5% solution.  I've use a 4.25% but only rarely and only on the advice of my doctor.  It's a strong solution and will take off a lot of fluid and could possible cause problems with low BP and cramping so I'm pretty careful when I use it.

Keep talking with your Mom's PD nurse and let her know what's happening.  It does take a little while to find the exact combination of fluid and dwell times for each person.

MiSSis