Twin Bags or the Cycler?

[LightLizard]

does anyone have info on the differences in using the double-bag method and the night-time cycler for peritoneal dialysis?
i'm just wondering how long my peritoneal cavity and stomach lining can last on either route?
is one more likely to allow for more time on P/D?

love

~LL~




EDITED:  Moved post to correct thread "Home Dialysis" - Goofynina/Admin.

[goofynina]

Hey LL, where ya been amigo?  Good to see your post my friend     Now, i am not understanding what double bag is?  I am on PD and i still dont know    can you explain a little more? please

[LightLizard]

'twin bag' 'double bags' those terms are used synonomously, as far as i know, which isn't far.

originally, i was on hemo dialysis with a catheter in my chest/neck.
when i expressed a desire to try peritoneal, i was given a belly-tube, surgically, and many boxes of dianeal (dialysis fluid). the double-bag, or twin bag method consists of using an intraveneous pole to hang the full bag from, while the empty bag is hung low on the pole, or laid on the floor. the stomach is emptied first, into the lower bag, and then the upper bag is emptied into the belly, to sit for up to four hours. the double-bag method is performed four times a day and does not require electricity, as the method depends on gravity.
the night cycler uses the same belly tube as an access, but is done while one sleeps. the dwell time is different in the sense that the fluid sits in the belly for between one and one-and-a-half hours, before being drained. the cycler continues this process throughout the night and the peritoneal cavity is flushed with fluid a total of six times per night, which leaves one's day free of dialysis.the cycler requires electricity and works on a 'stomach pump' level.
my question is regarding the relative efficiency of these two methods.
i have heard that the repetitive fill-dwell-drain of the night cycler puts excessive strain on the stomach lining, which means that logically, the method of the night cycler is not as efficient as the twin bag method, for longevity, or, for remaining on peritoneal dialysis for an extended period.
i just want to do what's best for my stomach lining, really, and am weighing the pros and cons of both methods.

love

~LL~

[goofynina]

Oh, i think i understand your question now,  I hope i dont confuse you but here it goes:  When someone goes on PD they usually start off doing manual drains, unless they find out they are a high transporter (where your body starts to re-absorb the solution after a short amount of time)  that is when they switch you to the cycler,  So i really dont think there is a difference to your peritoneal cavity if it is dwelling for 4 hours or for 2 hours, it is still going to hold the same amount of fluid just for a lesser time (on the cycler)   I love the fact that my days are totally free and i dont have to worry about having to drain every 4 hours.   I do know that some patients do not like the noise the cycler makes, but some dont mind (like me)    If it was up to me, i would definetly recommend the cycler, 

[LightLizard]

thanks nina! yes, i started on manual drain, as well. i was switched to the cycler shortly thereafter and find it the best, so far. but, as i mentioned, the cycler moves the fluid through the stomach 6 times per night, whereas the manual method does it four times, per day. my concern is that the more in and out, through the stomach lining, the more the wear and tear on the stomach lining, which means that one's ability to perform peritoneal dialysis may be shortened somewhat, by the cycler method.
no?

love

~LL~

[Ken Shelmerdine]

thanks nina! yes, i started on manual drain, as well. i was switched to the cycler shortly thereafter and find it the best, so far. but, as i mentioned, the cycler moves the fluid through the stomach 6 times per night, whereas the manual method does it four times, per day. my concern is that the more in and out, through the stomach lining, the more the wear and tear on the stomach lining, which means that one's ability to perform peritoneal dialysis may be shortened somewhat, by the cycler method.
no?

love

~LL~

Lightlizard it's a question I've been meaning to ask my home sister. I would have thought that the number of times you fill and drain is immaterial, it's the amount of time you have fluid in your belly that causes wear and tear.
I would think that say 4 x 2 litre fills over 8 hours would be roughly the same as 2 x 2 Litre fills over 8 hours. Youve got fluid in for the same overall amount of time.

[LightLizard]

thanks ken, that makes sense, of a kind. but it also makes sense that the difference is that with the cycler, the fluid is going in and out 6 times within a ten hour period as oppossed to it going in and out four times, through a 12-15 hour period. i'm really not certain, or convinced, that the time of the dwell is as relavent to the question, or not.
i'm sure it varies widely, from person to person, too, so I don't really know or even expect a distinct answer to my question. how many abdominal surgeries one has had is certainly a huge factor, among many others....

love

~LL~

[goofynina]

So, i am still trying to get this too,    Are you asking if it is better to hold the fluid for 16 hours opposed to 10?  Those of us who are high transporters really dont have a choice so i will take what i can get at this point ; 

[LightLizard]

well, my thinking is drifting towards 'more in and out = more wear and tear on the stomach lining = less time that one can stay on P/D, overall.'
i know P/D hasn't been around that long, so I'd be surprised to find a body of research that covers it and has any definite conclusions to offer.
dialysis itself is a real balancing act, as you know. it takes the toxins out of the blood, but also takes the good stuff, so we have to balance it out with intense attention to diet, medications and supplements. still, over time, the fact of deterioration becomes a reality and we are forced to recognise that dialysis is not so much a 'cure' as it is an attempt to slow down the process of deterioration that comes with kidney failure. so, i guess my question is, what factors do we pay attention to in order to facilitate the maximum benefits of P/D?

love

~LL~

[goofynina]

Just remember being sterile is priority,  Remember, one can always get a bout of peritonitis bad enough to stop the ability to be on PD too, so it is not only on which one is more gentler.  And wouldnt you think it would be better for the peritoneum to be filled in stretched 4-5 short dwells instead of 1 long 4 hour dwell, you raised a good question here, ya got me thinkin' LightLizard 

[LightLizard]

thanks nina. yes, i too have little choice in the matter, really, so i guess the question is more of an acedemic one, at this point. i doubt that there is an answer that could be applied to everyone, seeing we're all so different in our similar conditions...


love

~LL~

[LightLizard]

and then there is that aspect of peritonitis, which is probably a greater danger the more one connects and disconnects, which would mean the four connect/disconnects daily that the twin bags method demands is more of a danger than the once nightly that the cycler offers.

love

~LL~

[fluffy]

peritonitis hurts like you wouldnt believe. the only problem i have with the manual bags is that you have to empty them manually. seeing as how im lazy and i let them pile up it means emptying 15 bags of dirty fluid in one go, not fun at all

[KT0930]

fluffy, I have that problem with the cycler, too. Not with the dirty bags, but since the bags of fluid only come in 5000 ml size, and I only go through 8000 per night, I end up with some to empty out every morning. With my schedule, I don't always have time for that, so I end up with the clean bags piled in the bathtub until Friday night when I finally have time to empty them all (10 bags with 1000 ml each).

[fluffy]

i think we have a different cycler, i've got one that runs a line to your bathtub or toilet and empties that bag after every exchange, its a helluva useful feature. my cyclers a newton IQ somethingortheother

[KT0930]

no, we have the same cycler. I was talking about the clean bags that I have some left in, not the drain bag. Though the drain bag has a little bit left in it in the morning, too.

I don't put the tube in the tub or toilet to drain, though. Our dog sleeps in the bedroom and wanders at night sometimes, and I'm sure he'd knock the tube out of the toilet (it's about eight feet away from the machine), so I put the end of the tube in a 5 gallon bucket and empty it each morning.

[fluffy]

thats actually a good idea, cause the thought of that crap emptying out into my shower kinda makes me shudder. i have had the tube knocked out a few times by careless ppl, it wasnt a fun cleanup now i tape the thing down

[goofynina]

We put my tube in the toilet, between the seat and the bowl and so far so good, no accidents there

[KT0930]

a note about the bucket idea, I keep the lid on it, and have a hole cut in the lid that's big enough for the tube to fit through. That way it doesn't slip out on its own, either. Though you could probably just put more of the length of tubing into the bucket and have the same result.