I Hate Dialysis Message Board
Dialysis Discussion => Dialysis: General Discussion => Topic started by: murf on October 07, 2009, 02:30:51 PM
-
I have got a few questions to ask about Peritoneal dialysis. I am afraid that I will show my total ignorance in this matter. I am deciding to go onto PD after four years of Hemo. Firstly, how do you get the bags of fluid? There must be around 28 bags in any given week. Do you pick them up or are they delivered? I understand that there is a drain off, just like in hemo. Can you drain off the fluid into a bucket so you can sit anywhere in the house? Or do you need to be near a drain such as a kitchen or bathroom? What does the fluid smell like? Is the output of fluid equal to the input of fluid? So if I am using 2L bags, would I expect to drain off 2L of fluid. Do I drain off every time? Once again, my apologies for my ignorance.
-
The exact supply requirements will depend on whether you're doing manual PD or automatic with a cycler. All supplies are delivered by the Baxter or Fresenius people once a month or every two weeks. I can only really give you details on the Fresenius equipment, as that's what I use. Baxter will be similar with minor differences. Since I use two 5 liter bags each night, I have 30 boxes just for one month, each box holding two bags. In case of emergency, you're supposed to keep an additional 2 weeks of supplies on hand, plus there are three different dextrose concentrations of fluid for pulling off different amounts of fluid, so you'll be keeping a variety on hand. I'd expect 5 or 6 stacks of boxes up to your chest and about 2 feet wide, just for the fluid.
If you're doing manual you'll be doing 4 or 5 exchanges a day. Each bag is a twin bag with a connector between them - Fresenius stay-safe is a dial that fits into the organizer widget on the IV pole. First you set it to drain, and unclamp your clamp, then the fluid that's in you drains into the drain bag, which you've placed on the floor. Once that's done, you switch to fill, and the bag of fresh fluid, which is hanging above you from the IV pole, starts to drain into you. You should get a hanging scale ("fish scale") to hang the bag from, so if you don't use the whole bag, you can see how much you've used. When you're done, you go drain the bags into the toilet (easiest is if you keep a pair of scissors, and cut the corner of the bag). Then throw out the empty bags.
If you're on a cycler, you'll use one set of individual bags per night, plus a set of tubing. For my Fresenius Liberty cycler, I use two 5 liter bags and one cassette - it's an interesting piece of molded plastic with a latex membrane, that allows the pumps to push and pull fluid, but without ever contacting the fluid itself, it keep things clean. The tubing is connected to the cassette, and hangs out of the machine for you to connect to the bags. All those details will be covered in your cycler training, if you get on the cycler.
The drain line can go into a set of drain bags (supplied with your monthly delivery if you need them), or a bucket, or directly into the toilet if the line can reach. I use cassettes with extra long lines - both the patient line and the drain line are 20 feet. The fluid smells, well, I'm bad at describing smells. It's not putrid or really like urine, but it might smell bad to some people. It's pretty mild to me, and my mother even thinks it smells a little good, close to vanilla (but I disagree :rofl; ).
The output of fluid, if you dialysis is working well and you don't have much residual kidney function left, should be greater than the input because you'll be pulling off fluid. Every night, I use 10000 ml of fluid and have 800-1300 ml ultrafiltration, so if I were to use drain bags they'd be holding 10800-11300 ml of effluent. Actually, I do a manual fill in the evening, so that's another 1500+ to add on to that. My drain sets are split into 4 bags that each detach, so they can easily be carried to the bathroom to drain. Keep in mind 10 liters weighs over 22 pounds, so each bag in my drain set is easier to carry at about 5 1/2 pounds.
You'll drain yourself completely before each fill. With the cycler, it does that for you several times a night.
Okay, information overload, I know :banghead; but I think I answered all your questions.
-
Restorer - great information.
Murf - I was on CAPD (Manual) for 1.5 years before my transplant. Just like Restorer mentioned, it depends if you still have some residual. As for me, I did have some residual and I only did 2 exchanges of 2L (2000mls) which normally consists of 2.5% dextrose during the night (no more than 7-8 hrs). When I wake up in the morning I did 7.5% Icodextrin (good up to 12-16 hrs.) which I carried through out the day until my night exchange.
As for my drain, I normally take out between 2300-2500mls per each exchange.
-
I think all your questions were answered above but I had to share on the how do you get supplies part. I just got home from work and my entire front porch is covered in Baxter boxes. I ordered them and I know when they are coming but it is alway a shock to see how many of them there are.
-
Baxter also delivered for me. I never had to pick up the boxes. They are way too heavy. The delivery guy brings it in and place them in the closet under my stairs. He also rotates the boxes in the closet with the new ones in the back and the older ones to the front.
-
Yep, restorer's answered it all. I'm in NZ and get the boxes delivered too - and yes, it's always a shock to see 30 boxes in my front porch ha ha. I drain into a drain bag overnight with my cycler. I know a lot of people in the US have a tube straight to the bathroom, but I don't think that's available here. So I end up with a 12l bag to empty each day. I obviously don't do that! If I lived on my own I would insist on the extension tube. And they're not silly questions - they're very sensible questions.
-
Yup, pretty much what everyone else said. Occasionally my delivery date coincides with my doctor's appointment, so I specify to deliver in the afternoon. Never had a problem yet. I use one extension on my patient line (my cycler is out in the hallway), and two extensions on my drain line so it will reach the toilet. As for odor, my drainage stinks, to put it bluntly, so I make sure to flush it down as quickly as possible. My supplies cover one entire wall in my computer room.
-
Murf,
Just a note. If you drain into a drain bag i would suggest getting a plastic rectangular storage thingy. I have one about 6" deep and maybe 2 1/2 ft by 3 ft. Someone here mentioned this in case of leakage. I am SO glad i bought one (at any store). Cause one night i forgot to clamp the main clamp on the drain bag and in the morning i figured this out. Luckily all the liquid was contained in the storage canister rather then on the carpeting.
As for the smell of my outbound liquid it kinda smells like antaseptic IMO. But i only smell it while draining the bag.
I dont feel like the supplies take up alot of room. But we do have an extra bedroom. If i had a room bedroom house i may change that opinion.
-
Isnt it funny , i never noticed any smell at all !
-
Thanks everyone for the wonderful information. Another question. As the fluid input is comprised partly of dextrose (a type of sugar) does that preclude diabetics from PD? I have a controlled diabetes by diet only (no tablets or insulin).
-
I think restorer said it all. Did any one mention the amount of cardboard you will have. Ha Ha.
-
You will absorb dextrose from the solution. How much depends on how long your dwell times are and what concentration dialysate you use. That makes PD more of an issue for diabetics. You'll have to consult with your dialysis unit, dietician, and (future) PD nurse to see what's right for you.