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PD Port Problems (say that 10x fast)

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  • PD Port Problems (say that 10x fast)

    Hi. My mom, Carol (new to dialysis) and I (Tricia, caregiver) are in our 3rd week of home PD training. We were supposed to start on the cycler tonight but remain on CAPD due to drainage issues. Her port was placed to the left of her umbilicus and seems to be quite positional. It works best when she is either right side lying or sitting up. Since she sleeps on her back, the cycler doesn't provide adequate dwell time. And, CAPD doesn't give full drainage. I have to wake her and sit her up or have her turn to fully drain. Our goal is to get on the cycler. Ummmm.... what do we do?

  • #2
    I can only share my experience and observation from my pd. It is true that sitting up and sometimes other positional changes improves the flow thru the catheter. But part of the benefit of the cycler is that it operates under pressure and helps to literally "suck" the excess fluid out of your abdomen. I know that I personally have a problem with "pocketing" whereby sometimes >700ml of fluid remains in my abdomen even though the machine thinks it is done and I am pumped dry. Nearly daily, I do a Manual drain and I usually get 300 or 400 ml of fluid out (following a Last Fill of 100). Have a discussion with your PD Nurse about how things are progressing. As I recall I used my cycler 4 days after catheter was implanted. My early dialysis was always more than 2000ml nightly and after a few months, I settled in to ~1600ml where I remain today. Dwell time is unique to each person, but the nurse can adjust that daily if needed. I do 4 cycles of 1:43 snf I hsve friends who vary time and amount across the spectrum.

    The not fully draining comment, is that because the machine says that not enough fluid came out or are you assuming that your Mom has more fluid in her??? My fill is 2500 and my machine only alarms if it does not drain more than 2300mls. If I am dehydrated, my body seizes the extra fluid thru my peritoneum and that is just how it goes. Something does not sound right with your experience. What has nurse said to you???
    Last edited by richolquin; 09-29-2015, 12:24 AM.


    • #3
      Hi, Richolquin! Thank you so much for your help. So, the machine does alarm eventually. It's either because she needs to reposition (which she won't do if she's asleep) or because it thinks she's done (which she isn't.) She gained 6lbs in 3 days and had lower extremity edema over the weekend. However, today at the clinic, the cycler seemed to be working better. Granted, she was sitting up. But, we are going to try it tomorrow night and see how it goes. She also had an X-ray. It basically showed the port to be in the right place but with the tip turned upwards. I just want this work for her so badly.


      • #4
        I know your me. My catheter sits low in my abdomen and sometimes in the "suck" drain mode that thin is right on a nerve that causes me to scream in agony. I have learned to close the catheter and then get up and jump around trying to reposition it.

        If the xray shows good but the edema is building up so rapidly, it sounds to me like two things (I have learned from doing WRONG personally!!!). One is fluid intake during the day. I was warned by my nurse in the early days about fluid intake esp. if I consumed anything that had a potentially high sodium content. I know that it may not seem like it, but if I put on dress socks such as dressing for work, by the end of the day they either acted as compression stockings and my legs above where they hit are swollen or they allow the day's worth of selling to build up. Second thing is, it sounds like your Mom has not given it enough time for the pd machine's benefits to kick in. What strength of dialysis solution is she using??? It sounds as if her condition may warrant the use of Red solution perhaps??? I normally use Green myself, but depending upon blood pressure and conditions (like 106 degree days), I will use Yellow when appropriate. When I mix a Green with a Yellow, my UF is lower by a noticeable 300-400ml and I will use a double green after a few days and see that excess taken out.

        It is all a big puzzle and unfortunately, you have to experiment in order to see what works best for you... Good Luck!!!


        • #5
          MizzTricia....How's your mom? I am still not drain any better! Thanks Rich olefin for your comments. I have tried many things and nothing is helping With each fill I am left with around 500 ml not draining unless I sit I am losing tons of sleep. I am feeling hopelessness one have any tips?


          • #6
            Sorry for misspellings...


            • #7
              Hi, Williamsjl10. She had an X-ray which showed the port in the right place, but that cycler alarms every morning. So frustrating. But now, it doesn't matter what position she's in. I finally decided to just bypass the morning alarm so she can sleep. I figured, let's just see what happens with the current cycler settings. So after a week, she has no s/s of fluid overload and her Kt/V is the same as it was on CAPD. Her wt is up a little, but consistent. The nurse adjusted her alarms (still goes off in the morning, tho. But only once). She seems to think my moms problem is bowel related. So, we're now working on that. I'll let you know if that helps.


              • #8
                Hey, Williamsjl10. So we're on week 2 of the home cycler. She seemed to work out her BM issues, but she continues to gain wt, and had an accident the other morning which added to her depression (understandably). The Dr. & RN think the wt may be due to the 2.5 dextrose solution, since she had no s/s of retention or overload. But, today her feet are pretty swollen, plus we had a horrible drainage night. I think I'm going to do a 4.25 ultra bag this afternoon. Not sure when the so called "benefits" of dialysis are going to kick in. But I really hope it's soon. How is it going with you?