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  • Insufficient draining on initial drain

    I'm new to PD, and I am having problems with the initial drain on the night cycler. I am only draining a fraction of the amount in my peritoneal cavity, and I continually have to bypass the machine to start the process. My team suggested that I may be absorbing the fluid during the day. I started an additional gravity treatment mid-day, but I haven't seen results yet. Has anyone else experienced this?

  • #2
    Could be dehydration. Make sure your water intake is sufficient.
    How much solution are they keeping in you after each treatment?

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    • #3
      herbmcdowell thank you for submitting your PD scenario so others can learn from your experience. Typically if you have a long day dwell and you still produce urine you first drain on the cycler may be low because you have been able to eliminate some of the fluid through urination. You may also be absorbing some of the fill volume depending on your peritoneal membrane type, length of dwell, blood sugar if diabetic, oral intake and other factors that can influence the movement of fluid from the peritoneal cavity back into your lymphatic system. If you have performed a PET (peritoneal equilibration test) with your PD RN the results will provide information that helps to inform the appropriate length of dwell that is best for you. It is not unusual to absorb fluid on long dwell but it is important to understand if the absorption is causing you to have too much fluid in your system. I would encourage you to review your flow sheets with the PD RN and Nephrologist and discuss your daytime regimen to ensure your current PD prescription is optimal and individualized to your membrane type. I would also recommend you spend time with your renal dietician and review your daily fluid and food intake to see if anything is contributing to fluid absorption.
      M. Cassin RN CPDN
      Nashua NH

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      • #4
        I've had difficulty occasionally. I find that often it is because I have been constipated. I also found that if I take a couple of regular Tylenol before bed that I have no problems at all.

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        • #5
          Thank you for your question pparfitt65. Constipation can impact your ability to fill and drain on PD. It can also impede PD catheter function so it is a condition that you want to address with your care team to ensure you have a plan to avoid. Your Nephrologist may be able to recommend something for you to take daily such as lactulose to ensure you have regular bowel movements and avoid constipation. I don't believe that Tylenol on a regular basis is a recommended approach to resolve constipation so please have this discussion at your next clinic visit with your team. Hydration can impact your regularity as well. If you get dehydrated you may experience an increase in constipation. Daily exercise and movement can also help to increase motility and improve bowel function. Your renal dietician can also be helpful and provide you with dietary guidance that may help to prevent bowel irregularity as well so be sure to reach out.
          M Cassin RN CPDN
          Nashua NH

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          • #6
            I have that problem almost every night and have to bypass the machine.

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