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dinangkur
May 23, 2007, 12:46 AM
Hi,

My mother has chronic renal failure. She had CAPD as HD is not suiting her. From today they will start dialysis. Does it hurt? She is afraid about it. Most important thing is that she can't eat, whatever she eats she vomits. Doctor says this will improve when dialysis will start. She also had lot of excess fluid in her belly. At the time of CAPD doctor took out a lot. But there are more. I have a question about dialysis chemical. How much she needs to use (in liter) at single dialysis? I will post details about her within few hours. I like to hear your opinion. Thanks.

shay_pcb
May 23, 2007, 02:01 AM
Well, some people do get a little pain, but it is totally bearable. I get what we call "the drain pain". It's just a little pain at the end of the draining cycle. It's from the catheter sucking on the walls of the peritoneum since there is no more fluid in there. Not many patients get it though. Most can't feel anything when filling and draining. I'm a "lucky" one! lol

The nausea should get better after starting PD. It may take some time though bc she has to get all the built up toxins out of her body first. This takes time.

Everybody uses a diff amt of fluid per exchange according to their height, weight, kidney function, etc. No one here can give you a definite answer on how much she will receive at a time.

dinangkur
May 23, 2007, 02:37 AM
Hi,

I just returned from the hospital. She had her first dialysis. It went well. Doctor will use 3 bags for next 7 days to lower her creatin and urea.

She is 5ft and weight 39 KG. I believe she will be ok soon.

Beth Witten MSW ACSW
May 23, 2007, 11:22 PM
If she's going to be doing CAPD, she will need to learn how to do the dialysis exchange using sterile technique; how to choose the type of solution to take off the right amount of fluid weight she needs to remove; how to monitor her blood pressure, weight, temperature, etc.; how to understand her lab tests; and she'll learn how to record her treatments so her doctor and dialysis clinic know how well she's doing. If you have time to go through the training with her (and she's willing to have you there), you would probably learn a lot.

dinangkur
June 4, 2007, 09:40 AM
Hi
I'm pretty confused about sterile gauges, can you tell how could I do that At home cause Its not possible for me to buy the sterile one cause they might not be sterile properly yet again during PD sterile boxes will be opened several times.

Dori Schatell
June 4, 2007, 11:23 AM
Hi
I'm pretty confused about sterile gauges, can you tell how could I do that At home cause Its not possible for me to buy the sterile one cause they might not be sterile properly yet again during PD sterile boxes will be opened several times.
It's not a sterile gauge or anything that you need to buy, it's sterile PD exchanges that your mom will need to do. An exchange is when she empties out the used fluid that was in her belly and fills up with fresh fluid. Each time you connect her PD catheter (belly tube) to a bag of fluid, you will need to wear a mask, wash your hands, and do the steps as the nurse teaches you. Most people who do PD can do these things themselves, so it may be your mom who learns to do these steps. Either way, the dialysis center will teach the steps and should make sure that you know them before your mom goes home for PD.

dinangkur
June 4, 2007, 12:38 PM
hi
I know that but they told us before doing that exchange me or my mom have to clean up everything with germ killer we called it here hexasol and then do the dialysis but for that we need according to the nurse sterile gauge.
I think i've made you understand

Dori Schatell
June 4, 2007, 03:06 PM
Cleaning up with a product like hexasol makes sense, but I'm afraid I still don't know what a "sterile gauge" would be.

Beth Witten MSW ACSW
June 4, 2007, 04:11 PM
Could the nurse mean that your mother needs to clean her exit site where the catheter comes out of her abdomen using a piece of sterile gauze (a loose weave surgical dressing) or did she say you needed to use sterile gauze soaked with Hexasol to wipe down the table before she places the items that she will use for the exchange? Once sterile gauze touches the table, it's no longer sterile so don't know that's what she meant. I would suggest asking the nurse to show you what she means.

dinangkur
June 10, 2007, 11:34 AM
She is swelling from yesterday. Before CAPD she had lot of water in her belly. She was ok. But from yesterday her right leg is swelling and also now her belly. Nurses told us to take extra fluid out of her body 200ml extra in each dialysis (she is having 3 times each day). Now, when she sits, she felt pressure in her belly. Please, advice.

Beth Witten MSW ACSW
June 10, 2007, 01:17 PM
In the U.S. CAPD patients do at least 4 treatments a day. Some who are bigger do 5. If she's removing more dialysate (dialysis fluid) than she's putting in, she can reduce the amount of fluid that she's taking into her body or to use a dialysis solution with a higher sugar content.

In the U.S. the solutions used are 1.5% dextrose, 2.5% dextrose, and 4.25% dextrose. The higher the sugar content, the more fluid will be pulled off. However, the higher the sugar content, the more likely the solution is to scar the peritoneal membrane. Therefore limiting fluid is usually what the dialysis staff recommend first. In the U.S. most patients are limited to about 1 liter fluid a day plus the amount of urine they make.

Ask the doctor if the catheter is in the right place inside her peritoneal cavity. The tip should be near her rectum. Some patients feel the catheter for a while until they get used to it. If the catheter has flipped up, it won't do the best job of removing fluid. They should be able to x-ray to see the catheter. Sometimes the catheter will reposition itself with the patient's movements or the doctor can reposition the catheter.

dinangkur
June 15, 2007, 07:21 AM
hi,
today after I changing my mom's fluid I noticed some kind of floating fibre in the drained fluid and after few minuties fluid doesn't seem to be clear as were in the morning after draining.
I don't know what's the reason. My mom's doctor told me when we made this CAPD in her body that their might be some calcium loss through fluid but I'm pritty much afraid now.
What should be done now?

Beth Witten MSW ACSW
June 15, 2007, 08:03 AM
If what you're seeing looks like strands of cotton, it could be fibrin which is harmless but can clog the catheter. In the U.S. nurses train patients how to inject a little heparin into one bag a day to dissolve the fibrin. Ask the training nurse if what you're seeing could be fibrin and how to keep it from clogging the catheter.

If you can't read the lettering on the front of the bag when looking through the solution through the back, she may have peritonitis. Call the nurse. Generally they want to take a sample from the bag to test it to see what bacteria is causing the peritonitis to know what antibiotic is best to treat the infection. Peritonitis should be treated right away. Not only can it be painful but the infection can scar the peritoneum making it less able to allow the wastes to pass through from the blood.

Here is a website from the UK that lists possible problems with peritoneal dialysis:
http://www.kidney.org.uk/Medical-Info/pd/pdproblems.html

dinangkur
June 15, 2007, 08:38 AM
Hello,
Ya you are right it's looks like cotton fabric. I can inject heparin so it won't be problem. There's another thing, since from the begining of her dialysis an antibiotic injection is going on 3 times a day which is CEFTAZIDIME 500mg/vial. So i think there is no way infection could happen.
But still I need your suggestion and I'm looking the url you provided.

Thanks

Beth Witten MSW ACSW
June 15, 2007, 08:52 AM
I would not suggest doing anything until you talk with her doctor or training nurse.

Why is she taking an antibiotic and how long has she been taking it?

dinangkur
June 15, 2007, 09:30 AM
Mom's doctor is not avilable now but i talked with the nurse she suggested we better check to night drained fluid and let her know. I don't know why this antibiotic is going on but doctor told us to continue for 14 days from the dialysis started, he also told to inject vancomycin on the 5th day and we also did that.

Beth Witten MSW ACSW
June 16, 2007, 03:59 PM
If she just recently had her catheter placed, it may be that the doctor prescribed antibiotic to try to prevent her from getting an infection.

What kind of training did you/she get in how to do PD at home? How many days and hours per day was it? Did her dialysis program provide any reading materials to take home to review later? What did the nurse tell her about how to care for her catheter? Was she taught how to use sterile technique to make connections?

dinangkur
June 18, 2007, 09:44 AM
Hello Ben,
Lots of question I try to answer. First of all my mom is a paralised patient and her right side is totally off. So she can't do any part of the dialysis by herself. My father and me do the dialysis most of the time.It's now 20 days after the operation and from today we are stopping to give the antibiotic.
Actually PD nurse showed us for 7 days for 3 times a day how to do the dialysis and keep everything in sterile condition while the nurse was doing the dialysis. So far no reading materials was provided for us to read that later.They only gave us a proforma to keep the record of her dialysis(i.e time, amount of fluid, any medication, fluid color etc). That is all.
Me after taking back my mom home experiencing lots of problem so far I've asked you some.
Thanks to you about my previous problem I've asked the doctor directly he told me give Heparin now her drained water is clear and we are putting her two litre 1.5% bags at moring and at night. Yet she feels pain in her back in the kidney position and also her lower abdomen. We told the nurse about this, she told us to make my mom to walk but she is so much weak that even we can't move her while holding side by side. Doctor to keep her feed all the time. But she has a tendency not to eat we don't know why?Before dialysis she used to vomit but now she doesn't and takes food in small quantity. We try to give her rich food (like egg, milk, fruits etc) so that there should be no defiency. We are trying our best.

Thanks

Beth Witten MSW ACSW
June 18, 2007, 11:01 AM
You might want to look at the nutrition module of Kidney School that fits with her condition. It's divided into 4 sections: Hemodialysis with diabetes or not and PD with diabetes or not.
http://www.kidneyschool.org

She needs to eat enough high biologic value protein (usually animal sources) to get her albumin level to at least 3.5. If her albumin level is low, she is at higher risk of infection, hospitalization, and even death. Eating several small meals a day is one way to help people with poor appetite get enough nutrition. Some fruits and vegetables can be high in potassium which can affect muscles and make them weak and can cause the heart to beat irregularly. Be sure you know which fruits and vegetables have high levels of potassium.

If she's depressed (which is common especially with people who are new to kidney failure and dialysis), this could affect her appetite. You might want to read the module of Kidney School on coping with kidney disease.

If she's weak, it could be because she's anemic. Most patients on dialysis are. She may need iron and EPO shots to help build up the red blood cells that carry oxygen to the body tiessues. Without oxygen muscles get weak.

It could also be because she's debilitated and needs to move around a little more. Helping her to walk short distances several times a day can help her to build up strength. Life Options has an exercise booklet for people on dialysis that starts out gradually with exercises she can do sitting down. You can find this booklet under free materials for the booklet on exercise for people on dialysis.
http://www.lifeoptions.org

dinangkur
June 18, 2007, 12:54 PM
Hello Beth,
After reading your reply I'm pretty much depressed with our country's doctor. My mom's doctor didn't told anything what you have just expalined, he just gave us a small prescription to eat everything and make tastes after one month of Hb%, S. urea, S creatinine, S.electrolytes,S.calcium. Fortunately your explanation fits exactly to my mom. just a moment while I looked back all of her test report but there was no albumin tasting report. I guess doctor has never done it.
I'll check the albumin level after 10 days, it will be a month then meanwhile I'll check the Diet.

t is true that her heartbit is to much fast and some times it makes harder for me to check the exact BP level. Today it was 110/75. We happen to give her a banana dailly besides other fruits. It's highly potassium food and I never knew this matter.
She's is litle bit anemic too. We are giving her iron tablets but I didn't understand EPO what's that?

I'm checking the addresses you provided.

Thanks for your appreciation

Beth Witten MSW ACSW
June 18, 2007, 01:45 PM
I am really glad that you asked and hope that you get the information that you need about how to provide her diet the best diet so she can feel better and do more. Diet is a very important part of how well she'll do. You might want to share the Kidney School site with your mother's doctor. It might help him/her help someone else.

EPO stands for erythropoietin. Erythropoietin is a hormone produced by the kidneys that tells the bone marrow when to make red blood cells to replace those that have died. When kidneys don't work right, the body doesn't make its own EPO. Scientists have figured out how to make EPO. In the U.S. EPO is sold as brand names Epogen, Procrit, or Aranesp. It may be called something else in your country. You might want to read the Kidney School module on Anemia and Kidney Disease (module 6).

dinangkur
July 7, 2007, 04:53 AM
Hey Ben
It's quite good for somtime. Please don't feel otherwise again feeling some trouble, my moms' fluid that is coming out is qute clear, I can read the letter through it but i tlooks quite reddish in color.

Few days ago alot of fibers were coming with the fluid then pd nurse told us to use heparin and I used it 3 days continuously utill the fibre stops coming but the color of the fluid has been changed,

Any suggestion on this.

Thanks in advance

Beth Witten MSW ACSW
July 7, 2007, 02:02 PM
If the PD solution is reddish, it could have blood cells in it. I don't remember how old your mother is, but some women notice that they have some blood in their PD solution around the time that they ovulate or when they have their period. Does she have any pain? If so, it's possible that the catheter is rubbing causing some bleeding. Perhaps the amount of heparin that she got made her tissues bleed a little. Tell the nurse what you've told us and ask him/her what could be causing the bloody solution.

dinangkur
August 11, 2007, 05:34 AM
Hi,

Back with some more questions regarding fluid color. For last 10 days mom's drained fluid is not clear. If we leave the fluid for an hour then some white paste like product store at the bottom of the fluid. Then the color of the fluid is ok. I don't know why this is happening. We asked doctor, he gave us antibotic injection. We will start from today. But he is saying that color might not be ok in future. We are not sure what he meant by that. Can you please explain what might cause this? Is she lossing calcium or protein? Thanks.

Dori Schatell
August 11, 2007, 11:16 AM
It's probably best that you ask the doctor what he meant. I'm actually wondering if the "paste like" product might be strands of fibrin, which is a type of protein that is usually harmless (but can block the catheter sometimes). It's very good that you are keeping a close eye on the color of the fluid and alerting the doctor when it doesn't look right--that's just what you should be doing.

Beth Witten MSW ACSW
August 15, 2007, 07:18 AM
Has the doctor or the nurse seen any of the drain bags that look the way you describe. Is it possible to show a bag like this to one or both of them. If they don't think what you see in the bag is fibrin, they may want to do a culture on the solution to see if your mother has peritonitis, an infection of the peritoneal lining that is usually caused if there is a problem with the technique used to make the connection to the bag (breathing on the bag without a mask, not washing the hands thoroughly enough, not cleaning the exit site thoroughly enough, touching supplies incorrectly, etc.). In the U.S. patients who have peritonitis are usually taught to inject antibiotic into the bag of solution to clear up peritonitis. It's also important to know what bacteria is causing peritonitis because 1) you can tell where the bacteria is from (skin, nose, etc.) and what antibiotic will kill the bacteria. Knowing where the bacteria is from, can help the nurse know if he/she needs to do more teaching on how to avoid getting peritonitis again. Knowing the type of antibiotic that will kill the bacteria is important to clear it up fast so the peritoneal membrane isn't damaged.

dinangkur
November 4, 2007, 12:28 PM
Back with major Problem, Don't igonre viewing this huge post

Hello Ben,
It's been quite long since my last posting.I didn't get enough time to update my posting or get any sugeestion.
It's Mom all through my mind. And its my last hope that i would get some suggestion from you. Since the last posting she's got several peritontis attack.
And everytime I manage to keep it clean through antibioitics.I must tell you that none of the nurses nor the doctor had seen her after operation been made from the hospital.As the hospital is not in my city and I couldn't take her
because she's got paralysis in one side fully but I managed to keep informed them through the phone and told them the condition. Mean while few months ago again she was injured with brain stroke, she recovered after three days slowly. At that time I didn't stopped the
dialysis but continued. She was fine the but unfortunately her body condition was deteroiting that is she was not getting any physical strength. Don't know why? Doctor couldn't help us except saying that se will be alright. But she didn't recovered as per capd patients do.
Hb level in her blood was getting lower. We could hardly manage blood which is B-, one of the rare group in here. Still i found one bag B- blood and given to mom. I must tell body condition is still not good and geeting worse. We found her Hb level 8 and S.creatitine 5.1. I
don't understand how it is satisfactory but the doctor told me it is satisfactory result.
Now few weeks ago a serious condition occured at the palce of her operation point in belly some kind of water began to store as a result the skin was bulking, Finally it brust out with water. At this condition when I do the dialysis of her water comes trhough that point(for your understandin I'm attaching some pic of that place).
As per instruction we stopped the dialysis and continued antibiotics for seven days and we star the dialysis. I wwas fine after two days of starting dialysis same condition began to occur and now the doctor is not helping us he is telling us to take her to the hospital where the previous operation was made in another city. Actually he don't want give any
suggestion without money. This is what happen in our country bangladesh. Now our family doctor who is expert in medicine told us judging on moms physical condition that it will to risky to move her from one palce to another. He gave her(Gatifloxacin 400 mg daily one and Flucloxacillin 500 mg three times in day inorder treat that palce so we can do the dialysis. Dialysis is topped now.
My request if any thing could be done so that we could do the dialysis. I know i can't save her but still I want to try till her death so that she suffers less. Moms kidney doctor is not helping so I've no choice rather ask for your suugesstion.
Please do not through away viewing this huge post.

Help me!

Thanks

Unregistered
November 6, 2007, 10:05 AM
Hi,

It sounds like there are several things going on with your mother.
The strands or white stuff in the drain bag is fibrin, and the heparin will keep it from clumping together, which is important, because you don't want it to clot the catheter. You might try using the heparin in the overnight bag, once a day as long as there is still some fibrin in the drainage.

The reddish color of the dialysate is from red blood cells. This happens after surgery, or there can be bleeding from infection or trauma or chemical irritation.

The photos look as if there is an subcutaneous infection - an infection in the fatty tissue along the catheter. It sounds like there was "leak" where the dialysis solution seeped along the catheter from the abdomen into the muscle and fat. This often leads to an infection. And once you have an open wound as shown in the photos, there can be more contamination and more infection. Once the infection is in the catheter cuffs, it is very hard to cure, because the cuffs don't have a direct blood supply, so the antibiotic doesn't get to the infection in the cuff. A chronic infection also contributes to the "low blood".

I think the best treatment would be for your mother to go back to the surgeon who put in the catheter.
If that is not possible you might try to do dialysis only with your mother resting in bed and reduce the volume of the dialysis exchange to see if lowering the pressure in her abdomen will reduce or stop the leak.

We usually wait at least 2 weeks without dialysis hoping for a leak to heal. That is, for the opening that allows the leak to heal and close. You might try this again, but you need to check with your doctors to see if your mother can do ok without dialysis for that length of time. You might also need to be careful what she eats and how much she drinks while she is off dialysis.

Finally, you need to continue to treat any infection - either peritonitis, or an infection in the track along the catheter.

Your mother is fortunate to have someone who is so concerned about her and takes such good care of her.
My best wishes as you continue to deal with this very complicated situation. - A PD nurse from the USA

dinangkur
November 6, 2007, 08:33 PM
Thanks for the reply. I'm trying to do my best

helenkim
November 24, 2007, 12:57 PM
It sounds like your mom is same size as my mother. She was on PD for five years and recently changed to Home Hemo option. Like you and your mother, we were very new to the whole dialysis thing. So at after looking into things, we chose PD and exception for first 2 or 3 times, my mother did not handle the PD well at all. She counldn't handle the volume. The clinic suggest 2000 ltr 6 or 7 cycles each night. She was only able to handle 1 ltr which was not nearly enough to provde adequate dialysis for her. During this period, she had problems with swelling, vomitting, loss of appetite, phosphorus, you name the issues, we had it. Toward the end of it, she was doing 1300 volume 7 or 8 cycles, 10 hours each night. She still had all those health issues.

We are learning that there are no perfect solutions, however, we learned a year ago of the Home hemo dialysis using a machine called NxStage. After convincing her to try it for over a year period, we just started and realized that she should have been on the hemo all along. First, size of her body is too small to handle the correct volume to receive adquate dialysis.

After the surgery for Fistula, we began the home hemo training and hours are shorter, 2 to 3 hours, five times a week, and she looks different already. We are hoping to complete the training and do it at home, six days a week.

There are not perfect solutions, however, for our mother is also 4.9" tall and was 46 kg. You can email me at: helen.kim12@yahoo.com if you need to talk to someone. Hope this helps. Thanks.