Pain with PD dialysis

Ask Our Experts Dr. John Agar, Nephrologist
1

i am on PD dialysis is more than year: exactly 1year and three months. I have pain every night since I am using PD machine. After first surgery I have mostly drain pain. Eventually a year after using PD machine (May 2017) I have met with surgeon. Surgeon told me that the way I have explained my pain, looks like my catheter moving and should be make static. Surgeon however, did not promise that I would get rid of pain completely. I was not happy with this response, but I have decided to do a surgery.
The second surgery was on 6/19/2017… Form the beginning I felt insignificant pain on right side of lower abdominal, but then it become mush worst: I felt pain not only during end of drain cycle, but also during fill cycle and after that. I have also started to have pain just walking during the day. I have decided to visit gynecologist. Gynecologist suggests ultra sound and then cats scan. Nothing was wrong with, however cats scan result said this:
“There is moderate amount of free fluid noted in the cul-de-sac with dialysis catheter noted in the right lower quadrant with the tip noted adjacent to the uterus”.

Does this description explains that the such catheter placement can cause PD dialysis pain?

Is any way to exactly determine the correct placement of catheter without doing number of surgeries? I have two for now with no success.

Thanks for response

1 Like
2

I have passed on your question to a nephrologist and long-time PD expert, and will post the reply when I get it.

3

Okay, the doctor has some questions for you:

  1. How tall are you?
  2. What is your infusion volume (PD bag amount)?
  3. Is your pain most severe early in the infusion?
  4. Has adjustment in your prescription been tried–maybe a change in the % of glucose in the bags?
  5. Have you tried manual daytime exchanges, and if so, did they help?
4

Here are my answers:

  1. How tall are you? 5 feet 4 inches
  2. What is your infusion volume (PD bag amount)? 2000ml
  3. Is your pain most severe early in the infusion? most severe at the end of the drain and early in infusion
  4. Has adjustment in your prescription been tried–maybe a change in the % of glucose in the bags? I am not sure I know answer to this question. I am using 1,5% yellow
  5. Have you tried manual daytime exchanges, and if so, did they help? I do not do manual infusion, but Davita did manual exchange soon after second surgery and I have still have some pain. Even using machine soon after second surgery(6/19/2017) I had some pain. It become worst now. Now i have severe pain.
5

Thank you for your quick reply! I will share these with the doctor and let you know what he says.

6

Okay, a few suggestions:
– 1). A 1000 mL (1 liter) infusion might help.
– 2). Try keeping the drain bag to just 18 inches below the level of your mattress, to reduce the amount of pulling.
– 3). Ask your doctor about adjusting the pH (acid/base level) of the PD fluid. The standard bag is toward the acid side, and some people are sensitive to this, which can cause infusion pain.

7

It could be that the pain you are experiencing is due to blockage on the cath. This will not show up in scans if fibrin is the cause. You should not have had a second surgery prior to scans being performed. Surgery causes scare tissue which will interfere with your peritoneal cavities role in the dialysis treatment.

Have your PD doctor order the nurse to use heparin to dissolve the fibrin and see if this eases your pain.

Hope This Helps!