Drain Alarms every night

My father started PD 1.5 weeks ago and his drain alarm has gone off every night 1-3 times. He gets up and moves around and it is OK until the next drain. A lot of what I have read so far is at least 1 year old (usually more) and I know how fast technology moves so I thought I’d post again. He is on the Fresenius machine.
Advice I’ve seen-

  • Lower height of machine (I’ve seen bottom should be 6" below top of mattress)

  • Raise height of machine

  • Use Tidal mode

  • Change to one 2.5 bag and one 1.5 bag

  • Try different sleep positions

Obviously he will discuss with PD providers but I’m really confused about the machine height thing. Is there an ideal height (and if so why isn’t the cart that comes with the machine at that height)?

I just have to say that it is very disappointing that the people who presented this option to him didn’t tell him how common it is that his sleep would be disrupted 3 times nightly. They painted it as a perfect solution.

Thanks in advance

I am sorry to hear about the drain issues. I would not call drain issues common, I would say it’s the surgeons placement that is this issue. Unfortunately tidal will be the only option to help with the sleep unless you do have a second surgeon (with more experience with placement) look at it via ultrasound and X-Ray for potential adjustment.

If you father has at least a liter if urine a day, and some residual GFR…there are some very amazing once a day options using a manual exchange, no cycler.

Above all work with your PD nurse to find the best solution to keep your father on PD. This can be fixed and there are options for him to stay successful with PD and get rest.


Thanks Josh - I would say that manual is not an option. At 85 setting up the cycler is fairly intimidating but the 36 step manual process is terrifying to him and unfortunately he is alone most of the time.

We do a Only one 2L bag of extraneal that dwells for 12 hours. It’s a supply order of only 5 cases vs 35 cases a month for the patient. Most people think manual and picture 3-4 times a day, that’s why we hope to educate about “FILL, LIVE , DRAIN.” Extraneal also has no dextrose so is great for helping with A1C.

Ask your PD nurse and doctor and start with the tidal At 100cc it by 100cc until he finds the appropriate number to keep him sleeping. That has worked well for patients in the past. It’s important not to leave too much tidal or it can lead to overfilling. Hope you get it handled soon!

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What about hos bowels. They need to be totally empty for the machine to work . Ive been advised to use laxitives every day to keep my bowels empty otherwise im wakend by the machine alarms.

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Thanks Josh & Sherbear - I think he’s solved the problem. If he sleeps on the same side as the catheter while draining and that does the trick. He was sleeping on the opposite side before and I guess that kept the solution and catheter too far apart. He almost never alarms anymore.
Thank you both for taking time out to answer. Have a great day.

Very cool. Sometimes it’s the simplest fix to get the results you need!

i just wanted to shared my issues. i been hd for 7 yrs till i was forced over to pd on xmas since my arm got infected and the clinic ignored it after several surgical attempts my arm clotted . i started getting drain problems after i lost weight. then i started getting constipated and getting impacted stools after 6 mths. the manual would drain out About 2-300 extra litre of fluid where the machine beeped all night. it worked for a while when i laid in my right side. but it started slowing down more and more. because it was taking so long for me to drain it was cutting into my dwell time so they adjust the machine to no matter how long it drains my dwell still stays at 90 mins, which makes my total treatment to no less than 10 hrs. if i fell asleep hard and i dont hear the alarms to resume ill stay at the same cycle. one day i had to dialyize for 20 because the alarms kept me up and i was so tired id fall asleep during the alarms. i also developed alot of stomache issues, such as slow digestion. i barely eat just so i can dialyze. i refuse to get a revision cuase it has nothing to do with catheter. they also wanted to cut my omentum but i refused. your omentum is a very important piece of far to keep to prevent infections. clinics and docs dont always know best…

What have you done about the constipation? Are you taking linzess to control it or just senna and colace? Every problem You are describing is related to constipation and drain issues…lost dwell, etc.

Here’s information about different kinds of PD catheter problems. There is a section on problems with outflow. It recommends ways to correct the problem. You might want ask your doctor to do more testing to determine the cause and/or seek a second opinion. As Josh says, constipation is a very common cause of drain problems and this article gives some suggestions for that. https://advancedrenaleducation.com/wparep/article/complications-of-pd-catheters/

I understand pd can take awhile to adjust to your body. It is true you must have empty bowels for it to work properly. It took me a good few wks to get my bowels to empty enough with laxatives nightly. I was also having a lot of pain even during the day with a poking feeling which we felt was the end of the tube in my belly. Was too long as I’m very small so we took a piece off to make is smaller which helped . I now drain with no alarms and very little pain.

Thanks so much for sharing. It is so important to not only have the negative situations, but to include the struggles and success. It can sometimes take me weeks to get a patient successful. Urine output, solution volumes. It’s important to be patient with the nurse and doctor while they fight for your success. It’s especially hard if you have been on hemodialysis for a while before transitioning to PD. The important take away is stay positive and fight to stay on it!

Hoe long have you had the machine? Because overtime the tiny drain holes in the cassette bay may get plugged up do to the toxins contained in the drained fluid. I set the drain line to drain in the bathroom sink and over time a thick layer of white stuff formed around the bathroom sink drainage formed. What happened with the bathroom sink is same same fluid coming out the peritoneum throught the tiny drain holes in the cassette bay, therefore it can be inferred that overtime thay also get plugged. I had the same problem and asked for new machine, I recived on Sunday and no more alarms the treatment goes flawlessly.