I am doing at PD at home it’s been a week and they have doing 4 exchanges 2 yellow bags 2 green bags I think they are overloaded me on fluid my legs are swelling and stomach feels like I have a t a lot fluid left in even though I take off what I put in and maybe a little more I told my RN she said it will get better with time I think it’s getting worse not sure what to do was going to try to get my doctor but not sure how you get him he goes all over he’s the clinic doctor I don’t like that I use to have a kidney doctor I went to his office but he do t see dialysis patients I have to been seen in clinic but with PD your only seen once a month not sure what to do I think my script needs lowered to less exchanges
Did you just switch from hemodialysis to PD or did you just start dialysis?
Hello! The best person to call with these types of concerns would usually be your PD nurse, and I hope you have done that again if you are still feeling unsure of yourself. Your nurse is correct in the sense that in the first couple of weeks of PD, some patients get a little bit puffy as they learn to manage fluid-- especially if they’re coming in after having been on HD or have little (if any) residual kidney function. People really do sometimes see improvement little by little. However, I have had to dialyze PD patients coming off on HD to avoid fluid overload on occasion. You’re still in your first week, if I were your nurse, I’d want to know you were feeling like this.
It sounds like the “little by little” approach might not be working well for you right now if you’re finding more swelling in your body. The best way to track fluid status is by weight on a regular basis. One of the first questions I would ask if I was taking care of you, would be how above your target weight are you?
The next thing I’d want to look at is your treatment sheets. It’s good that you are taking off more than you are putting in, it’s a solid start, but by how much? It sounds like you need to remove more fluid than your current plan. It could also mean you’re not fully draining and putting more fluid weight on that way.
Have you noticed yourself drinking more since being on PD? Sometimes the sugar in the bags makes people thirsty. If you’re having fluid build up, you may need to think about limiting how much you’re drinking until you get into balance. Are you constipated at all? That can prevent fluid from draining fully out.
If you were my patient (NOTE: this is not medical advice) one of my first suggestions here would be for you to switch out at least one of the yellow bags for a green. You remove the least amount of water from your body using the yellow 1.5% strength. You should remove a little more water using a green 2.5% bag. A lot of PD nurses start off on a 2-1-2-1 CAPD schedule, I would think that a 2-2-2-1 would be better. If you didn’t see slow and steady improvement after that, I would probably say go for the red bag. Again, this is not advice.
Keep good records of your weights, blood pressures, and exchange volumes. Keep in touch with your nurse especially as you adjust to doing this yourself. It’s okay to call every day to report a weight and come up with a plan for which bags should be used and talking about the results. If you were my patient, that is what we would be doing. Hope this helps a little.
I didn’t see anything on this about diuretics. Do your patients not have high dose diuretics to promotes RRF? If patients have fluid our eyes should first be focused on how can we regulate and maintain more of their fluid balance with their own body. Why increase dialysate and dextrose exposure if there’s a possibility urine output can increase? There are far too many dialysis patients not on diuretics on HD and PD.
My patients did indeed have high dose diuretics on board, and I’d always much rather kick patients in the kidneys with diuretics than sugar-blast a volume overloaded person on PD. That said, I don’t know if this patient has RRF or if they came in with nothing after having been on HD. I needed that question answered first before going there. Until then, we can probably both agree that the patient should probably not be using 1.5% (especially on that day exchange) if they’re getting overloaded in the first week. In my own practice, I prefer adding an extra 2h 2.5% exchange during the day to it balanced if needed, rather than go for a 4.25% but I didn’t say that part either since technically that would be giving advice, and remember-- this is a patient who has been home for one week. They truly need to be receiving this information from their own home program and conferring with them over changes to the plan. 