Fresenius Slow Drain while laying down

Hello everyone my brother is new to PD just started about two weeks ago had his catheter placement on 7/24 /23. His post op and recovery went well. He did his training and everyone went ok. He has the Fresenius Liberty cycler and the very first night at home he got slow Drain alarms on his very first cycle, at around 1200ml out of 2000 ml. After checking all the lines for any kinks , making sure his catheter was ok we didn’t know what the issues was. The machine kept alarming and even the stop alarm turned on, so after calling after hours nurse she said to stop treatment. After letting his PD nurses know, changing the prescription and even getting a loaner machine to rule out malfunction he is still having this issue after every fill his has to sit up to drain. His liquid is clear and there is no fibrin , he isn’t constipated this only happens when he is laying down, sitting down he drains fine. His lack of adequate sleep is really starting to affect him. Has anyone had this problem I would really like to help him out so he can get the dialysis he needs.

I’m sorry your brother is having these problems. I reached out to a former home training nurse who had some suggestions that your brother might want to discuss with his nephrologist and home training nurse.

She said that when a patient has these alarms, it is usually positional. The end of his PD catheter that’s inside his body could have flipped, or it could be in a weird “pocket” somewhere, or up against something that’s obstructing flow. She also said that a “tidal” prescription can solve this problem. With tidal PD a portion of the dialysis solution is left in each cycle. The nurse can set the minimum drain volume to be lower than expected to “float” the catheter a bit rather than have the patient’s anatomy collapse around the catheter.

If it’s not positional, the initial drain low volume might be lower than expected because some of the solution is being reabsorbed if your brother has some glucose solution in his belly all day. If it’s predictable like that, the nurse can set the expected volume lower.

Finally, your brother could try positioning his cycler higher or lower than the height of the bed or he might try sleeping in a different position, like sleeping on a couple of pillows or elevating the head of the bed on risers. Those things might help.

It would be good if his nurse and doctor modified his prescription to see what could help. He needs to get enough sleep as too few hours or poor quality sleep can adversely affect health, thinking, and quality of life.

You and your brother might want to consider joining the Home Dialysis Central Facebook group. This members-only group has more than 7,000 members some of whom are on PD. Others are on home hemodialysis. Still others work in dialysis. People in the group share tips and tricks for living a good life with dialysis. There are 4 questions to answer to be admitted to the group, which you can find at Home Dialysis Central Discussion Group | Facebook.

My husband has been on dialysis for over a year now and he has always had problems with the drain. We have tried everything. No solutions. He is so tired he does nothing else. But sleep all the time. The only thing we have not tried is another machine.

OMG that poor thing! Yes! My husband goes through the same damn thing. Annoying for me, but he is lacking in sleep and I am worried how so little sleep will affect his heart. One thing that seems to calm the machine down, is sleeping on his back tilted upward (like he would on an adjustable bed that was raised up). We’re going to get an adjustable bed however for now he uses pillows. Strange thing is, he was using an adjustable bed in the hospital and their machine beeped more often during the night than my husbands at home. Another thing that goes wrong sometimes is the faulty hoses from Baxter that have leaked. Praying things get better for you brother… but have him try lying on his back propped up a bit - not sitting completely upright.

Another option would be to switch to manual exchanges. Others have switched and found that they slept better and were able to fit manual exchanges into their daily life.

I feel this is a very common problem. I do not feel it is anything that the patient is doing. I see it all to much. We have tried another machine and that did not work. He was in the hospital with another type of machine and it did not do it. Our next step is go back to the dr that put the cath in. I feel it is a waste of time. I truly believe it is their machine. HELP!!!

Thinking again about what you said about the drain working better when he was in the hospital on a different machine, how was he positioned in the hospital bed? Hospital beds may be higher or lower than your bed at home. Where was the machine compared to the bed? Was it higher or lower than the bed? Do you have an adjustable bed at home where he could try adjusting the bed to see if that helps. There are two manufacturers of dialysis machines. I suspect most clinics use one or the other, but you could ask the doctor to prescribe the Baxter machine that he used in the hospital. Some people have reported drain issues with Baxter too.

I heard there is an on going lawsuit against the liberty cycles for leaks in the machine. My husband is about to go on home dialysis and this is what he’s suppose to get. I am very concerned.wondering if anyone was able to get a different system on their insurance. Thank you for your time.

I looked on the FDA database for device recalls. In 2019 Fresenius recalled some items that could result in leaking into the machine if the cartridge on the cycler set is damaged. The cycler set includes disposable tubing and a cartridge that goes on the cycler machine. The FDA determined it was “use error.” However, the question is whether that determination is accurate and what could have been done differently to avoid that problem.

Most dialysis clinics have contracts with companies that make the equipment they use in-center and at home. You can read about the different PD machines at Peritoneal Dialysis Machines - Home Dialysis Central.