My 68 year old father is currently in the hospital about to undergo the procedure to implant the catheter for PD. I am assuming that he will be given the option of doing the exchanges or using the cycler. Given that he does not sleep for more than 40 minutes at a time and is up constantly throughout the night, using the exchanges will allow him the freedom to choose the PD schedule that works best for him. Is this correct so far?
The next issue he faces is that he may not be able to wait the 4 weeks of healing time of the catheter because they need to remove the fluids while he is still hospitalized and ease his labored breathing. The question is, how soon can they start PD after the catheter is implanted?
And last but not least is the issue of attending 3 to 4 days of intensive training to learn how to do the exchanges. He currently doesn’t have the energy to sustain himself for an 8 hour period at a time. My initial thoughts are to get a jump start on his PD trining while he is still in the hospital, someone who can answer all his questions, allievate his mind,and begin an exchange training program with him. Is this a reasonable expectation?
Thank-you, to all involved in this wonderful site for the communication and the opportunity to be involved with outr loved ones healthcare.
Welcome to Home Dialysis Central. I’m a site administrator, not a PD nurse, but hopefully I can get you started with some info & other folks will jump in.
Given that he does not sleep for more than 40 minutes at a time and is up constantly throughout the night, using the exchanges will allow him the freedom to choose the PD schedule that works best for him. Is this correct so far?
Um, yes, pretty much, so long as the manual exchanges (if that’s what he chooses) are spread out over the course of the day. Usually they’re done at breakfast, lunch, dinner, and bedtime. If your dad doesn’t spend 8-10 hours in bed at night, a cycler may not be the best fit for his lifestyle. Why doesn’t he sleep better, though? That little sleep may interfere with his cognitive functions, and I certainly hope he doesn’t drive a car–sleepiness is as deadly as being under the influence of alcohol or drugs when driving. If possible, it would probably help his overall health if he could sleep better.
The question is, how soon can they start PD after the catheter is implanted?
How long the catheter must heal can depend on the individual. In many cases, the medical team will put a central venous catheter into a patient’s neck and start them on hemo–this is best avoided. If the catheter isn’t fully healed, another option may be low volume, recumbent-only PD, which means he’d do exhanges with less fluid than usual, and only while laying down, not sitting up. We have an article on this technique that you can print off and bring to your dad’s doctor to see if this might work for him if his catheter isn’t ready to use for regular PD. You can read the article at: http://www.homedialysis.org/v1/rotating/0505topicofthemonth.shtml
My initial thoughts are to get a jump start on his PD trining while he is still in the hospital, someone who can answer all his questions, allievate his mind,and begin an exchange training program with him. Is this a reasonable expectation?
I’m really not sure about this one; it will depend on the hospital and training nurse. If your dad is cognitively impaired, they may be reluctant to allow him to do PD at all unless someone else is there to help him & also go through training with him.
Thanks for the welcome and for getting back to me. His sleep issues are really twofold. The first of which is that he has rarely needed more than 5 hours sleep a night, and has always been an early riser. The second as of lately involves claudication in the legs and finding a comfortable position to sleep in. But his cognitive function remains as high as ever, and he does nap thoughout the day as he needs it.
So the issue of cycling during the night vs exchanges throughout the day kind of points to doing exchanges, unless of course he can tote his machine throughout the house during his nightime excursions.
He did have his catheter put in today and there was discussion about putting in a central venous line until the catheter site is ready to use. So you were right on the mark there, it did help us to better understand the direction in which the Docs were going and what they were going to do as far as getting the fluid from him before they release him.
Thank-you so much for the information, it helps a great deal.
As far as his education classes we will look into setting up an initial consult through his kidney doc, to see what options are available to him and my mother. I would have to imagine that there are alternatives to those who cannot withstand the rigors of all day-3 to 4 day classes.
Finally, just to give you an idea of what my father has gone through in the past couple of years. He is a high risk cardiac patient with a dual pacemaker and defibrillator. Less than 2 years ago a kidney thought to be cancerous (turned out to be a simple cyst) was removed, and the other one damaged during an abdominal aortic aneurysm procedure coupled with a phem-phem bypass. (probably could have qualified for a buy two get one special).So you can imagine the stress on the heart and the trouble breathing with the fluid build up, and the urgency to get the PD port going as soon as possible.
Once again, ty for the info, I’ll let you know how things turn out…
My daughter has been on PD for 3 yrs. She uses the Cycler at night, and we do one exchange in the afternoon. PD does allow more freedom and we can choose which best fits our life styles. Since your dad has issues with sleeping at night because of leg problems, and this could be restless Leg syndrome, very common in renal failure and dialysis patients. I watch my daughter sleep sometimes and her legs just MOVE, JUMP, I know at time these movements keep her awake, and also on occassion she has SCREAMED and jump out of bed with leg pain, cramping. I have found that this is a very good indicator her PD needs adjustment< with the correct dialysis this is occurs less. The PD Nurse will do accuracy testing often, at least I hope so, very important. Many problems while on PD happen because the patient may need the fliud intake adjusted. Making sure the PD is accuate is so important !!!
My daughter has had 2 PD caths. Both were used right away, we were trained on her first Cath. while she was still in. Spent 3 days of intensive training. She lost her first Cath. 2 yrs. later to infection. For her second Cath. we did 48 straight hrs. of diaylsis, surgeon pulled it and she had Vancomycin and we had hoped she could go 5 days without dialysis before re placing another Cath, she only made 4 days due to potassium levels. It was replaced and we used it that night. Worked fine ( Thank goodness) After all this time I know I am thankful we trained as we did right after the Cath. was put in while she was still in the hosp. Even now she will have should pain now and again. Make sure when you PRIME the lines the AIR is out, I have learned it PULL and CLICK the line with your finger to make sure the air is out reduces this from happening.
I wish you all the best and remind your Dad, to take those Phosphrous Binders !!!
Is this drowning feeling common when starting? How, exactly, does it feel like drowning? I nearly drowned once and I think I might panic at the feeling.
Aside from that, what does PD feel like? I’m on HD now and sometimes when I’m carrying too much fluid I feel bloated like I’ve eaten too much and it’s difficult to breath. And by too much fluid I mean still less than 3 kilos, so it not that much by some standards. I’m concerned I might not be able to tolerate PD.