Pain With PD

My daughter is 9 years old and has been on PD for a month now. She cries through her exchanges saying it hurts. She says it hurts in her stomach and in her upper leg. If anyone could offer any insight to this, I would appreciate it. I wasnt aware that PD would be painful. I have made her doctors aware of it and they are not putting to much into it except saying that it will get better with time, well, its been a month now!!! Has anyone else on PD had pain with the exchanges?

Does your child do CCPD (cycler) or CAPD (manual exchanges). Does the pain start right away or is it worse toward the end of the fill? Where does she feel the pain? How long does it last? How warm is the solution when it is drained into her peritoneal cavity? How much solution are you using with each fill?

She does CAPD, 4 exchanges a day. The pain starts about the middle of drain off and last thru the fill. She has pain in her stomach and in the top of her left leg. The solutions is kept in a cooler with a heating bag set at low. It is not too hot. We fill each time with 800ml 1.5% solution. Thank you for your response.

[QUOTE=kirstins_mommy;11956]My daughter is 9 years old and has been on PD for a month now. She cries through her exchanges saying it hurts. She says it hurts in her stomach and in her upper leg. If anyone could offer any insight to this, I would appreciate it. I wasnt aware that PD would be painful. I have made her doctors aware of it and they are not putting to much into it except saying that it will get better with time, well, its been a month now!!! Has anyone else on PD had pain with the exchanges?[/QUOTE] Can you tell me …are you from Canada ? I feel for you right now she’s a baby on PD that to me is just outright $%@%$ I have a feeling that you may not have been aware of “ALL” options. Richard C/O Jessie (18)

Actually, children are MUCH more often placed on PD than hemo, and it makes sense to do it this way. Needles are even harder for children to handle than for adults (who often don’t handle them well), and PD has a number of other advantages as a first therapy for anyone, which you can read about in our article at: http://www.homedialysis.org/v1/rotating/0206topicofthemonth.shtml.

Kirsten’s mommy, I’ll forward this thread to a couple of PD expert nephrologists I know and see if they have any thoughts about questions you could ask your daughter’s doctor or nurse, or tests you could request to find out what’s going on. Pain is not normal in PD. Sometimes people who use a cycler have a “pulling” pain when draining, or a referred pain to the shoulder if there is air in the lines; or a misplaced catheter can cause pain. But I don’t recall hearing of anyone in pain from doing CAPD. I’ll post any replies I get.

I heard back from one of the nephrologists, and here is what he said:

"Minor pains related to PD usually subside within 2-3 weeks, so painful dialysis exchanges for more than a month requie re-evaluation by the girl’s nephrologist.

The most common reason of pain at the end of drain and the beginning of inflow is a too-long catheter with a straight intraperitoneal segment. The pain in the top of her left leg may indicate that the tip of the catheter is located very low in this area. Plain X-ray may show whether this is the case.

It is also possible that the girl’s peritoneum is very sensitive to pain, even with slightly lower pH at the beginning of inflow; however, this would not explain the pain from the middle of outflow.

In my patients I used the following maneuvers to alleviate the pain:
• Slower infusion and drainage rates
• Incomplete drainage
• Tidal mode for nightly peritoneal dialysis (not suitable for CAPD)
• Solution alkalization (Na bicarbonate: 2 - 5 mEq/L)
• 1% Lidocaine - 2.5 ml/L (50 mg/ exchange)
If these maneuvers were unsuccessful, the catheter was replaced.

Instead of a straight catheter, a coiled catheter should be implanted. It would be advisable not to insert it very low. Most of the pediatric nephrologist insist on partial removal of the omentum, so I believe that the girl had this already done."

Omentum is a “curtain” of tissue inside the peritoneum that can block the flow of a PD catheter, which is why it is often removed. I hope this helps–you can print the email off and bring it to your daughter’s nephrologist.

My son is 12 and he does ccpd, he has pain during the initial drain and the first fill. He said his pelvic area hurts and i’ve had to give him tylenol a few times and just distract him by playing games. During the dwell it seems to feel better. It’s been 2 months now, he was on dialysis before when he was 6 and never had this, i think it’s where the tube is placed. He had recurrence of FSGS in his transplanted Kidney.we are waiting to retransplant soon.
*(Fingers crossed). I hope your daughter feels better.