PD drains

Hi Judy,
My wife went through alot this year with her kidneys. In May, her kidneys are shutting down due to polycystic disease. We had her right kidney removed and a PD cathidor installed. She was on Hemodialysis for about a month. Then we started the PD dialysis. At first, it was not working out. She went down to radiology. They put a dye in and found that they had to move the cathidor. They insert a wire and move it. Then, we tried it again. It still wasn’t working out. Her initial drain would vary so much, 538 to 1008 ml. And the UF also vary each night, -382 to 317 ml, that is right a negative 382 to a positive 317. She was retaining lots of water though. Her ankles were swollen. She was filling up with fluids. They put her on Hemodialysis for about 3 weeks. She lost the fluid within a week. They also move her cathidor all together. Under surgery, they removed the original one and insert a new one on the other side of her belly button. This is the second day of the PD dialysis. And it is not working again. The past two nights, I hardly had any sleep. The alarm keeps on going off. Yesterday, it was only for initial drain and 1 of 5 drains. The numbers was low. Initial drain was 21 ml. They only gave her 500 ml at the clinic. Total UF was -934 ml, not good. Last night, Every drain was alarming! Initial drain was 762 ml. And the total UF so far is -853 ml. Two sets of alarms goes off. One is Low Drain Volume and the second is Caution: Negative UF. And she is still on because we constantly got to shut off the alarm and resume the program. What can we do to make this PD dialysis to work?

I am so sorry to hear about all of your wife’s catheter problems. For PD patients, a good functioning catheter is of course of the utmost importance. There are several reasons for mechanical failure of a catheter. You did not say that the fluid went in easily–but I am assuming that it did. This means she has one-way obstruction of the catheter, and in her case it is poor outflow. The tip of the catheter needs to be deep in the pelvis and sometimes the surgeon has not properly placed the catheter there. Thus the fluid can flow in but not out completely, and fluid will accumulate in the belly with each exchange. Another reason for poor outflow is constipation, which is the MOST common problem in poor catheter outflow. In this case, even if the catheter is properly positioned, outflow will be obstructed. A very vigorous bowel prep is needed prior to surgery and it is important to keep the bowels open for the catheter to function well. Yet another reason for poor outflow is omentum wrapping around the tip of the catheter. Everyone has omentum in the peritoneum but some have a large, more active omentum. In this case, the surgeon needs to either remove some of the omentum or to tack it up to the upper abdomen to keep it away from the catheter tip. And finally, the catheter tip may flip up and lodge under the diaphragm and thus there is poor drainage. It seems that in your wife’s case, even though the surgeon removed the first catheter and placed a second one that perhaps it is not clear what the problem really is for poor drainage. The only thing I can suggest at this point is to addresss the issue of constipation with the neprologist and PD nurse. Perhaps several days of laxatives will be the remedy—but you must be sure to use only ones the nephrologist and PD nurse suggest. You could also return to the surgeon and ask for some explanation of the problems of the first catheter and the current one as well. The dye study should have told them about the problems. So, good luck. I know this is very frustrating. You may need a surgeon who is well experienced with PD catheters to help you.

The cathidor was moved. She had taken laxitives. We had found out that the machine was at fault. Now her readings are much better. Her total UF is over 1000 ml each night. We called Baxter, he suggested to exchange the machine and we did. Now, the only time the alarms go off is to check the patient line. We did everyting else trying to get it work.