PD low drainage problem

Hello everyone. I have been on PD for a month and half now. My catheter was installed August 2008 - that is over 15 months ago. This past august my nephrologist found out the catheter was blocked by calcified fibrin and it was removed by radiologist using manipulation. I started the pd dialysis (CCPD) in mid September this year. Since I started the PD dialysis I was plagued by low drain alarm at night The doctor suspected constipation and gave me kleen prep but it did not help. He changed the 1.5% dextrose to 2.5% dextrose. The 2.5% gave me shoulder cramps and chest pains that were unbearable. The only down side to 1.5% dextrose is that I absorb 95% of it if the dwell time is more than an hour. He made 7.5% Icodextrine my day dwell solution. The good thing is Icodextrine removes extra fluids and I dont absorb it either. Only I absorbed it couple times and I think that was because the dwell time was 15 hours. Last Friday they performed a manipulation to correct the low drainage problem which they attributed to the tip of the catheter being stuck to the body of my belly. They corrected the problem by manipulation. They have used the die and cat scan to locate and manipulate.

The sad thing is that the problem is still unsolved and I continue to get the low drain alarms in every drain. I have 7 dwells of 1 hour and a last fill of Icodextrine. I called the nurse for answers and she contacted my nephrologist and I have appointment with him this coming Wednesday. She told me he wants to discuss alternatives for the PD. In the mean time he told me to use CAPD with Icodextrine as my night dwell and drain it in the morning. Absolutely no day dwell or exchanges since I absorb the 1.5% dextrose.

  1. My question is what shall I ask my nephrologist on Wednesday
  2. It is my wish to continue with PD and absolutely I dont want HD. What are my options.
  3. How can I convince the nephrologist to order another manipulation to correct the problem and place the tip of the catheter where it belongs.
  4. Prior to the last manipulation my bowel was cleared with kleen prep. Also Peritoneal cavity was filled in with TBA to make sure there were no fibrin blockage. Apparently as the cat scan showed the tip of the catheter got stuck to the skin of the belly due to mucous development as they said. They unattached the catheter tip from the belly on Friday.

Please advise with your opinions and input and thanks in advance

Here are a few questions you might want to think about or ask about:

Where is your catheter placed? Is it very low in your abdomen? Since the catheter is curled, it may not have much room to drain off fluid.

Have they tried using heparin into the catheter regularly to help keep down the fibrin development? Sometimes that works.

Has your nurse tried to see if they can get out the fibrin clot using a syringe? Sometimes pulling back on the syringe can cause a catheter to embed in the wall of the peritoneum or to flip the catheter.

Could omentum have wrapped itself around the catheter covering the holes that the solution is removed through? Omentum is a thin lininig of the peritoneal membrane that supports the internal abdominal organs. If so, ask if it can be removed or tacked up laparoscopically? This is possible.

Can they replace the catheter and put it on the other side of your belly or could you have a presternal catheter?

Thanks Beth for your great effort. Here is what have been done regarding my fibrin:

There is no longer any fibrin in the tube at the exit site. I use 1ml of fibrin on each bag every night. I use 2 bags of 5000ml 1.5% dextrose and 1 bag of 2500 of Icodextrine. I only use 1000 of the Icodextrine for day dwell when I use the cycler. Right now Im using only 1000 to 1200 CAPD Iodextrine for night dwell only and no dwells or other exchanges in the day time until I meet with my nephrologist next Tuesday the 10th. Also BTA which is more stronger than heparin was made to dwell in the PD cavity for 2 hours to un-clot any fibrin that may be around the catheter in the peritoneal cavity.

I will certainly ask my nephrologist if omentum is the culprit. I don’t have any problem with in-flow fluids but I do have an out-flow problem (poor or limited drainage).

The catheter tip is exactly where it is supposed to be according to the xrays and there are is no constipation issue at all.

The laproscopy thing is something new to my ears and I will certainly ask the nephrologist about it. They have been using xrays and cat scan with dye to get a view as to where and what is happening with the catheter tube. The xray only shows them the general location of where the tip is of the catheter is and only shows them two dimensional view while the cat scan with the dye which they call peritoneograph is what they use for 3 dimensional view.

What my nurse tells me is that they have done enough and that they want to talk with me about the other options out there which I understand it to be a code for going hemodialysis which I dread because of the stories I hear about how people feel on hemo. I want to be independent and stay with PD.

And by the way I am in Toronto, Canada and I use Baxter products. Luckily for me I don;t pay anything out of pocket including medications and other supplies such as masks, some vitamins (iron), tapes, etc and also aranesp.