The system then applies positive air pressure to the soft plastic membrane and pushes solution out of the chamber.
The system applies pressure alternatively to the opposite ends of the chamber so that the solution continues to flow. This means that if negative pressure is applied to the right side to pull the solution into the chamber, positive pressure is applied to the left, pushing the solution to the appropriate destination.
However, for moving solutions to and from the patient, the system uses pneumatic forces. The system measures volume of the solutions using the Ideal Gas Equation principle.
It monitors the pressure in the chamber area, and uses it to calculate the volume of air after it pushes the solution through one stroke.
The volume of air then estimates the volume of solution moved. There is no set rate for dialysate solution draining. However, it then also calculates the actual drain rate, monitoring for slow flow and low flow. These cutoffs are some of the parameters that prompt the low drain volume alarm and negative UF alarm to sound, as appropriate.
The system incorporates drain logic, integrating all this information prior to sounding alarms; for example, it will allow slow flow to continue without sounding the alarm if the minimum drain time has not elapsed. If the appropriate functions on the cycler are enabled ie, adjust dwell up and adjust dwell down , the system will calculate the therapy parameters using the actual fill and drain rates from the previous cycle.
Solution temperatures are monitored by a solution temperature protective system, which uses a microprocessor, temperature sensor, and cutoff switch. An alarm is sounded within 5 seconds of sensing an overheated condition.
In an attempt to maximize safety, the system continuously monitors various parameters including fluid volumes and flow rates, and alarms in case of an issue. In this situation, the cycler may at times stop moving the solutions and wait for the problem to be resolved by the user.
It will display the type of alarm and may also record it on the Pro Card, if used. In case of a power failure, or if the power switch is switched off during therapy, the cycler closes the occluder. If power returns within 30 minutes, the system will resume therapy without alarming. This is particularly helpful as patients may continue to have uninterrupted sleep if performing therapy at night.
However, if more than 30 minutes lapse, the cycler alarms. If power is restored within 2 hours, therapy can be restarted; if longer than 2 hours have elapsed, then the therapy must be ended and restarted from the beginning. The Baxter HomeChoice Pro features a Pro Card, which is a computerized data transfer feature, which was first introduced in The Pro Card information may also be transferred through to the dialysis center using a modem and phone line system, but this requires some specialized processes that are not yet universally utilized.
We interviewed a total of 18 nurses from these six centers Supplementary material. The comments were not necessarily amenable to tabulation, so we have collected and interpreted them for the purpose of this paper. We focused on addressing the benefits and challenges of the cycler in the opinion of nursing staff. We have attempted to categorize these responses based on similarities and will highlight the key areas. Overfill or increased intraperitoneal volume is a complication inherent to the current modes of operation of the PD cycler, and not specific or limited to a particular model, manufacturer, or technique.
Overfill refers to excessive solution in the peritoneal cavity, beyond the target volume, or PD prescription fill volume. Some of the factors that increase the risk of overfill may be patient dependent, ie, the manner in which the patient performs therapy, and others are more mechanical.
Both Fresenius and Baxter cyclers now have a built in feature of the I-Drain to avoid the problem of increased intraperitoneal volume or overfill, and will attempt to drain the patient completely prior to infusing any dialysate into the peritoneal cavity. The cycler does not allow the patient to bypass the I-Drain under normal circumstances, and while this attempts to help in avoiding increased intraperitoneal volume, unfortunately it also leads to a lot of anxiety among patients who can experience significant I-Drain pain when the cycler may try to empty an already dry peritoneal cavity, irritating and tugging on the peritoneal membrane.
This is because cyclers use pneumatic forces to pull fluid from the patient, as opposed to the conventional manual exchanges where dialysate flows out into the drain line by gravity. Drain pain can occur as a consequence of a siphoning effect of draining fluid where sensitive intra-abdominal tissue eg, bowel wall, omentum, bladder wall, fallopian tubes, uterine wall, etc is sucked up against the PD catheter. However, some of our staff helped clarify that the Baxter cycler does allow the I-Drain alarm to be set to 0 mL, in which case it will allow the patient to avoid this issue and the alarm will not sound for Low Flow Volume or Drain.
It is key to ensure that the I-Drain alarm is set appropriately. If set too low, the patient can experience problems of increased intraperitoneal volume, with dialysate remaining in the peritoneal cavity, and if it is set too high, the patient may experience drain pain. While the purpose of alarms that were built into the cyclers is to ensure patient safety and use of proper technique, they can sometimes pose challenges for the patients and staff.
Our survey results reveal that patients and nurses feel that at times, the cycler alarms are too generic. Other staff indicated that at times the alarms continue to beep for an extended period, and can be time consuming to investigate and resolve. Teaching patients to find and address the exact problem for each alarm remains an ongoing process. Both Fresenius and Baxter manuals dedicate detailed sections to troubleshooting of alarms. Although patients are provided with these manuals to guide them in addressing these alarms, most patients tend to look at the display screen for guidance rather than refer to the large manual.
If future models of the cyclers incorporated features of more specific alarm trouble shooting and guiding patients via the display screen, it would certainly make the cycler even more user friendly. Numerical data are entered using arrow keys to adjust values. An optional, compact keyboard for data entry could be a more user friendly and feasible future alternative.
Many patients with end-stage renal disease are elderly, and the level of their technical education and experience varies widely. Some may initially perceive the cycler as being complicated, and are doubtful regarding their ability to learn to perform CCPD. These patients need reassurance about the ease of use of the newer cycler models, its advantages, the support system available via the dialysis unit, on-call PD nurses, and help lines provided by Baxter and Fresenius.
We propose a future opportunity for development to be the capability of remote live access to cyclers. This would be particularly comforting for the elderly patients who may be initially fearful. Although help-lines and on call PD nurses are currently available as mentioned, live support would be a stronger backup for these patients.
Baxter already offers a feature of phone line and modem use to transfer therapy information on the Pro Card to the dialysis unit, hence remote live access of the cycler may be the next step in development for future cyclers. The need for re-training patients with reminders of key techniques and providing refreshers in sterile techniques during connections was a common need among many of the centers we surveyed.
Additionally, despite home visits, staff are unable to mock a full home treatment and have to teach in sections, while trying to fast forward through sections they are not focusing on at that time. This may make it difficult for the learner, and it can take up to a week of performing CCPD at home before it all comes together for the patients. Both Baxter and Fresenius provide help lines available to patients and staff. We have received good feedback in our survey from the nursing staff, about the support provided to patients via these help lines, where company representatives are able to assist with trouble-shooting problems.
Although few patients make this transition, we wanted to explore what factors contribute to this decision. Find important updates here. It was not too long ago that automated peritoneal dialysis APD was introduced as a home dialysis treatment option for people with chronic kidney disease CKD.
In , the APD machine also known as a cycler was released to a select few CKD patients who could perform peritoneal dialysis PD using a machine at home. Peritoneal dialysis showed high demand in the s and the APD machine allowed many PD patients to free themselves from performing manual PD exchanges during the day. If you have considered peritoneal dialysis using a cycler but would like to know more about how it works, this tour may help you better understand so that you can talk with your doctor about this home dialysis treatment.
Rather than performing manual peritoneal dialysis exchanges several times throughout the day, a patient can do automated peritoneal dialysis while they sleep. Automated peritoneal dialysis is done using a machine that fills your peritoneal cavity with fresh dialysis solution, also called PD fluid or PD solution, and after a specified dwell time, drains the solution with waste out of your body and then fills your peritoneal cavity with new dialysis solution.
The average treatment time for automated peritoneal dialysis is 9 hours at night while you sleep, but your doctor will prescribe what is best for you. Aside from the APD machine, there is required equipment and supplies that help you perform peritoneal dialysis treatments:. The APD machine is programmed to drain the solution through the PD catheter to the drain tube or drain line. Once the draining is finished, new dialysis solution is released from a dialysis solution bag to the peritoneal catheter that leads to the peritoneal cavity where the solution will dwell for a certain time based on the patient's prescription.
This process will repeat until the APD treatment is completed for the night. Documenting your APD treatment — Documenting your treatment is also important. This allows your doctor and nurse to see how you are doing at home and help adjust your treatment to be just right for you. There are different ways to do this depending on the dialysis system you use.
Your training nurse will help you understand what needs to be documented. The peritoneal dialysis machines have been designed to be user-friendly and generally use similar equipment and supplies to perform APD.
Before you receive a cycler, you will go through peritoneal dialysis training with a PD nurse. Here is a description of two automated peritoneal dialysis cyclers. You may be prompted to type in your total fluid volume, therapy time and fill volume, among other things. A patient can have one to four bags of dialysis solution attached to the machine for the treatment in one night, depending on your prescription.
It weighs 25 pounds. This machine remains programmed for future use, until the prescription is changed and needs to be re-entered. A patient may manually enter numbers such as number of fills, dwell time and drain time, among other information.
After the numbers are entered, the Newton IQ will ask about other information, including if the PD solution bags need to be pre-warmed or if you would prefer the instructions in English, Spanish or French. Newton IQ sits 10 inches high and the machine is This cycler also weighs 25 pounds.
Each machine comes with a booklet or handout to help guide you through set up in case there is something you are unfamiliar with on the display screen.
It is recommended to call the manufacturer first, Baxter or Fresenius, in case of major machine issues. It is best to call the manufacturer when the problem occurs so that they can better assist you with trouble-shooting the problem. Both manufacturers have hour per day hotlines to help assist you with any cycler problems.
A few weeks before you start peritoneal dialysis , a surgeon places a soft tube, called a catheter, in your belly. When you start treatment, dialysis solution—water with salt and other additives—flows from a bag through the catheter into your belly. When the bag is empty, you disconnect it and place a cap on your catheter so you can move around and do your normal activities.
While the dialysis solution is inside your belly, it absorbs wastes and extra fluid from your body. After a few hours, the solution and the wastes are drained out of your belly into the empty bag. You can throw away the used solution in a toilet or tub.
Then, you start over with a fresh bag of dialysis solution. When the solution is fresh, it absorbs wastes quickly. As time passes, filtering slows. For this reason, you need to repeat the process of emptying the used solution and refilling your belly with fresh solution four to six times every day. This process is called an exchange.
You can do your exchanges during the day, or at night using a machine that pumps the fluid in and out.
For the best results, it is important that you perform all of your exchanges as prescribed. Dialysis can help you feel better and live longer, but it is not a cure for kidney failure. You may feel the same as usual, or you may feel full or bloated.
Your belly may enlarge a little. Some people need a larger size of clothing. Most people look and feel normal despite a belly full of solution. You can do exchanges by hand in any clean, well-lit place. Each exchange takes about 30 to 40 minutes.
During an exchange, you can read, talk, watch television, or sleep. With CAPD, you keep the solution in your belly for 4 to 6 hours or more. The time that the dialysis solution is in your belly is called the dwell time. Usually, you change the solution at least four times a day and sleep with solution in your belly at night.
You do not have to wake up at night to do an exchange. With automated peritoneal dialysis, a machine called a cycler fills and empties your belly three to five times during the night.
In the morning, you begin the day with fresh solution in your belly. You may leave this solution in your belly all day or do one exchange in the middle of the afternoon without the machine.
People sometimes call this treatment continuous cycler-assisted peritoneal dialysis or CCPD. You can do both CAPD and automated peritoneal dialysis in any clean, private place, including at home, at work, or when travelling. Before your first treatment, you will have surgery to place a catheter into your belly. Planning your catheter placement at least 3 weeks before your first exchange can improve treatment success.
Your surgeon will make a small cut, often below and a little to the side of your belly button, and then guide the catheter through the slit into your peritoneal cavity. However, most people can go home after the procedure. After training, most people can perform both types of peritoneal dialysis on their own.
Most people bring a family member or friend to training. If you choose automated peritoneal dialysis, you also need to learn how to do exchanges by hand in case of a power failure or if you need an exchange during the day in addition to nighttime automated peritoneal dialysis.
Your health care team will provide everything you need to begin peritoneal dialysis and help you arrange to have supplies such as dialysis solution and surgical masks delivered to your home, usually once a month.
Careful hand washing before and wearing a surgical mask over your nose and mouth while you connect your catheter to the transfer set can help prevent infection. A transfer set is tubing that you use to connect your catheter to the bag of dialysis solution. When you first get your catheter, the section of tube that sticks out from your skin will have a secure cap on the end to prevent infection. A connector under the cap will attach to any type of transfer set.
Between exchanges, you can keep your catheter and transfer set hidden inside your clothing. One branch of the Y-tube connects to the drain bag, while the other connects to the bag of fresh dialysis solution.
Dialysis solution comes in 1. Solutions contain a sugar called dextrose or a compound called icodextrin and minerals to pull the wastes and extra fluid from your blood into your belly. Different solutions have different strengths of dextrose or icodextrin. Your doctor will prescribe a formula that fits your needs. In automated peritoneal dialysis, you use a machine called a cycler to fill and drain your belly.
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