When collecting an adequacy on the cycler should the patients have a zero for their last fill volume?

Questions About PD

Yvonne T, Nurse from RI asked
When collecting an adequacy on the cycler should the patients have a zero for their last fill volume?

1 answer

Nurse Canada and Nurse USA January 21, 2020

We thank you for your question. In general, there are different cycler models out there and the answer to your question depends on the manufacturer and the on the patient’s prescription. However, one basic principle we must not forget is that we should check the patient’s adequacy when the patient is performing the daily regular prescription. With that said, no modification to the prescription should be made; if the patient has a last fill, then the program should not be changed to zero for the last fill.
 
If the patient has a last fill that is the ‘same’, then there is no need to make a change in order to collect effluent for adequacy. The problem for adequacy testing arises if the patient has a ‘different’ last fill.  The PD machine will empty the heater bag first into the drain receptacle, then transfer the ‘different’ PD fluid – e.g. icodextrin (Extraneal) – to the heater for the last fill. This ‘dumping’ of PD fluid into the drain receptacle creates a dilution of the effluent and will lead to an inaccurate adequacy result.
 
Therefore, if the patient has a ‘different’ programmed last fill (e.g. Extraneal), for adequacy testing, the home training nurse should have the patient change the cycler machine program from ‘different’ last fill to ‘same’ (or similar language depending on the machine). This action will prevent sample dilution. It should be noted, in order to have enough PD solution to get through the cycler treatment, the nurse might have to have the patient add another bag of dextrose solution for that night. While the UF for the patient for that night might be slightly different, the total volume of PD fluid used will be the usual prescription. For the next night, the program on the cycler machine will then need to be changed back to the patient’s usual prescription.

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