Drain Pain, Overfill, and how they are Connected

Automated cyclers used in peritoneal dialysis: technical aspects for the clinician

“…The pneumatic forces may cause abdominal discomfort resulting in patients switching to TPD, CAPD, or other dialysis modalities. 7 A recent Canadian survey of 293 APD patients suggests that drain pain may have been of significant severity and directly responsible for approximately one fourth of patients in this survey switching to TPD. 8 This survey population of 293 APD patients was estimated as 15% of the PD patient population in Ontario, Canada.…”

“…The cycler is able to calculate the fill time, drain time, minimal flow rate based on the specifications for the machine, and appropriately sound alarms or warnings if these are not met. 7 , 8 …”

“…Overfill refers to excessive solution in the peritoneal cavity, beyond the target volume, or PD prescription fill volume. 7 , 8 Cycler models for both Fresenius and Baxter are programmed to detect overfill by a number of algorithms and will alarm if they detect risk of increased intraperitoneal volume.…”

“…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. 7 …”

“…In the case of TPD, these forces may be dispersed or diffused, with the residual solution acting as a buffer between the patient’s peritoneum and bowel wall. 7 However, although TPD may reduce “drain pain”, it may also increase the risk of overfill. 11 …”