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One of the first phrases I learned in Vietnamese language school before going In-Country was một lần nữa, meaning one more time. It just kinda rolls off the tongue when speaking Vietnamese. In the military, you learn to do lots of things, One More Time. So it is with alarms on my company-issue Liberty Cycler.

Last Wednesday night on the first main drain cycle the cycler hung up and essentially at every “pump” drained only 1 or 2 mL of fluid instead of the normal 12 to 13 mL. I called “tech support” and after over half an hour on the phone, it was agreed that my case would be “escalated.” What this means, in reality, is that a faceless, clueless, and heartless representative of Fresenius would contact my clinic dialysis nurse and deny me cycler replacement. This is exactly what happened. The excuse was that I had not been faithfully calling tech support every time I received alarms and thus they could not justify replacement. Nothing was said nor has it ever been regarding just how many times something like alarms have to be reported before action is taken.

Along the way, Fresenius always comes back to everything which does not include their cycler as being at fault. This incident included questions as to whether my catheter was properly placed and operational/not blocked. Responding to the blocked aspect, the cycler always fills well, and recently I had a manual drain test conducted by my Fresenius team with no abnormalities detected.

So, in consort with my dialysis nurse, we scheduled a xray exam to look inside to see if anything is untoward in my stomach with my catheter system. The full report is below: I’m good so my strategy is to report every burp of the cycler’s drain problems until someone smells the coffee or I die from sleep deprivation.

Exam AR Acute Abdomen Series 08/10/2023

History: Poorly draining PD Catheter

Technique: 5 views of the lumbosacral spine

Comparison: None

 Findings: There is moderate curvature of the lumbar spine with convex to the right. Moderate degenerative changes lower thoracic and lumbar spine.

No fractures of dislocation. Large amount of formed stool is seen within the right colon. Curvilinear tube overlying left lower quadrant of the abdomen. There is a larger bore catheter identified with the distal tip overlying the mid aspect of the lumbar spine at the L4 level on the AP view and overlying the area of the LS level on the lateral view.. CT may be more helpful.

Moderate degenerative changes lumbar spine. Mild to moderate degenerative changes of the hip joints bilaterally.

Moderate vascular calcifications of the abdominal aorta and iliac vessels.

Impression:

  1. There is mild to moderate curvature of the lumbar spine with mixed the right.
  2. 2. There is a curvilinear catheter seen overlying the left lower quadrant of the abdomen. There is a larger bore catheter is seen overlying the lower mid abdomen. CT may be more helpful for placement if no drainage..
  3. 3. There is a moderate to large amount of degenerative changes lumbar spine.
  4. 4. Significant amount of stool is seen within the right colon.