I understand it takes Aksys 15 hours to get ready for machine preparation, but if there is an alarm and the patient is not at home it could delay the machine being ready for next tx. Has anyone had a problem with this and how do you deal with it?
Bill, our resident Aksys expert hasn’t been around lately so I will try to answer from some of his earlier responses.
As I understand it there is no way to reset the machine so if that happens, or if there is a power outage for example, you will miss that treatment. When you are doing daily dialysis missing one treatment is not a major disaster.
The Aksys machine cycles through a self disinfect and prepares dialysate several hours prior to your scheduled treatment time. I believe the total cycle time is about 15 hrs. I heard that they have a product that attaches to the machine and will page their technical support center when an alarm occurs. They cannot clear the alarm remotely, but can call you or your helper if the alarm can be cleared by the user, or dispatch a repairman immediately if needed.
Hemo writes:
believe the total cycle time is about 15 hrs. I heard that they have a product that attaches to the machine and will page their technical support center when an alarm occurs. They cannot clear the alarm remotely, but can call you or your helper if the alarm can be cleared by the user, or dispatch a repairman immediately if needed.
Seems like this could be quite a problem if the patient or helper isn’t at home 24/7. I wonder how often this occurs on average?
I’m here - I’ve just been lurking; there are a few threads I’ve been wanting to post to lately but I have been short on time (I installed my counters this weekend so my kitchen remodel is nearly done - a month late and 10% over budget but at least I got it done).
One correction to the info posted - the Aksys takes about 8 hours to get ready for a treatment. The 15 hours is the amount of time it requires between treatments: 7 hours post and 8 hours pre with an idle period inbetween. My machine comes out of idle about 7 am and then is ready for treatment at about 3pm.
I normally treat around 7pm so my machine stands at the ready for four hours. I set it this way so it comes out of idle before I go to work that way if there is an issue I can fix it - otherwise it could sit and beep until I got home after work. I haven’t heard about a paging system though I did suggest that it would be a good idea - I work about 20 minutes from the house so I could pop home if I knew there was a problem.
I haven’t had an alarm early in the preperation process for a long time - can’t remember the last one. Most recently I have had an alarm during the last step of the prep process which is not a big deal - after addressing the issue the machine gets ready about fifteen minutes later.
Bill writes:
One correction to the info posted - the Aksys takes about 8 hours to get ready for a treatment. The 15 hours is the amount of time it requires between treatments: 7 hours post and 8 hours pre with an idle period inbetween. My machine comes out of idle about 7 am and then is ready for treatment at about 3pm.
I normally treat around 7pm so my machine stands at the ready for four hours. I set it this way so it comes out of idle before I go to work that way if there is an issue I can fix it - otherwise it could sit and beep until I got home after work.
Could you explain this again? I am confused. What occurs during the 7 hrs. post, the 8 hrs. pre and the idle time? At what point does a problem occur if it does? About how often is there a problem?
Sorry for the confusion Heather. I am making it sound complicated and it isn’t, the way I see it there are just three stages - pre, idle and post. During the post treatment stage the PHD is going through its heat disinfect procedure and various system checks - this takes 7-8 hours - when this stage is complete the PHD goes into an idle stage. Then the machine will take itself out of the idle stage and go through a 7-8 hour pre treatment stage where the PHD makes the 50 liters of ultra pure dialysate needed for treatment. These times are approximate and would vary in my experience due to water pressure differences. Here’s what I expect to happen tonight:
My treatment tonight will end at about 11pm and I have the PHD scheduled to be ready tomorrow at 4pm I expect the idle stage to be short tomorrow, perhaps an hour and then right about 7am the machine will start getting ready and will usually finish ahead of schedule - today it was ready at 3:15, 45 minutes ahead of schedule.
I have few problems these days, my machine just chugs along and it has trained me well, but there are definitely good and bad alarms. If a water filter gets clogged with sediment, which happens here suddenly when our water reservoirs “churn” seasonally, then the machine wont be able to get ready and when I change the filter after work the machine will take 6-7 hours to get ready. I’ll dialyze late at night if I have to or I’ll just punt and skip until the next day. Other times the machine will fail one of the self tests it does as a last step in the pre stage, which can indicate that a line kinked or something and the PHD can be ready ten minutes after the alarm is cleared and the green key is pressed.
Bill,
How long are your txs? Is it possible to do nocturnal txs with the PHD? We understand there is a trial going on currently to get the PHD approved for nocturnal.
Hi Bill,
Just from the information you’ve given, would I be right in concluding that for a person doing say 8 hours of nocturnal daily, assuming it was possible with the PHD as I’m sure it will be, the machine would end up running virtually 24 hours a day?
Pierre
Heather, lately I have been running for three hours for three days in a row and then for two hours for three days in a row. For example I try to take Thursdays off then I’ll run for three hours F-Sa-Su. Then on M-Tu-W I’ll run for two hours. I like having the shorter runs during the week because between work and dialysis I can put in a couple hours on my “to do” list of household projects.
Pierre when I did the daily nocturnal study last year they changed the PHD’s software so that it would get ready in 12 to 13 hours. I think that was one of the factors they were studying. When the new version of the PHD comes out with the intergrated heperin pump I think it will be available for nocturnal treatments without further FDA approval. NKC had an individual doing nocturnal on the PHD - he used an external heperin pump - but I think that individual’s circumstances changed and he had to go back to day time runs. I do an occasional long run - I just infuse heparin periodically during the run.
Thanks for answering my question, Bill. The reason I ask is that, from what I can tell, the Aksys is the one machine that potentially most addresses the needs of the typical home hemo patient - not that the NxStage doesn’t have advantages also, like transportability and no permanent hookups - my concession to Gus 
I like the idea of the machine making it’s own ultrapure dialysate, and I think the concept of installing the blood circuit once a month and then letting the machine clean and disinfect it automatically in between treatments is great. But I don’t think I would be comfortable with the machine running all night and then most of the day, and neither would my landlord I’m sure.
One thing we often say on here, including me, is that it’s not a big deal to miss a nocturnal treatment. That’s true as far as health goes, but, if I take advantage of no fluid limit, I’m not going to be very comfortable skipping a treatment when I’m already 3 kilos over my dry weight, even though I can. So, my feeling is that nocturnal requires very good reliability.
This is all academic for me at present, because Aksys isn’t available to me anyway. But I do think it’s an interesting concept.
Pierre
Bill writes:
when I did the daily nocturnal study last year they changed the PHD’s software so that it would get ready in 12 to 13 hours. I think that was one of the factors they were studying. When the new version of the PHD comes out with the intergrated heperin pump I think it will be available for nocturnal treatments without further FDA approval. NKC had an individual doing nocturnal on the PHD - he used an external heperin pump - but I think that individual’s circumstances changed and he had to go back to day time runs. I do an occasional long run - I just infuse heparin periodically during the run.
Bill I have some questions:
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How long were you involved in the study doing nocturnal txs?
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What was the length of the nocturnal txs and what did you do for heparin?
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How did the other individual’s external heparin pump work?
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How did you feel on nocturnal txs with the PHD as compared to how you feel doing short daily txs?
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During the study how did the participants deal with alarms that might of thrown the schedule off if they were not at home? Did the software provide a bigger window in case and alarm occurred while a participaant was out?
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With the hours the machine currently uses to prepare the machine do you feel it is possible to do 8 hr. nocturnal txs?
Peirre writes:
I like the idea of the machine making it’s own ultrapure dialysate, and I think the concept of installing the blood circuit once a month and then letting the machine clean and disinfect it automatically in between treatments is great. But I don’t think I would be comfortable with the machine running all night and then most of the day, and neither would my landlord I’m sure.
Maybe someone can clarify, but our understanding is that whether the PHD is used for SDD or SND txs., it runs the same amount of time and the costs are the same. And, the energy/water costs seem to be less (approx.$30-35/month) then what others have quoted for their model machines.
- I did two studies, both were for a little over a month. The first had me doing every other day nocturnal and the second had me doing daily nocturnal.
2 & 3) The runs lasted about 8 hours. I used an external heparin pump which just hangs on an IV pole and infuses heparin at a steady rate over the run and then shuts off at a predetermined time. It works just like the pumps built into the standard machines but stands alone.
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I felt good but tired. I never felt well rested and it was hard to work a full day the following day.
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I didn’t have alarms but the software did allow for a bigger “window” because the machine got ready quicker.
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Daily nocturnal? Yes I think it could. You could do 6 or 7 hour runs over night for sure. If I had a heparin pump I would probably mix in a nocturnal run a couple times a week.
Do you think that maybe the reason you didn’t feel well rested with nocturnal was because you didn’t have long enough to get used to it? I’ve read where patients say they have trouble adjusting to nocturnal the first weeks, but then they become acclimated to it.
If you would like to do a couple of nocturnal txs a weeks is it a problem getting a heparin pump?
Yes I think you are right. If I was going to do nocturnal I would have set up my space for nocturnal rather than just adapting my current room set up. WHen I did every other day nocturnal I really didn’t sleep well on the machine. Towards the end of the daily nocturnal study I was sleeping better but still not as well as the solid 7-8 hours I get while doing short daily.
It is the lack of a heparin pump that holds me back from doing a couple nocturanl runs during the weekl - for instance Friday and/or Saturday night.
To be totally honest, while I do sleep on nocturnal, it’s not really a deep, restful sleep. I don’t find it is, anyway. It’s more like a wakeful sleep, kind of like a soldier sleeps in a foxhole. For one thing, you have to wake to any alarms that might happen. They don’t happen every night, but sometimes they do. I mean, you’re sleeping with bloodlines and needles attached to your arm, so, you’re bound to have some pressure alarms now and then.
If you don’t wake up, you’re going to have to lose that blood circuit when you do eventually wake up. That in itself is not a disaster, but it’s not something you want to have happen too often. But on the other hand, despite that, I find I feel well rested in the morning anyway. Sleepiness does catch up with me by afternoon though. Maybe it would be easier for a younger person as far as that goes.
Pierre
Bill,
I was asking why can’t you get a heparin pump?
Pierre,
How often do you get alarms?
Most nights, none after the first 20 minutes or so, after the pressures have stabilised. Sometimes, I can’t resist rolling over on the side where my fistula is. This seems to affect the blood flow in that arm, and after a while, I get a venous or arterial pressure alarm. There is the occasional night when I get more frequent alarms, maybe once a month. By more frequent, I mean like 3 or 4 during the night. Even with buttonholes, I’m guessing that some nights the placement of the needle tip is slightly off and my fistula ends up spasming. So that will cause pressure alarms. The other nights, I started having arterial pressure alarms, and the arterial pressure was higher than usual. I didn’t see anything wrong, until I noticed my dachshund was lying on part of my arterial bloodline on the floor. He is kind of dark, so I didn’t notice him right away
Most nights, everything is pretty stable though.
Pierre