Crashing my NxStage Machine: Pilot Error at Fault

By Peter Laird, MD

Today of all days, I woke up early and ready to go with dialysis from the get go. I had set up the machine last night all the way through the complete prime ending on the standard “23.” According to Dialysis Dan, you can shut the machine off and restart it several hours later which I have done on more than one occasion. All went well when I awoke and turned the power switch back on getting a"40" alarm for power outage, that quickly resolved with a tap to the yellow alarm button into a repeat two minute priming session, once again returning to my “23” system check.

I went through the remainder of my usual routine eager to be on the road by 3 pm today for a two day weekend to Las Vegas. My wife and I are frequent visitors to Las Vegas, not for it’s casinos or gambling mind you, but it is where my wife’s cousin lives less than 4 hours from our house. My wife is quite close to her cousin who for years was her only relative with her from the Philippines in the US. I enjoy spending time with her husband who is retired from the Air Force. However, whenever the best laid plans can go wrong, they will go wrong when visited by someone called Murphy.

I utilize a 2.5 liter rinse to remove an unwanted plastic taste unique to the NxStage machine. Many don’t consider what a dialysis machine “tastes like” not realizing that they all have their own individual taste based on the type of plastic used. For myself and a relatively small group of dialysis patients, the NxStage machine has a strong plastic taste at start up. Lately, I discovered that much of the plastic taste I experience is greatly reduced if I don’t turn the warmer bag on until I have actually started the blood pump after hooking up. Try drinking bottled water on a hot day with the plastic water bottle sitting in the sun for quite some time and you get the same concept of a strong plastic taste worsened by the heat exposure.

However, today, of all days as I was of course up early, well relatively early I would state for my own personal waking up time, I had the machine all set to go, the car was gassed up, my wife has packed our things, the only thing standing before our well set plans was an infernal dialysis machine that today decided to show me who was boss. At first, my rinsing procedure went well until all of a sudden, the dialysate pump turned on all by itself even when I told it to stop several times. I thought I was going to break that blasted red stop button from pressing on it again and again and again. I had an assortment of alarms from 4 to 20 to 35. I looked over the set up and all looked well. I had hooked up yellow to yellow, green to green, and white to white. I had snapped and tapped until all the bubbles disappeared and it looked like all was in order.

Yet, the machine kept turning itself on with no one touching the buttons just like Skynet on the terminator series. I began to call it a “STUPID MACHINE” and becoming quite exasperated with the entire situation. I turned off the machine, counted to three and then restarted the power button with all appearing well again for several minutes until that loud “Chop, Chop” sound with something turned on again all by itself as pumps began to whirl internally. After several attempts to gain control of the machine, I called tech support to seek their advice. I explained as best I could in my exasperated voice the situation, only to hear their answer that the machine had some how entered into a re-prime mode and that is why I had the numbers doing what they were doing as well as the dialysate pumps operating in self control mode with no over ride. Not to disparage the tech trying to deal with an over heated, red faced, doctor/patient quite out of control of his wits, but perhaps I left out come of the important details as I began my heated diatribe against this out of control, self starting machine.

After 20-30 minutes of cursing this “STUPID MACHINE” I turned it off and started to disassemble it for a second setup. Much to my consternation, I discovered the problem when I began to unhook the yellow “pee” line finding one of the yellow clips still CLIPPED. Whoops, I thought to myself, will a machine except my humblest apology for all that I had said against it’s loyalty to me. After all, I had cursed this infernal machine for nearly 30 minutes and even threatened bodily harm against it, yet all along it had tried to tell me several times over what the stupid pilot had done wrong in setting it up for its run by reminding me of that number “35.”

I sheepishly informed my now upset wife, well upset really isn’t a good word for her state of agitation at this point, what the “STUPID MACHINE” did wrong. Surprisingly, she had all of her sympathy for the machine and none for me this morning. After all, part of our plans had been to get to Las Vegas early enough to go to her favorite Filipino restaurant before it closes at 9 pm today. With a 4 hour drive after completing dialysis, it is not looking good to make it by that time, all because of pilot error, my NxStage machine dutifully as always tried its best to flash “35” telling me exactly what was wrong several times over, but this pilot chose to blame his faithful machine instead of simply stopping and listening to what it tried to tell me several times over.

That same machine is now eagerly purring beside me as it cleanses my blood. It has long since forgotten it’s master’s quick tempered tantrum wrongfully waged against it and as it always does when the pilot sets it up well, it chugs along day after day after day in perfect unison singing it’s joyful songs of work as it saves my life, one day at a time. Too bad the pilot isn’t as perfect in all ways as this ingenious little machine that even tells me what I do I wrong, if I would only listen. Perhaps that is a lesson of more things in this life as well.

Thank you NxStage for this incredible little machine, even when I am not thinking of kind words towards a poor little machine that really instead always says, I think I can, I think I can and it does. Perhaps you can persuade my copilot in our drive to Las Vegas in a few hours that I really am not as stupid as she thinks right now. Somehow, I have a feeling that this drive to Las Vegas will be a bit longer than usual.