Day 1 of Training on Nxstage

Hi Pat

You and Ralph are champs for you two working together so well and keeping the public up to speed on your progress. A big thank You…

From the reports it sounds like nxstage still has some bugs to work out. Do you and your team plus nxstage see these as minor bugs that are very fast to fix or are bigger set backs?

You were not on nxstage at all before this? So you can or can not say what your thinking is on this new set up?
bobeleanor

bobeleanor, The system one is perfectly up to snuff. The pureflow has some programing glitches but Nxstage works fevorlessly to get things worked out.
I think as we use the system and find small problems they will get them resolved. I am now draining the batch I made the other day so I can make a new batch tomorrow and be ready for Monday night if the cultures come back ok.
Draining is working ok.
We will take each day as it comes and work through any glitches. One of the very big things is that we have a SUPERIOR center. They help us work through anything. I could not say anything bad about them. I thank GOD every night that we are at the Rubin Center.
Pat

Thanks for explaining about how batches are made, Pat. Sounds simple and would save all the trouble of hanging bags, storage etc. Are you saying that the batches are tested before you use them? How is it done?

It is great the way NxStage and your center works with you. This is a model that others should follow. Patients succeed with good education/coaching/support.

Heather1, Yes the batch is tested for clorimines using a chlor test strip.
This is done at the end of one of the attachments. I will be taking pictures as I go so everyone can see what I do.
Yes we are very lucky to have such a progressive center. They are truly the BEST!
Pat

Hello Pat,

Give my Best To your Ralph.

Do you know if this new set up will be something that everybody on nxstage now will have to use, or will we have option of staying with the bag set up?

Thanks So much
bobeleanor

Well, I did not get to post the results of Sunday night (first night on own).
For me it was pretty rough. We had to use the bags since our water cultures were not back. Lifting 9-5l bags up to the pole for me is pretty hard, than add the saline bag and finally the tiny bag with the heperin in it I was pooped just doing that in our confined area. (We still have all the stuff from the Fresienus nocturnal for about a month until they see how Ralph is doing)
The System One is a computer and you must do things in sequence, which I thought I did. But had to reset the dialysis cartridge a second time to make things work. When that was complete, I had an male end brake off in a connection that was steril. So had to get new cartridge and start over again.
Had a problem with the Heperin machine and finally decided to have the ladies wake me at 2:15 AM to just give Ralph a bolus. Finally setteled down about midnight. At 1:30 Ralph had to go to the bathroom. Well being new at this this was certainly a challenge but we made it. Now it was 1:45 am and called the center and told them I would put the heperin in than and I was going to sleep until morning. Machine finally finished at 6:15am, so I got about 4 hrs sleep. I was DEAD on my feet. Had to go to work.
Monday after work went to center with heperin machine and I never was given the right line to use with the machine and bag so that was the problem.
Got new lines and went home at dinner, put up bags for Monday night and went to sleep for about an hour.
Started the process to get Ralph on and was a llittle nervous but every thing went very smoothly! Hallelujah! Went to be about 9:15. Thought I was going to sleep all night til morning. But the dog decided she needed to go out at 12:30. Got her back in and back in bed and fast asleep.
Did not wake up till machine was done at 5:00am.
I feel so much better today.
I will let you all know how tonight goes.
bobeleanor, Not sure how, when or if everyone will be using the water filtration. I would suspect that the water system is much cheaper to use.
Pat

Pat wrote: “I have to do water cultures in the am and bring them to the center to be sure the water is A-OK.”

Going back to your very first post in this thread Pat, how often do you have to do water cultures?

Sorry to hear all the trouble you had with the current tx, but sounds like you handled it really well.

Pat, Thanks for keeping us informed. How many bags would it take to do a full nights treatment? I take it you would have to get up every so often to switch bags or is my thinking wrong?

Marty

Heather1, cultures are done quarterly but water is done monthly just like on the Fresieus.
Marty,
The number of bags depends on the RX. Since Ralph will be on 60L a night (tonight will be the first using the Pureflow) We will have to do a new batch every day. So for Ralph to be on the bags we will use 9- 5L bags. The maximum connection to bags is 9. The other person on nocturnal uses I believe 20L so she uses 4 bags.
I know that after a week or 2 I will have it down “pat”. Clean up in the AM is a breeze! Just do a rinse back, pull needles, and dump every thing in the garbage.
Marty, the machines both the System One and the Purflow are much quieter than the Fresnieus and the RO!
Hope this answers qustions.
Pat

Pat, Thanks for the answers. It sure is sounding like the way to go. I can handle quiet and I can handle dump it in the garbage and go. I can also handle having bags as a back up if the water system goes down. Last summer our water system had a faulty pump and they issued a boil water warning. I had to reclean the RO take dad in-center and skip a treatment. A hassle I would just as soon have gone without. Tell Ralph, we will be anxious to hear if he still has the energy and feels as good as he did on the Fresni. in a month or two. Sure do appreciate you letting us bombard you with questions.

Marty

Marty,
So far he feels the same. Time will tell.

Last night (Tues) Went pretty well for first time using the purflow.
I kept getting a red alarm 38 checked the book and checked everything.
Finally called Chris and felt so dumb when she said have you check the clamp on the drain line. Oops! once I did that it was go as usual. Took Ralph off 1 hr early as he needed a bathroom trip and the machine already had pulled off his goal. But draining the little that was left in the Pureflow and than starting a new batch took all of about 15 minutes. It is much better using the Pureflow. All the bags Ralph has to use seem to get in the way of each other. Alhough if we have to it will work also.
Now I need to just keep doing what I am doing to commit to memory the steps.
I will be making up a short cut sheet for myself. Once I get it perfected and working real well, when you do get the Nxstage I will share it with you. Chris gave me one that Donna the other nurse made but I would like mine to have a little more detailed I am a methodical person.
Pat
PS: I will be taking pictures as we go along and I will probably post them on Gus’s site.

Pat, how are the monthly water and quarterly cultures done?

Since the bags will now be used for backup only, I wonder how long the bags are good for since they are not used regularly?

Like Marty said, it is an advantage to know that the bags can be used for backup if there ever is a problem with the water.

Heather1, First the water cultures are done on the Pureflow where lines are attached between the bin with the dialysate and the black pur pack. They are done monthly. The LAL’s are done quarterly. But if you don’t use the water system I can not see how you would do cultures.
Now for the Bags, They sent me just enough for a week. The bags that I have are dated 8/08. So you can see that you have quite a while to use them.
Pat

Thanks, Pat. With cultures and water testing, do you just bring in a sample of the water to your unit for them to test it? We have never done this before so I don’t know how it’s done. For the monthly would they just have you bring sample at the same time as your doctors visit?

Heather1, We do the waters the same time we draw bloods and send them to Spectra Labs in California.
Does that answer your question?
Pat

I believe the practice is to do water cultures once a quarter. Your dialysis facility has to do water cultures for in-center treatments so I’m sure someone can explain how to do this.

Water cultures of the machine and RO are done monthly. Water samples from the purewater line and LAL are taken quarterly.

Set up and treatment went pretty well. We were supposed to do pre and post bloods (which I did). But forgot to get the information off machine in the morning before I turned it off.
So we will try again tonight.
Really enjoying the easy clean up in the morning and I feel a little more confortable initiating the treatment.
Practice makes it easier each night.
Pat

[QUOTE=Pat Colongione;11058]Set up and treatment went pretty well. We were supposed to do pre and post bloods (which I did). But forgot to get the information off machine in the morning before I turned it off.
So we will try again tonight.
Really enjoying the easy clean up in the morning and I feel a little more confortable initiating the treatment.
Practice makes it easier each night.
Pat[/QUOTE]

Good Day Pat and Ralph

Pat you said you forgot to get information off the machine? I take it you mean the total # on volumes. But I was thinking that you are hooked to computer and the internet to a base computer. And that everything at least for the #'s would be taken at the base. I mean right now I’m on nxstage (day use)and have to fill out flow sheet ,then take totals at end. You don’t have to do that right? then what totals # do you have to take? Can’t the computer do the totals #'s?

bobeleanor

bobeleanor, Yes we are hooked thru the internet but those things are not recorded. The Software that Nxstage is using leaves much to be desired. Once we see how well this is working for us Nxstage and our head tech will get together and produce better software.
When we travel we will have to make out those sheets as well. Right now I fill in some of it.
Last night went better again.
But
Started to make batch this morning and everything was going fine. Left to do errons came home this afternoon at 4 and it was beeping. Looked and it was on hold because of a power outage. Nothing else in the house showed we had a power outage so I think it may have only been for a second. This tells me it is very sensitive. So will go on a little later tonight. That is ok since I don’t have to work tomorrow.
Each day it gets easier.
Pat