Dialysate empty before end of treatment

Is anyone else having this problem dialysate bags are empty 8 minutes before the end of treatment and then alarm 14 goes off… I have been doing an early wash back procedure.

If I do more than 5.5 hours at dialysate flow of 500 I run out of dialysate and move another container in for the remaining 45 minutes or so. The alarm sounds for about 2 minutes until the air in the pipe is replaced by dialysate. To avoid this, and to dialyse up to 8 hours, reduce the flow to 300. (Fresenius 4008B)

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Sounds like you’re using NxSatge with that caution 14 alarm or air in the dialysate line. Call Tech Support and document this if it happens a lot. Also sounds like you’re not using the pureflow. Could be that lot of bags could be a little short. This should not happen.

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CThank you. My husband only dialysis for 3.15 hours. No stage are going to replace the cycles as they say it sounds like a timing problem but thanks fir your help. We have only been at home for 3 weeks and even the first time with the nurse in charge we had to perform an early rinse back. It has happened every day since installation. Very off putting fir a newbie. So scary.

Many thanks for your help. I have phoned NxStage and they got me to reset number 70 in system settings “Maximum Flow volume for end of treatment” It was originally set to 1L and now it is set to 1.5. I was frightened I may go wrong but Pauline at NxStage was wonderful and talked me through it

Your welcome. We have been on NxStage for 7 years and found Tech Support very helpful…and believe me I think I have seen just about everything.

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It is all so new to me and I’m so scared at the moment but then it’s only been three weeks at home. So many alarms though even though we follow all instructions by the book.

You shouldn’t really be getting “many” alarms. I’m the caregiver for my wife and we go weeks without an alarm(knock on wood). We also run 3 1/2 hrs at 320 blood pump speed and 30L of dialysate with very low pressures. We were trained at 500 and only 20L and did have more alarms. Talk to your home nurse. Good luck.

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Thank you for your kind encouragement. My husband runs at 320 blood pump speed and uses 30L too for 3 hours 15 minutes. When you say very low pressures what does that mean please.

Our venous pressure runs around 125 and arterial around 95. At 500 blood pump speed when we started our VP was >250 and arterial 185. Very high and definitely not good for your fistula or heart. Glad to hear your at 320.

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The whole “at home” thing is very scary. I am/was the caregiver for my husband, who had his bladder and both kidneys removed nearly a year ago. We were trained on NxStage and went solo on June 1. After 4 months he is back in-center, because it was too stressful for me. At first it was OK, the machine would alarm, but the NxStage tech folks were terrific and talked me through the problems. The worst one was when I did something out of sequence: I was going to have to start over with a new cartridge, but the sack of dialysate was going to expire before the treatment was complete, so I had to get him to the hospital to have his treatment there. Also, during the last month, my husband started getting symptomatic – BP would start out very high, decrease to the normal range, then crash at the start of the 3rd hour when almost all the fluid had been removed – to the point where he felt he was going to pass out, and wanted me to stop treatment. Resetting the UF to 0.0 did not satisfy him. I objected to ending treatment early, because he was not getting his blood cleaned sufficiently. At the next monthly team meeting at the clinic, the nephrologist suggested that we add additional treatment(s). That was pretty much the last straw. We go from one person not having a life going in-center to two people not having a life doing home hemo. It felt as if I was always doing a treatment, preparing a batch, cleaning up, etc. with no time to simply get my hair cut or go to the dentist. I was emotionally exhausted all the time. All I wanted to do was sleep, not make dinner, not do anything else. And I felt guilty for feeling selfish. People told me that as a caregiver, I have to take care of myself before I can take care of anyone else, but there was neither the time nor the energy for that. Thankfully the team has been very understanding and they have not given me any grief about bombing out of the process! I am happier with him back at the clinic, but of course he is not. Now we are going to explore PD, graduating asap to nocturnal.

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Thank you so much for your comments. You have described on here exactly the scenario we have been experiencing. I have felt so terrified all the time. Things came to a head with me 6 weeks ago and I too had a breakdown. I had been so poorly to the extent that I was prescribed antidepressants by my doctor but was advised I must tell him my fears which I have now done. He too has returned to the hospital for treatment and has promised that he will not put me through home HD again. I still feel so guilty and a failure though.

Exactly! There were times, though, when he added to my stress, because he always wanted to know how much time was left. Every 30 min. when I took the readings, I would write down the time remaining. And he never understood that the time on the machine was not the same as the time on a real clock. The approx. 3-hr. treatment time stretched to 4 hrs. or more because of all the prep work, priming time, and clean-up, which made it comparable to the typical 4-hr. in-center regimen. My failure is sort of a shame, because I was really good at cannulating, and the blood did not bother me all that much … although sometimes it was scary because he’s on a blood thinner. There were times when I’d pull the needles, hold for 15 min., then try to put on the bandages, and he’d start spurting. I had to call the ambulance a couple times! And to save time, he wanted me to pull both needles at once like they do in-center, but I refused. When I had trouble getting the bleeding to stop, I would lay out extra gauze squares and make more bandages, but I still ran out. He didn’t care that at that point there were not enough hands to both hold where the needles had been and make more bandages. My back would hurt, my hands would cramp, etc., so I am relieved to not have to do this anymore. Now I am wondering what to do with all the leftover NxStage supplies, because they won’t take them back. I thought about donating this stuff to the hospital, but they use the big Fresenius machine, not NxStage. I’ll try eBay, I guess! And I now have a lifetime supply of tape, gauze, gloves, etc. NannaDi, I must say that I am so glad that I wrote my thoughts here. It’s great to find somebody out there who completely understands what it is like and how hard it is emotionally. One funny memory of all this is when we’d be at the hospital in the ER (for whatever reason) and Paul would mention that we were doing home hemo. They’d look puzzled, ask me if I was a nurse, and I would say, “No, I’m a retired librarian.” They were always dumbfounded when I’d say that, and then be really impressed when they realized I was not joking.

My doctor too was shocked that we were doing the procedure at home on our own. She was under the impression that a nurse attended the sessions and found it hard to believe that they only visited every two months. I have never had any medical training prior to our dialysis training as I worked as a P.A. At least I was lucky in the fact that my husband did his own cannulating. Our hospital insists that patients on home HD handle their own fistula. It was very frustrating most of the time for both Tom and I when he failed to find the right place. He too is on blood thinning injections so every try resulted in lots of blood loss, sometimes hitting the ceiling and walls. I too found this scary as while trying to get the needle into the top hole, the bottom one which was already inserted would clot. I was frantically trying to inject saline into the needle and draw off to stop it clotting and at the same time clean away the blood from the top hole. On one occasion it took 6 hours just to cannulate and we ended up at the hospital where they had to make a fresh entrance into the fistula in order to dialyse him. Even now whilst he is attending hospital many of the nurses fail to cannulate and have to call someone else to do it. I am so relieved that he is back attending the hospital. We, like you have masses of supplies here. I’have not discussed this yet with our unit. They do use a couple of NxStage machines here in the UK for training so hopefully they can take the 96 boxes of water, boxes of saline and cartridges.

Mine will do this, I have 4 bags on the IV pole and one on the warmer. When I have about 7 minutes left I get caution 14. I found out if the bag on the warmer doesn’t have enough weight in it when it gets low for the warmer to sense it. So when I use bags and I get down to the 7 minute mark I take the last bag off the warmer and hang it on the IV pole and not get the caution alarm 14. It will stay warm for the time I have left. Hope this helps

I have this problem off and on. I called NxStage the first few times. They said it is a timing issue in the cycler. They say it is ok. But it sort of freaked me out at first. Now I just wait for the 9 to clear and rinse back. I don’t get an alarm. It just beeps, goes to 9, then clears to zeros for rinse back.