My wife and I are both Respiratory Therapists, we went to home hemo training very quickly, did very well and then went home. A different unit, same model was sent to our home. We could never complete treatment and return my blood because of the A&V pressure alarms. Why are they set so low, much lower than the in center units.
We were told to go back to in center Hemo, no call from the Nephrologists, no changes in settings, go back to the center.
We are very disappointed and don’t know what to do, what are our best alternatives?
Michael and Janet Michael
Kansas City, MO
Hi Michael,
It sounds like you’re on hemodialysis, not peritoneal dialysis. It would be great if you’d re-post your question in the forum for home hemodialysis. I may have a response for you but don’t want to post it here since it might be confusing since you’re not on PD.
Call Indiana University Home Dialysis, they are outstanding. 1-317-963-6850. In your field, I doubt you would have a hard time finding a job 
Indiana University Home Dialysis has my five-star seal of approval.
Are you using a NxStage cycler? If so, and if it wasn’t the cycler you used in training, you probably got a cycler that was set at the NxStage default for arterial alarms – 220. This is the way the NxStage cycler is delivered. The home training nurse should have helped you reprogram the cycler for the specific settings you need. It sounds like the home training nurse may not have made a home visit for your first dialysis during which he/she would have reprogrammed the NxStage arterial alarm setting. The clinic is supposed to give all NxStage patients a form that includes the settings specific for them. NxStage would need this to walk you through how to make the change. The arterial alarms are usually reprogrammed to 240 or 250 to eliminate nuisance alarms that occur with lower settings. So far as not being able to return your blood, your home training nurse should have trained you how to manually return your blood if there was a problem (power failure or alarm you can’t correct other than air in the line). In fact, your nurse should have shown you how to correct all alarms on the machine during your training instead of correcting them himself/herself. I have a friend who was a home training nurse back in the 1970s-1980s and she would do things to the machine while the patient-in-training wasn’t watching to see if the patient or care partner knew how to correct that alarm. That’s probably the way all patients should be trained so they don’t get anxious when an alarm occurs.
If you don’t feel comfortable with the training you received or the support you’re getting now, there are many dialysis clinics with home programs in the Kansas City area. You can check for daily home HD on the Home Dialysis Central Find a clinic database or find NxStage clinics on their website. I’d suggest you call NxStage tech support and ask the clinical educator to call you or to contact the nurse(s) at the clinic where you go to talk with them about how the machine defaults are set and that they need to reprogram the machine if a patient needs to have different alarm settings. Otherwise they could lose many patients to other clinics. Bottom line…You should not have to go back to in-center HD.
Michael, I have to wonder how experienced your home training nurse and the rest of the staff was. Please don’t blame yourself or your wife for this–it really sounds as if you did not get the proper support. Don’t give up! Beth and the others have given you some excellent advice. It may be that your best bet is a different, more experienced clinic.
Thanks Dori
We are asking for more training at home, that are willing, so we"ll see.
Thanks Beth, I asked if the home units pressure limits could be set higher like the in center machines. The DR. said no.
The machine at home came directly from NXStage, they told me they were set at 260. I don’t know, they never went over changing that setting.
The training went well, we felt ready, but the alarms almost sent us to divorce court.
There is a social worker there that has been most helpful and communicated our desire to try home hemo again. It’s only because of him that have talked to us and agreed to more training when a nurse is available.
Hi Michael,
Did you ever get more training? Did your training nurse do a home visit? Did the training nurse check the arterial alarm setting for your NxStage to see if it truly was set at 260 or if it was set lower?
Hi Beth, yes we are about to do some retraining, two days in house and two to three days at home with a nurse.
My Renal Dr agreed to increase the pressure limits to 280. We wanted them to check the settings but they say they can’t, it’s set at DaVita.
I’m cannulating myself, and will be using button hole needles soon.
Were eager to get back home.
I’ve heard the NxStage User Guide has information that tells you how to check the settings. When you’re not on the machine, you could call NxStage technical support and ask them to help you walk through how to double-check to see where your arterial alarm is set.
@ MMichael
If you need help setting your limits, I can help with that. I use the NxStage machine, and I had to set it up when I got it. It is very easy.
Be Well!
Dave
Thanks Dave,
We have been at home by ourselves for three days now. My pressures run 250 at times for awhile, then settle down. My fistula is still pretty new, not showing yet, but better than it was the first time we tried home hemo.
I would like to increase the pressure limits a little bit just to avoid an unnecessary alarm.
You could tell me here or e-mail at kcpapa2@att.net.
The NxStage technical support personnel can also tell you how to adjust the pressure limits on the machine. You could also ask to talk with one of the NxStage nurses who trains the dialysis clinic nurses to teach patients.
Indiana University Home Dialysis has my five-star seal of approval.