I have wondered about the various arrangements for machine maintenance in home programs. I understand with NxStage, if the machine breaks down, the company sends out a new machine by mail. And with Aksys PHD, they use their own techs which fly in to do repairs. What arrangments occur with other make machines?
If I have a technical problem during the night, I call first thing in the morning, and a tech is usually at my place the same morning, sometimes in the afternoon. I’ve never had to miss a treatment due to machine breakdown. It has always been repaired the same day, even on Saturdays. I guess people who live way out at the edges of the region might have to wait until a tech can get there by road, but that doesn’t apply to me.
Preventive maintenance is done every 3 months.
Pierre
Hi Pierre,
In-center there are often problems with machines. But I would think that is because, the same machine is used by so many patients and handled by so many techs. Have you found that machine problems are rare at home?
I would describe problems as infrequent, but not rare. So far, I’ve had a faulty BP module replaced and a module inside when I was having TMP. Everything is modular, and it basically just pulls out. Other than that, there was the crack in the ultrapure filter housing which I mentioned in another thread, and just the regular planned maintenance at 3-month intervals. Another time, I thought the conductivity indicator was off, but it turned out it was the little tabletop conductivity meter that needed adjustment, not the machine.
You’re right. The techs say the home machines get almost no use compared to the ones in centre.
As I said before, I’ve never had to miss a treatment because of a technical problem.
Pierre
Fresenius has excellent middle-of-the-night telephone technician service I have used perhaps 10 times in a thousand treatments. Daytime M-F service and repair comes from our center.
Mel
Mel,
How many patients are in your home program and are the techs who service the machines incenter the same ones who handle the repairs for home patients? If you have a breakdown on the weekend, do they get the machine running in time for the next day or do you have to go incenter?
What you said about maintenance for the Aksys PHD is not quite true. It depends on where you live in relation to how close a technician is to you.
I am in Houston, and when I first started using the PHD I had a local tech. That was great because whenever the machine needed attention, whether it was something unexpected or it was regular maintenance, my local tech was always over at my house working on the problem either the same day or the next morning. I think I only had to miss 1 treatment in the past 4 months with that arrangement because the service was so speedy.
Things have changed now, however. The person that was my local tech is no longer wiht Aksys and they have not hired a replacement for him yet. So now, when something needs attention on my PHD, the tech that comes out to service my machine is either the tech who is handling all of the machines they have in the Denton, San Antonio, and Houston by herself (which means that if she is in Denton that day, she won’t be able to make it over to my house until the following day at the earliest) or they fly someone in from another part of the country to work on my PHD. Unfortunately, this has resulted in several missed treatments.
I am desperately looking forward to the day when they hire a tech that is local to Houston again so that any problems can addressed promptly and I won’t miss more treatments because there was no one available to fix my PHD.
Jane, I believe there are currently five HD home patients in our center. The techs who come to our house are the same ones who handle the in-center machines. The Fresenius machines are very reliable and most of the times I’ve run into a problem it has been my fault and the Fresenius tech talked me through the solution over the phone. There have been very few missed treatments – less than five in more than three years from machine failure and power failure combined – and my Jane has never had to go into the center for treatment. One of the enormous advantages of nocturnal is that missing a treatment or two treatments is simply not a problem. Most all of the tech visits are for quarterly maintenance, not repair. For us machine failure and maintenance are just not matters of concern.
Mel
Jane, Our center has hired private contractors to do our quarterly yearly and reguired maintenance on our Fresenius machine. They have to drive 5 hrs one way to get to our home and the service is excellent. They usually come the next day after the machine breaks down and we are back running that night. And as stated if you miss a treatment and your on nocturnal it’s no big deal you are well dialyzed.
The center which is the closest to us is starting a program with the PHD. I am waiting to see how the maintenance issue works out with them. We live in a rural area and the closest airport is a couple of hrs. away.
Marty -
I’m just curious - where are you located? Do you think that you are in a location where an Aksys tech is local and can get out the fix machine problems quickly, or do you think a tech is going to have to be flown in every time in order to support the PHDs?
I don’t think the PHD tech will be local as there aren’t any other home hemo programs in our area. So there either going to fly in, drive in or Aksys will have to train someone in our area. I think service will be a mess for a while but will let you know what I hear.
Marty -
I’m sure it won’t be a problem with your getting very timely support for the PHD, even though you don’t know of anyone other local program. You are right - until/if they hire a local tech to support the PHD’s at the center, my guess is that at least while the program is getting up and running “smoothly”, their will be a tech assigned to your area full-tiime to hanlde any issues that come up with the PHD’s. Once their PHD program is up and running, though, a tech will mmost likely have to either fly or drive in to your area when needed. Hopefully that have to happen to often.
Please do keep me posted on how the support for your area works out.
Eston Burciaga
I’ll let you know when I hear.
am in Houston, and when I first started using the PHD I had a local tech. That was great because whenever the machine needed attention, whether it was something unexpected or it was regular maintenance, my local tech was always over at my house working on the problem either the same day or the next morning. I think I only had to miss 1 treatment in the past 4 months with that arrangement because the service was so speedy.
Eston writes:
Things have changed now, however. The person that was my local tech is no longer wiht Aksys and they have not hired a replacement for him yet. So now, when something needs attention on my PHD, the tech that comes out to service my machine is either the tech who is handling all of the machines they have in the Denton, San Antonio, and Houston by herself (which means that if she is in Denton that day, she won’t be able to make it over to my house until the following day at the earliest) or they fly someone in from another part of the country to work on my PHD. Unfortunately, this has resulted in several missed treatments.
I am desperately looking forward to the day when they hire a tech that is local to Houston again so that any problems can addressed promptly and I won’t miss more treatments because there was no one available to fix my PHD
Eston,
I missed your post above and only just now noticed it. Has anything improved with this situation? It upsets me to hear that Aksys does not provide better/consistent service like you had when the tech was local. It seems to go without saying, that for dialysis patients, missed txs should not even be in the equation. Good service is essential. Was it your understanding that you would have missed txs when you signed on with Aksys?
Most home dialysis patients are Medicare Method I patients. In this case, the dialysis clinic orders the machine and supplies for the patient. It orders from companies that it has contracts with. The patient does not typically sign up with a company unless the patient is a Medicare Method II patient. Even in that case, the patient uses a machine that the dialysis clinic staff know and can train the patient on. Contracting is done at a facility or corporate level, but I have heard that patients have influenced clinics to consider one machine or another.
So far as machine maintenance is concerned, several people have discussed this in several threads. One thing that isn’t discussed as much is the obligation that the clinic has to provide backup dialysis for home patients that need it. This is a requirement of Medicare certification for a home dialysis program. When I worked in dialysis, our patients who had machine problems that made it impossible for them to do dialysis came into our clinic for one or more backup dialysis treatments. It wasn’t always easy to fit people in, but we did it because we didn’t want any of our patients to miss a treatment.
It’s great that the NxStage machine is transportable and the company is willing to ship out a different machine in trade. However, if someone was planning to do dialysis one day and found that his/her machine was not working, wouldn’t it be at least the next morning before the working NxStage could arrive by FedEx or other overnight shipping service? If so, wouldn’t that person miss a dialysis treatment too? Maybe the person could do dialysis right away if he/she was home all day, but wouldn’t the working patient have to wait to do dialysis until the next evening? Unfortunately, if a machine problem can’t be fixed by the patient, it usually means some disruption in the normal dialysis schedule.
Doing dialysis frequently certainly seems to improve outcomes. I am very glad that all of you are conscientious about your treatments. I’m sure it’s going to serve you well. However, it makes me wonder if clinics are less likely to offer backup dialysis if a machine problem causes someone on frequent dialysis to miss an occasional treatment compared to how quickly that same clinic would offer backup dialysis to someone doing dialysis 3 times a week. Eston, since Aksys hasn’t had a technician in your area, how long have you had to go without dialysis before your machine was repaired? Did you tell your clinic that your machine not working? Did your clinic suggest that you come in-center for a treatment? For the rest of you, what are clinics offering when you tell them your machine is broken? What do they do if you complain about having to miss a treatment because your machine isn’t working and the technician isn’t local?
Yes - it was made very clear to me when I had my first talk with my tech (at the time - my local tech) that there may be times when a machine repair would take more than a day and I would most likely have to dialyze in-center until the machine was up and running again. I was told that it wouldn’t happen all of the time, but it definitely would happen. I knew of this “down-time” possibility when I went into my home dialysis using the Aksys PHD. My tech was correct - of all of the times when I have needed some support with Bertha, only one of them required more than a day of downtime.
I also knew when my local tech was no longer with Aksys, that the chances of having to dialyze in-center went way up due to my new tech being unavailable. It was, and still is, just a fact. I know that Aksys is doing their best to provide a local tech in the Houston area again - as fast as possible. I also know that finding someone to take care of an Aksys machine is not an easy task. I have a Computer Science Engineering degree, and after having seen the insides of the PHD and talking with my (old) tech about the PHD’s software I know how extremely complex the entire system is. I would not want to be in the shoes of the person at Aksys responsible for hiring a tech for the Houston area. It is hard enough finding and hiring a person savvy enough to maintain a suite of Windows computer systems, much less someone to maintain several systems as complex as the PHD. Aksys can’t just “pluck” someone out of the local IT school and expect them to be capable of maintaining their systems at an edequate level. Truthfully, if that is what they did in order to provide a tech local in my area, I imagine that I would be extremely unhappy with the capabilities of that person to properly diagnose and troubleshoort Bertha.
I am in constant communication with the home hemo program at my clinic. If there is something going on with Bertha that requires support from Aksys, I always try to make my clinic aware of it. Usually, when the home hemo nurse finds out that my machine is down for any length of time, he urges me to come and dialyze in-center so that I won’t miss a treatment. I typically decline his offer because I know the Bertha will be down long enough to cause me to miss only 1 treatment. The time that I called and told him that I was going to have to wait 2+ days for Bertha to be fixed, at that time I also told him I felt that I really needed to dialyze. Without any hesitation, my home hemo nurse told me that I should come in to the clinic for an “emergency” treatment. He wanted me to come in that day, but since doing a treatment in-center was not very palatable to me, I decided to wait and see if Bertha was going to be usable later that day or not. Unfortunately, as the day drew to a close I knew that she wasn’t going to be fixed for at least another day. As soon as I realized that, I called my center. It was about 8:30pm that night. I told them of my inability to dialyze at home due to machine problems. They were able to find a chair for me in the first shift the very next day. I was actually surprised at the flexibility they showed in getting me in as soon as possible, because they are almost always full - especially in the first shift of the day.
I was unable to dialyze at home for 3 days total, and it was on the 3rd day that I went in to the clinic for an “emergency” treatment. That period of 3 days was defintely the longest I have ever had to go without being able to do a treatment at home. All other time there was a machine malfunction, I only had to miss 1 treatment. Whenever I do have to miss a treatment at home, I simply re-arrange my diaysis schedule for the rest of the week in order to get my 5 days in. It is definitely inconvenient to have to rearrange my entire schedule fo the week, but it’s really not a big deal. Sure, it’s a drag to have to go a day with extra fluid on me when Bertha breaks down and I have to miss a scheduled treatment. But in reality, that is my choice - to miss that treament. My clinic is always an option for me if I feel like I have got to get my treatment for that day. I just abhor treating in-center after doing home hemo for several months now, so I don’t utilize my clinic’s availability unless I don’t feel like I have a choice.
I think that dealing with the unforeseen circumstance of a machine failure is just one of the things that go along with home dialysis. I also think that every one of us that has chosen to do home hemo has made the decision to work around those days when our machines are unexpectedly down. With the Aksys PHD in particular, machine breakdowns are just part of the whole picture and you just have to be aware of that fact going into their program. I guess that is just one of the unfortunate negative aspects of choosing to use a machine as complex as the PHD. I expect machine failuers to happen because the machine as comples as it is, but in return I get a dialysis machine that requires very minimal interaction (translation - time) from me in order to get a treatment started and stopped. Compared with the other home dialysis machines, the time spent on setting up and tearting down the PHD is almost nothing. I will take the benefit of a minimal amount of time for each of my treatments with the PHD versus a substantial amount of time with other home dilaysis machines in order to perform each of my treatments any day. Especially when my only other real option is to use a home dialysis machine that I have to spend 30+ minutes at the start and stop of every treatment. If that means that I have to miss a treatment here and there, I can live with that.
The loss of my local Aksys tech is something I wish never would have happened. But, unfotunately, it did. I know that there are several reasons why any tech may or may not stay with a company; all of those reasons are out of my hands. It’s not like I could have tied my tech down and force them to stay at Aksys just to make sure I always get timely support whenever I need. (Although - that sure would be nice I if could have done that!) I can’t blame Aksys for losing my local tech, either. Having employees leave is part of any business. I would be very naive if I actually thought “once an Aksys tech, always an Aksys tech”. That’s just not how things work in the real world, unfortunately.
I’m just lucky that there is a tech that is local to the Texas Region. If I can’t have a tech local to Houston, at least I have a tech local to Texas; a tech that doesn’t have to be flown in every time Bertha decides to act up. Sure, the tech for Texas sometimes can’t get out her on the actual day a problem occurs, but at least I know she will get out here in a reasonble amount of time. I’m also glad that the tech has agreed, in the first place, to handle such a huge territory (Dallas, San Antonio, Houston) for however long it is going to take Aksys to find and train a tech local to Houston.
Despite the fact that I did wind up missing 3 days of treatments at home one time due to machine failure and the lack of “same-day” technical support from Aksys, I don’t reget having chosen the PHD as my home dialysis machine. Based on everything I have read about other home dialysis machine alternatives (the comparably long set-up/tear-down times associated with more traditional machines, and the seriously questionable long-term side-effects of the conveniently portable NxStage System One), I am extremely glad that I have chosen the Aksys PHD as my home dialysis machine. It would be nice for me, however, if a local Aksys tech were hired and trained quickly!
Eston Burciaga
Eston,
Thank you very much for explaining how all of this works. The expectation is not that a tech will be there immediately to fix the machine unless one happens to live close to a local tech. So one must choose between rising fluid/toxins or going into the unit for a tx., or more. Hopefully, this does not happen too often. To get into perspective, how often would you say your machine has broken down since you started home txs?
Do you call the Aksys tech directly when there is a machine problem or does your unit nurse make the call? Is there a hot line, such as Fresenius has, for asking questions in case a tech can walk you through minor machine problems? Are you informed the approx. time a tech will arrive or must you cancel your plans for the day to wait for the tech to show up? Do techs work 7 days a week or is it an extra problem should the machine go down on their day/weekend off? About how much time does the tech spend in your home repairing the machine? If you have to go into the unit, do you stick your own needles ( think you said you have a leg access, but would home patients with buttonhole use their buttonholes incenter?).
Sorry for all the questions, but I’m not through yet. You said that you at leaste have a tech for your state. Is it even worse for home patients who do not have a tech for their state?
If you don’t mind me asking, what is it about going incenter that you dislike so much? I’d like to start a thread on this as I’d like to know how others feel about this, too. I frequently read that patients in home programs would never want to return to in-center no matter how much work they must do to set up their txs.
And finally, I understand what you mean about the tradeoff of having a few more machine problems for the convenience of having such little machine preparation. But really, does the PHD break down anymore than other machines or is it that the techs are not as closeby in all areas?
Beth,
I am still waiting my turn to get into a home program. I asked my doctor if the unit would fully back me up if my home machine was down and she said “Yes, definitely”. I had wondered about this as I wouldn’t want to be told, “Sorry, we’re full today”. I’m glad to hear you say that it is a Medicare regulation that the unit must back up home patients when their machine is down. But I still wonder what would happen if the shifts were full- would the unit then have to find a chair in another unit?
Marty writes:
Jane, Our center has hired private contractors to do our quarterly yearly and reguired maintenance on our Fresenius machine. They have to drive 5 hrs one way to get to our home and the service is excellent. They usually come the next day after the machine breaks down and we are back running that night. And as stated if you miss a treatment and your on nocturnal it’s no big deal you are well dialyzed.
I have heard that some programs hire private contractors, but I’m not clear on what this means. Are these the same techs that maintain the machines at your unit or does this group of techs strictly handle home program repair? Do they work for the Fresenius corporation? If they have to drive 5 hours to your home, yet still provide excellent service, that says a lot.
The occupation of dialysis techs for home programs is certainly different. Imagine driving 5 hours to come service the machine and save the day for patients who must get back to a life saving tx. I wonder if they like the job or get sick of it?
Hi Jane,
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I have heard that some programs hire private contractors, but I’m not clear on what this means. Are these the same techs that maintain the machines at your unit or does this group of techs strictly handle home program repair? Do they work for the Fresenius corporation? If they have to drive 5 hours to your home, yet still provide excellent service, that says a lot.
The occupation of dialysis techs for home programs is certainly different. Imagine driving 5 hours to come service the machine and save the day for patients who must get back to a life saving tx. I wonder if they like the job or get sick of it?
In answer to your question, some dialysis clinics use their own machine technicians who work on machines in their clinic to do routine maintenance and repairs for home patients as well. Some may limit how far away a home dialysis patient can be from their clinic because of the travel time to get to/from the patient’s home. Some clinics have contracts with the companies that make the machines to do routine maintenance and repairs. I’m not sure if it’s possible to use a combination of these two which would allow a clinic to service patients who live farther away using the contracted machine tech and use the staff machine tech for patients that live closer.
I suspect that it takes a certain type of person to do machine maintenance and they probably don’t get the credit they deserve. Besides the technical skills the technician would have to have, he or she would have to understand how people cope and how important it is not to get defensive when someone is frustrated or angry because their machine broke down and threw off their schedule. The technician would also have to be willing to be away from home on a moment’s notice. The payoff is the appreciation that they get from patients and families…and sometimes snacks or even meals from grateful patients and families.