I thought of analogy to explain the difference between using bagged dialysate for the Nx Stage and the Pureflow bulk dialysate system. The analogy works for most technology and it really isn’t an original analogy. I developed it because there are some late adopters who just have difficulty switching technology regardless of how much it may improve their lives. I thought this might help them to give the new technology a try.
Going from bags to Pureflow is a lot like going from depending on a horse to a motor car. One knows his horse is dependable and sees those first rickety motorcars having problems in the rutty roads and thinks, “my horse has worked for me all my life, no need to try that smelly, mechanical contraption.”
After a spell though he notices his neighbor on east has bought a car and he sure can get to church on time. He notices his neighbor doesn’t have to deal with all the manure and buying feed and watering his horse. But, he loves his dependable mare. She is always there for him, even if he sometimes has to call the vetrinarian in at 1:00 a.m. for a stomach ailment. Surely, his neighbor has to take his car into the mechanic from time to time, he thought.
Then one day he notices his neighbor on the west has a truck. He his moving a heck of a lot of grain in no time flat to market. Now he starts to scratch his head and think for a spell. But, the spell passes and he decides he’ll stick with old Bessy because she is reliable and because he just always has had horse.
One day he has to bury old Bessy because she died of old age. By that time he notices that both of his neighbor’s farms are flourishing and that the farmers seem to have plenty of time to spend with their families. He understands that they each bought a machine that acutally washes their clothes. He couldn’t fathom not having his wife spend all day Saturday on the washboard. “What else would she do with her time?” he thought to himself.
So, he bought himself another horse and lived his life to the fullest extent possible and died a happy man.
[COLOR=indigo]Life is full of choices. That is the beauty of it. [/COLOR]
Hey Riverdude
I like your analogy. I haven’t hear anything good so far about the Pureflow. Tell me how it is setup. We don’t have a bathroom near our bedroom and I was told that would be a problem. Our Pee line snakes through the house and so far it has worked well. Even the grandkids know about it and respect it.
I love the PureFlow. I have had very few problems with it and to me it is a piece of cake.
If you have ever used a dialysis machine like at the centers with an RO, let me tell you about machine problems with an RO, left you avenue to do back up except in center or skip a night. The cleaning once a month takes between 4 to 5 hrs, and two weeks later you have to bleach the product line. Floods, my oh my! So you can see the Pureflow and the Nxstage is the best. And Ralph really feels better on Nxstage!
Pat
Pureflow is GREAT! We had some issues at first, but well worth it.
We get 3 treatments per batch. Takes about 10 minutes, at the most to get a batch started. I do that at night just before I go to bed. Next morning, check for chloramines. If it passes, you are ready to start using it. What could be simpler? Not sure what you have been hearing, but ignore it and go with the pureflow as soon as it is available.
Again I ask, do you have to have a water source near your machine? What would you do it you didn’t? I would love to knock down the hallway of boxes by my front door. My house looks like UPS West.
You know what would be cool? That the Pureflow SL is capable of filling your own dialysate jugs for travel. Or perhaps they re-design it to use Sorbent technology.
However, you can’t compete between bagged and stationery…you see they both have their reasons for use. Bagged is flexible, and can be taken anywhere so its the perfect freedom. The question is, “Can NxStage design a method where we can re-fill our own at home” ?
Now comes Pureflow Sl, its heavy, its dark, its not as flexible as bagged. Sometimes it don’t behave right and you have to wait for it or perhaps miss a day. Its heavier than the cycler itself. You can’t travel with this. If you hate to travel, maybe this is for you!
You don’t have to choose. You can do both. The pureflow needs to be fairly close to a water source, but if not, run a flexible tube from where you want to dialyze to where the water is. I don’t see why there would be any real maximum distance. the only thing is hiding the tubing. I have Denise’s pureflow in the living room. I cut a hole in the wall and connected to the washing machine connection.
As for traveling, you keep a few boxes of bags around for backup, just in case there is a problem. If you are traveling very far, arrange with Nxstage in advance and they will ship your bagged dialysate to be there when you arrive. (I think there is a minimum on this, but I am not sure what it is.)
The cycler just sits on top of the pureflow and you actually connect your lines to it each treatment just like you would to your bags. If there is a problem, you could always hang bags for a treatment or 2 until the problem is resolved.
As for the timing, the pureflow makes a batch of 20 liters at a time. We use 20L per treatment, so that is obviously 3 treatments. I start a batch at night before we go to bed and you have 72 hours to use it before it expires. We get up in the morning and do a treatment. If you count the time between 1st and 3rd treatments, that is 48 hours plus the length of the last treatment that we need to use it up. So, 72 minus the 8 hours of sleep the first night gives me 64 hours until batch expires and I need roughly 51 hours. That is 12 or 13 hours to spare.
I’m really not sure why anyone wouldn’t be able to use up a batch before expiration.
[quote=billable;13146]As for the timing, the pureflow makes a batch of 20 liters at a time. We use 20L per treatment, so that is obviously 3 treatments. I start a batch at night before we go to bed and you have 72 hours to use it before it expires. We get up in the morning and do a treatment. If you count the time between 1st and 3rd treatments, that is 48 hours plus the length of the last treatment that we need to use it up. So, 72 minus the 8 hours of sleep the first night gives me 64 hours until batch expires and I need roughly 51 hours. That is 12 or 13 hours to spare.
I’m really not sure why anyone wouldn’t be able to use up a batch before expiration.[/quote]
That bothers me, it literally controls you now…where’s the true freedom now? You see why the bagged dialysate really wins. The schedules are flexible with bagged dialysate and you use every drop of it.
There has to be a way to be able to use the extra dialysate without worrying or stressing out yourself that you have to get on when the machine says so.
I really think the Pureflow SL has plenty of room for improvement. Other than that its better than anything else out there right now, so its really worth it. The more support and feedback NxStage gets the better their products will be.
I would bet that the 72 hour limit was an arbitrary time that they decided to use during testing the machine. It is pretty much a sealed system once it is made, so why not 84 hours? or 96? Like I said, it fits our lifestyle fine. Even if it was 100 hours, we would still use it within the first 72.
You are probably right in that, if Nxstage gets enough feedback, they could extend the batch expiration time.
I guess it would limit you somewhat in choosing your day off, if you are really worried about getting to use the whole batch. If I used one treatment and wanted to skip a day, I would still skip. The next day after we dialyzed, drain the remaining batch that is going to expire anyway. Empty it and make a new batch. The dialysate is the cheapest factor in the whole equation and they aren’t going to charge you extra.
You don’t want to be wasteful, but if you need to waste one every once in a while, I don’t think it’s a problem.
There’s an actual reason for the 72 hour limitation. It is currently due to FDA regulations regarding the use of the dialysate, tubing, etc. NxStage is apparently trying to get approval to extend the time limit since it is for all practical purposes a closed system.
I’ve been using PureFlow now for about 6 weeks, and have had a few problems, which mostly can fall under the category of “what an idiot I am”. The one issue which has irked me the most is a #15 alarm, which indicates that the door is open, and forces you to drain. Because I’ve set a specific schedule, that forced me once to use bags for a couple of days.
For the last year, I got myself on a schedule of starting dialysis between 9-10 pm. Yes, I know that means I finish pretty late, but I then go to bed immediately, unless I’m really pumped up. I start a new batch on Sunday and Wednesday mornings anytime between 10am-12pm and am ready to start dialysis after dinner. Works out great! I haven’t had to change a PAK yet, and am curious how that will affect my schedule.
[quote=Rich Berkowitz;13151]There’s an actual reason for the 72 hour limitation. It is currently due to FDA regulations regarding the use of the dialysate, tubing, etc. NxStage is apparently trying to get approval to extend the time limit since it is for all practical purposes a closed system.
I’ve been using PureFlow now for about 6 weeks, and have had a few problems, which mostly can fall under the category of “what an idiot I am”. The one issue which has irked me the most is a #15 alarm, which indicates that the door is open, and forces you to drain. Because I’ve set a specific schedule, that forced me once to use bags for a couple of days.
For the last year, I got myself on a schedule of starting dialysis between 9-10 pm. Yes, I know that means I finish pretty late, but I then go to bed immediately, unless I’m really pumped up. I start a new batch on Sunday and Wednesday mornings anytime between 10am-12pm and am ready to start dialysis after dinner. Works out great! I haven’t had to change a PAK yet, and am curious how that will affect my schedule.[/quote]
Hello Rich, welcome!
I have a few questions for you. Do you have casters on your Pureflow SL? Now if you want to dialyze for the weekend at a family members or friends house do you still have your heater and bagged dialysate with you or did NxStage requested those back?
Overall, between 0 - 10 how satisfied would you rate the Pureflow Sl?
Re:casters, No. I just put gliders on the bottom of the PureFlow, but they’re not working as well as I hoped. Unlike others, I don’t have my cycler on top of the PureFlow. My prior setup for the cycler was so good that I didn’t want to change it. I put a lot of thought into it when I brought the cycler home in 2/06. I built a stand that works perfectly for me. I went to the Container Store and built a stand from the Metro heavy metal shelving parts and had the store cut down the legs to about 23 inches with 3-inch casters, less than a standard 26 inch stand (the 3 incehes makes all the difference in the world regarding reaching controls and seeing the display). I put two shelves in and a basket hanging on the front with one drawer on the side. The part I added I’m really proud of is a 27 inch television swivel which the cycler sits on. With the swivel, I can reach all sides of the cycler without any help from others. That means I can reach the switches as well as the hanging saline or anything else by myself. Unless something drastic happens, I do dialysis totally by myself. I also do dialysis with my laptop on my lap so I do all of my charting directly into an Excel spreadsheet and simply email mt Tx sheets to my center on a weekly basis.
Because I don’t have the cycler on the PureFlow, the PF unit is in a closet about 1 ½ feet from the cycler, just close enough to make all of the connections. (I’ll attach photos later).
I haven’t dialyzed away from home yet, but plan to do so with bags. I also kee a three-four day supply of bags in reserve incase there is a problem with PF. But believe me, there sure is more room to walk around the house now. I use to get shipments every two weeks, and still had about 35 boxes lying around.
Other than “idiot” problems, I think PF is great – give it a 7 so far; it still can use some improvements (a few suggestions I’ve already passed on). I find myself sitting around waiting for the prime to end because I get all of my setup done well within 18 minutes. I find the fact that you don’t have to connect the MLA to the four bags and setup the warmer to be a big timesaver. Also, I don’t have to take out another minute and a half to run a wasteline. Teardown afterwards is also much quicker. Now, if I can only not be an “idiot” so ofter and make “stupid” mistakes I’d even be much happier. The process has become so automatic, sometimes, but not often, my brain twitches and I forget a step. I’ve even called tech support only to get real embarrased I did something stupid.
Nice post Rich. That closet must be really close to be able to hook up to the pureflow. We have ours between the recliner my wife dialyzes in and the couch. I sit on the couch with my laptop and also post to a spreadsheet to keep info. I would like to see yours to compare.