Saw the following post at ihatedialysis.com. Has anyone here on nocturnal experienced this alarm? He says NxStage technicals advice does not satsfactorily solve the problem.
"HemoHelper
Newbie
NxStage Alarm #14
« on: November 15, 2006, 12:20:17 PM »
My partner have been on Nxstage for about two months. She gets to sleep while I attend to the alarms. She is on nocturnal (7 hours) treatments. The machine has introduced sleepless nights for me. It keeps alarming yellow #14. Yes, There is air in the dialysate line. it is located at the cartridge in the line between the heater and the cartridge (green clamps). There is a chain of bubbles that goes in and out like it is breathing. These bubbles are present after the prime… so it is there before I do the tubing switching before connection the patient. I am very careful when hooking up the cartridge (green clamp) to the heater (green clamp) I let it drip dialysate into the connection before tightening to make sure there is no air bubble enter the system. Guess there is some bubbles coming from the heater later when the treatment is running… Don’t know as I try to get some sleep and not up until ALARM #14 wakes me up. Is anyone else on Nocturnal having this problem?
NxStage suggest that I increase the dialysate rate to 3.5 to try to pull the bubbles thru the system… When I try to increase the flow to 3.5 from 2.8 it only allows me to increase to 3.2 (clinic set FF max 30) The only way to get it to 3.5 is change the UF rate to a lower rate. Then the treatment time is longer because of the rate change. This is unacceptable as I would like to get the UF and Hemodialysis to end about the same time…Which I now have about 7 hours. I’ve tried to extract the bubbles from the line by using a syringe with some dialysate attached to the line coming out of the cartridge. Would you believe I actually get about .2 cc of air. Some nights this works and other nights I still get the 14 alarm. but it is better. By the way the alarm 14 happens any time after 2 hours into the treatment. usually happens before the #2 alarm. Usually after the 14 alarm is reset within 5 minutes the #2 alarm (Normal Check) comes on…
I would get #14’s that would not reset when I first started. It had something to do with the tube within the tube style cartridge. They sent me different cartridges to fix the problem. Also one thing I was told is that when primeing you should prime the green clamp line on the heater front first then the one on the top. I was told that that would help with #14 alarms. SInce the new cartridges I never get #14 alarms.
LSB
[QUOTE=Leafsunbear;11146]I would get #14’s that would not reset when I first started. It had something to do with the tube within the tube style cartridge. They sent me different cartridges to fix the problem. Also one thing I was told is that when primeing you should prime the green clamp line on the heater front first then the one on the top. I was told that that would help with #14 alarms. SInce the new cartridges I never get #14 alarms.
LSB[/QUOTE]
Hi there;
What cartridge are you using??? We are using CAR-161-B. Are you using something different?
Don’t any of theses people have the text book that has all the alarms listed. Have they been trained in how to do home hemo?
1 don’t panic 1 don’t panic
2 while in training do you ask a million and one questions to point where the home team gets sick of hearing your voice?
3 Did your home team go over the alarms that come up and test you to see if can answer them?
I’ve been on nxstage for 8 months and yes I had alarms , but I was trained don’t panic , and keep text book within hand reach. If you have this many problems or there are that many people who you are doing work for in problem answering, maybe you should not be home or your co horts should not be home. To see your posts one would think dialysis was and is something that should stay in center? Everything has risks “driving a car” “waking up in the am”
I’m very glad to have nxstage and home dialysis, without home dialysis I would not be alive. For you see I can’t go to a center. If I had to go to a center where mylife depends on a person with a GED and 6 weeks of training, the risks would be to great.
bobeleanor
Don’t any of theses people have the text book that has all the alarms listed. Have they been trained in how to do home hemo?
1 don’t panic 1 don’t panic
2 while in training do you ask a million and one questions to point where the home team gets sick of hearing your voice?
3 Did your home team go over the alarms that come up and test you to see if can answer them?
I’ve been on nxstage for 8 months and yes I had alarms , but I was trained don’t panic , and keep text book within hand reach. If you have this many problems or there are that many people who you are doing work for in problem answering, maybe you should not be home or your co horts should not be home. To see your posts one would think dialysis was and is something that should stay in center? Everything has risks “driving a car” “waking up in the am”
I’m very glad to have nxstage and home dialysis, without home dialysis I would not be alive. For you see I can’t go to a center. If I had to go to a center where mylife depends on a person with a GED and 6 weeks of training, the risks would be to great.
bobeleanor[/QUOTE]
Bobeleanor
Your response has nothing to do with the 14 alarm… I hope that this site would be used by people that was looking for information and those that would like to share their experiences with problems/alarms/good fortunes doing dialysis at home… By the way are you an NOCTURNAL??? As I am finding out; there is not a lot of us using NxStage for nocturnal (7+ hours) a night. Our problems and alarms may be different than those that are using NxStage for daily dialysis…
Heather; Maybe there should be a different section in this forum for NOCTURNAL users…
[QUOTE=Unregistered;11307]Bobeleanor
Your response has nothing to do with the 14 alarm… I hope that this site would be used by people that was looking for information and those that would like to share their experiences with problems/alarms/good fortunes doing dialysis at home… By the way are you an NOCTURNAL??? As I am finding out; there is not a lot of us using NxStage for nocturnal (7+ hours) a night. Our problems and alarms may be different than those that are using NxStage for daily dialysis…
Heather; Maybe there should be a different section in this forum for NOCTURNAL users…
HemoHelper[/QUOTE]
hi
alarm 14 is the same no mater what. if you set the machine on the west coast or east ,day time or night alarms are the same. maybe they is a book for night time user of nxstage where alarms are # some way as to not be the same. THis I would find hard to think why nxstage would do this? Alarm 14 is an air in sytem which in most cases happens (if not all) if the person misses something at the start. If you get air in the line once your up and running you get a different alarm. I hope to start night time dialysis on nxstage this spring, my time just won’t see me getting it set up with the new sytsem. stop and think
bobeleanor
HI Folks
sorry to so short.
I’ve read about some problems that nxstage is having with nocturnal, which is why I thought it was still being tested in center settings. I also understand that a handful of home consumers are being asked to try nxstage. But these are people who understand the whole process and have back ground that the drs. centers and nxstage feel can handle problems and give reports to said people.
As I understand it a person now uses nxstage for 6 days a week for 2.5 hrs uses on avg.20L. So if you go to 5 or 6 or 7 hrs a person may run into problems. If said person keeps the same amount of solution but runs it over 2 or 3 times the set time of 2.5 hrs.
Since I have been home after the first week of doing what was trained to do ,I then started to adjust the flow #'s etc. I now do 4 days a week same amount of solutions but have slow down the solution rate, I’ve run solution 6.0 FF 28 UF rate1.0 and BPS from 350 to 420. The nice about the machine seems to be the time . If I need to get things over and done for time problems, dr or centers etc. I do it short and get it over ,but If I have time I run as long as 4 hrs.
@ Bob,
I run Nocturnal and I had no prior knowledge of Home Hemo. I do it at my own home without the assistance of nurses or monitoring either. I run six days a week for eight hour treatments. I use 25ltrs of dialysate and I just figure that in with my treatment math. So your information is a bit off, sorry.
As for the #14 alarms, they are not always just air alarms. You will get them if you run out of dialysate before the end of your run. Also as I mentioned before, I was getting unrecoverable #14’s that had nothing to do with patient error. Which is what you seem to be saying they are caused by. When this was happening I was in training and one day a NxStage tech was there. She tried to clear the alarm and could not clear it. Turns out it had to do with how new my machine was(it was to sensitive) and the older cartridge. They moved me to a newer cartridge and it stopped happening. Still it didn’t have anything to do with how I primed the machine.
peace;
LSB
alarm 14 is the same no mater what. if you set the machine on the west coast or east ,day time or night alarms are the same. maybe they is a book for night time user of nxstage where alarms are # some way as to not be the same. THis I would find hard to think why nxstage would do this? Alarm 14 is an air in sytem which in most cases happens (if not all) if the person misses something at the start. If you get air in the line once your up and running you get a different alarm. I hope to start night time dialysis on nxstage this spring, my time just won’t see me getting it set up with the new sytsem. stop and think
bobeleanor[/QUOTE]
bob
Yes, the 14 alarm is air in the dialysate side of the system… no matter how you are using the System One (Nocturnal/daily short treatments) all alarms are the same. When you switch to Nocturnal to make it a gentle dialysis the blood pump is run at a slower rate. (we run blood pump at 200) The fluid pump rate is also reduced (19.6 ltr divided by 7 hours = 2.8 dialysate rate) The bubbles that are in the dialysate line between the sensor and heater does not get pulled thru the system because the pump isn’t running fast enough to pull the bubbles down through the carrtridge. This will eventually cause the 14 alarm as the bubbles will collect in the line above the sensor where the tubing is reduced before exiting the cartridge. Guess there is some air entering the system thru the heater and dialysate bags. Do not know where else the air bubbles could be coming from. Checking the air trap in the heater bag… It has the air in the corners ONLY some air bubbles in there so even if you hook a syringe on the bag you do not extract any air…
Maybe it is our machine that is the problem. (NxStage tech support do not think it is the problem). But we have bubbles in the line after the prime is done and machine is in #23 state. recirculating saline thru the system. I have the air bubbles going in and out of the cartridge on the line with the green and white clamp… DOES anyone see there bubbles??? It is like breathing; the chain of bubbles goes in and out of the cartridge on the line with the green clamp.
[QUOTE=Leafsunbear;11318]@ Bob,
I run Nocturnal and I had no prior knowledge of Home Hemo. I do it at my own home without the assistance of nurses or monitoring either. I run six days a week for eight hour treatments. I use 25ltrs of dialysate and I just figure that in with my treatment math. So your information is a bit off, sorry.
As for the #14 alarms, they are not always just air alarms. You will get them if you run out of dialysate before the end of your run. Also as I mentioned before, I was getting unrecoverable #14’s that had nothing to do with patient error. Which is what you seem to be saying they are caused by. When this was happening I was in training and one day a NxStage tech was there. She tried to clear the alarm and could not clear it. Turns out it had to do with how new my machine was(it was to sensitive) and the older cartridge. They moved me to a newer cartridge and it stopped happening. Still it didn’t have anything to do with how I primed the machine.
peace;
LSB[/QUOTE]
Hi there.
Do you have any bubbles in the cartridge’s green and white clamp line after you are thru with the prime and the system is in #23??? It goes in and out of the cartridge. What is your dialysate rate set at? (25ltr/8hr = 3.1) is this correct? My partner has been on Home Hemo Dialysis for 5 years. We were dialyzing using the Fresenius 2008H machine. For five years we had just a hand full of alarms most of them were because of human error… forgot to refill acid jug. Only once we had a machine problem… Blown fuse… We have been using the NxStage for about three months. Super machine… A lot easier the use and maintain as compared the the Fresenius. Just need to get this machine to cooperate and let me get some sleep… extracting the bubbles before I attach the heater line seems to work for us. that is 80% og the time no alarm until the #5 at the end of the treatment.
HemoHelper
[QUOTE=Leafsunbear;11318]@ Bob,
I run Nocturnal and I had no prior knowledge of Home Hemo. I do it at my own home without the assistance of nurses or monitoring either. I run six days a week for eight hour treatments. I use 25ltrs of dialysate and I just figure that in with my treatment math. So your information is a bit off, sorry.
As for the #14 alarms, they are not always just air alarms. You will get them if you run out of dialysate before the end of your run. Also as I mentioned before, I was getting unrecoverable #14’s that had nothing to do with patient error. Which is what you seem to be saying they are caused by. When this was happening I was in training and one day a NxStage tech was there. She tried to clear the alarm and could not clear it. Turns out it had to do with how new my machine was(it was to sensitive) and the older cartridge. They moved me to a newer cartridge and it stopped happening. Still it didn’t have anything to do with how I primed the machine.
peace;
LSB[/QUOTE]
Hey LSB
Like I said I was not aware that nxstage was home yet for nocturnal use. And I knew that if a person uses 6 days at 20L x 2.5hr then went to nocturnal 6 days, something would have to change. Solution amounts ,flow speeds etc.
How do you like nocturnal on nxstage? I hope to be able to get started in the spring doing noctunal. What a time saver?
Sorry once more if I was out line
bobeleanor
Bob;
Please never mind me, I seem to be a complete jerk online. I am not sure what it is, pretty sure it is something deep inside that comes out when I am online. Or maybe I am just pretty much an all around jerk. Most of my friends just laugh me off, you should see it when someone new comes round.
I love nocturnal on the NxStage machine. I am able to run slow blood pump speeds and I seem to get even better dialysis. If you have any questions please feel free to ask me. I will try and not snip your head off;)
peace;
LSB
Hemohelper;
I am not sure why you are getting your #14’s. I do have air in the sline line after the prime at Stage 23. Yet I don’t get #14’s. Air is not the only reason you will get #14’s. You can get them when a dialysate(green) line is kinked or clamped. this happens sometimes when we forget to unclamp the green clamps. Send me a Pm if you’d like to talk more…
LSB
We have been at an impass many times with technical issues re my family member’s tx. Somehow, we always connect with someone who has the solution just in the nick of time. The net is such a great thing, because it connects ppl from everywhere and eventually someone out there in dialysisland will be able to crack this case of the mighty #14 alarm : ) It may be another patient who has experienced the same thing or a dialysis expert who decides to drop in and answer your post. Don’t know how long you’ve been visiting the net, but it has been a powerful tool for us in our dialysis education. It is surprisng that such a small percentage of the ESRD population posts to the boards, but remember, it only takes one person with the correct answer to make your day : ))) I am a hemo helper , too, and I heard you loud and clear when you stated you needed a solution to this alarm problem so you could get some uninterrupted sleep. Hopefully, the solution’s on the way…
[QUOTE=Leafsunbear;11332]Hemohelper;
I am not sure why you are getting your #14’s. I do have air in the sline line after the prime at Stage 23. Yet I don’t get #14’s. Air is not the only reason you will get #14’s. You can get them when a dialysate(green) line is kinked or clamped. this happens sometimes when we forget to unclamp the green clamps. Send me a Pm if you’d like to talk more…
LSB[/QUOTE]
LSB,
Since you are also getting the chain of bubbles after prime at stage 23. then the only thing that must be causing my 14 alarm is the air sensor in that line is too sensitive. Because I know that line is not kinked or clamped… when the alarm goes off… My only solution has been for me to extract the air from that line before I connect it to the heater line. it has been successful for the past 7 treatments. There must be a way to get the machine to push the bubbles through the lines during prime… Tried to run for 6 hours which increased the fluid rate to 3.2 but it still did not push the trail of bubbles through the system… It ran all night (because I extracted the bubbles before I connected the heater line). When I woke up in the morning there was a chain of air bubbles in the line going in and out of the cartgidge but no alarm… Maybe there wasn’t enough air in the line to cause the alarm. So the increase rate of dialysate still isn’t enough to get these bubbles thru the system. Glad that you are not experiencing this problem. Hope NxStage engineers figure this one out… In the mean time I will continue to extract the bubbles from the cartridge before attaching the heater line.
Hemohelper;
The NxStage techs haven’t got an answer for you? I am very sorry about that. I would think that you having to extract the air bubbles is adding another step that could in turn add some risk to your set up. It frustrates me that you are not getting better support out of NxStage on this issue. Maybe you need to turn your outside voice on when dealing with them. You should not have to add a step to your set up. The cartridge and machine should work just like they do for everyone else. If there is an equipment error then they should fix it. I am not sure why you even have lots of bubbles in that line after prime. I have no problem chasing the bubbles in that line during stage 23. There seems to be something wrong here. I hope you the very best and I think you should call NxStage every treatment that you have to extract the air from the line. That is an extra step and you should not have to do that every time you run. Occasionally sure it would be fine, but not all the time.
Peace;
LSB
[QUOTE=Leafsunbear;11372]Hemohelper;
The NxStage techs haven’t got an answer for you? I am very sorry about that. I would think that you having to extract the air bubbles is adding another step that could in turn add some risk to your set up. It frustrates me that you are not getting better support out of NxStage on this issue. Maybe you need to turn your outside voice on when dealing with them. You should not have to add a step to your set up. The cartridge and machine should work just like they do for everyone else. If there is an equipment error then they should fix it. I am not sure why you even have lots of bubbles in that line after prime. I have no problem chasing the bubbles in that line during stage 23. There seems to be something wrong here. I hope you the very best and I think you should call NxStage every treatment that you have to extract the air from the line. That is an extra step and you should not have to do that every time you run. Occasionally sure it would be fine, but not all the time.
Peace;
LSB[/QUOTE]
LSB;
You are saying that when you are in stage 23 you can chase bubbles thru the (White/green clamp) line that comes out of the cartridge??? I would like to know how this is possible… Do you ever see a chain of bubbles going in and out of the cartridge in this line after the prime in stage 23??? By doing the snap and tap you are able to get these bubbles thru the cartridge? Wow that is what I need to happen to our machine… so I don’t have to extract those bubbles before hooking up the patient.
By the way what is your system setting? for:
26. Prime Timer------------0
27. Prime FP---------------100
28. Prime UFP--------------40
29. Prime BP---------------360
30. Recirculation FP--------40
31. Recirculation BP -------320
These are my settings. It is also the the settings that is the suggested system settings for prime on the literature that comes in the cartridge box.
If you are using the same system settings and able to chase the bubbles out of this line that I am having problems with then there must be something wrong with our machine. Possible cause the fluid pump is not properly set-up causing it not to pull those air bubbles thru the system during prime or after stage 23. Because We have used about 5 different Cartridge lot numbers. Or it probably has the dialysate fluid air sensor set too sensitive.
Really appreiate your inputs.
HemoHelper
Hemohelper;
I do not know the setting you mention. I have noticed that during stage 23 we have air going in and out of the cartridge and we don’t get the alarm??? I think you need to really pressure the techs more.
Good luck;
LSB
You are saying that when you are in stage 23 you can chase bubbles thru the (White/green clamp) line that comes out of the cartridge??? I would like to know how this is possible… Do you ever see a chain of bubbles going in and out of the cartridge in this line after the prime in stage 23??? By doing the snap and tap you are able to get these bubbles thru the cartridge? Wow that is what I need to happen to our machine… so I don’t have to extract those bubbles before hooking up the patient.
By the way what is your system setting? for:
26. Prime Timer------------0
27. Prime FP---------------100
28. Prime UFP--------------40
29. Prime BP---------------360
30. Recirculation FP--------40
31. Recirculation BP -------320
These are my settings. It is also the the settings that is the suggested system settings for prime on the literature that comes in the cartridge box.
If you are using the same system settings and able to chase the bubbles out of this line that I am having problems with then there must be something wrong with our machine. Possible cause the fluid pump is not properly set-up causing it not to pull those air bubbles thru the system during prime or after stage 23. Because We have used about 5 different Cartridge lot numbers. Or it probably has the dialysate fluid air sensor set too sensitive.
Really appreiate your inputs.
HemoHelper
Hi HemoHelper
If you are talking nxstage , I’m not sure where you get some of these #'s. I had different alarms over the time I’ve been home. The only time I got a yellow 14 was the green line from MLA bag got stuck where the line comes from the side of warmer. I just gave a quick pull and end of alarm.
When you get to part 23 the machine has sent the saline though the all the tubes. And if you have everything hooked up right, it at this stage you do the snap and tap. You start with red line ( I really snap and tap hard) , then I take filter off and bang the crap out it. Then put filter on holder. Vent blue port cap , then snap and tap blue line. This is all happening during stage 23. Really snap and tap. Make sure everthing is tight, then snap and tap. On the MLA bag once I have it hooked to solution bags (I hang 4 bags I have two feed lines left) I vent the two feed lines first, then vent the green line that comes from the side of warmer, then top vent and I push air i see atop of MLA bag in the warmer. Then I hit stop. My setting are dialysis flow rate are pre set , so when I hit stop the green top screen reads 1.5 my UF rate is 1.0 my BPS is 200. I then go into and put my UF volume in. I hit the up button on green top screen till it stop it’s own. I’m then ready to get on. Once on I go and up my flow for solution and blood speed my UF rate stays the same. I don’t take much off, my avg is .6 kilo My blood flow is 400 and solution rate I change as to my time. if I have time 6.5 if I need to get it done 7.4. By the way I’m still doing day time
I have no idea of # 26 to 31 my machine has no 26 to 31.
Hey LSB , is that the basic for your set up?
bobeleanor