NxStage alarm #14

Discussions for Patients, Family, and Friends HD For Patients
21

Hey LSB

I’m don’t understand what hemohelper means by #26 thur #31

What I was saying is once you get past the 18 miniutes start up , I do what in my book is called the snap and tap . In other words grap the red line with two hands snapping the line to chase or rid the red line of any air bubbles, doing the same to filter turn filter blue post cap topside up and tapping on filter to rid filter of air, then vent filter at top blue post. I do see air running thur lines going back into saline bag. thur the blue line and yellow waste line. These are the colors that I have. Once I’m sure air is out line I hit the stop button. I guess everyone has different preset # in once they get to this point. I sometime have a had time talking

bobeleanor

22

@bob;
I am not sure where Hemohelper got all those numbers from either. Stage 23 is stage 23 on every NxStage machine, as for as I know. My partner sets my machine up, saline and dialysate bags, after I break the machine down in the morning. Then later that night, usually about four to five hours before I plan to go on the machine, I insert the cartridge and do the prime. When the prime is done I move the filter up to it’s holder. I usually turn it upside to down when I put it in the holder, blue clamp clooser to the ground and red end highest/ opposit of how it goes when you run. I then tap and snap the red line all the way to the filter. I then remove the filter and bang it on all sides upside down and right side up. I do this with the palm of my hand. I then chase from the filter up the blue line. I do this routine about three or four times over the next few hours. Just before going on the machine I do this again. I also try and make sure the dialysate line gets as much air chased threw it that I can. I sometimes get the air bubbles that Hemohelper is talking about, but I never get the alarms. I think hemohelper needs to be more proactive(annoying) with NxStage and make them do something about it. I would feel different if others were getting the same issue. I hope this helps explain some, if you have other questions feel free to ask them. If I can help I would like to.
Peace;
LSB

23

[QUOTE=Leafsunbear;11450]Bob;
I am not sure what you mean? Ellaborate please.
LSB[/QUOTE]

LSB/Bob
This is HemoHelper…
Those settings that i am refering to is when Your center set-up your System One…(Usaually set-up before your training) See NxStage System One User’s Guide. Appendix A… If you were not involved in or trained to do these setting or do any changes while in training, then you would not know what the default settings are. In my training documation I have a copy of what the center had set these settings. If you don’t have any knowledge of what these settings are You might ask your training nurse and see if they will share this information with you. IF you were to get a replacement System one because your machine failed you would need to make sure these settings are correct/set to your center’s default before you could use it… Any way I have been doing some changes to their default settings… BUT BEFORE I DO ANY CHANGES I MAKE SURE I CONTACT THEM AND GET THEIR APPROVAL. Since we are doing NOCTURNAL with a 200 blood flow rate It is what my defalut is when you press STOP. I have been able to also set the FP rate as I know it will always be (19.6 ltrs divided by 7 hours= 2.8). Uf rate varies depends how much fluid we need to remove. then on the volume screen I have dialysate vol pre set at 19.6… Yes, we use 20 ltrs (NxStage suggested the 19.6 ltr number. (on 95% of the treatments all four bags are dry and the bubble in that line ends the treatment sometimes there is just a trace of dialysate in the bags…). This makes it faster and easier when getting the System One ready to hook up the patient. If you haven’t been trained doing this I would suggest that you contact your center and the next time you are in for your monthly check-up have them go over the process.

HemoHelper

24

[QUOTE=Unregistered;11482]LSB/Bob
This is HemoHelper…
Those settings that i am refering to is when Your center set-up your System One…(Usaually set-up before your training) See NxStage System One User’s Guide. Appendix A… If you were not involved in or trained to do these setting or do any changes while in training, then you would not know what the default settings are. In my training documation I have a copy of what the center had set these settings. If you don’t have any knowledge of what these settings are You might ask your training nurse and see if they will share this information with you. IF you were to get a replacement System one because your machine failed you would need to make sure these settings are correct/set to your center’s default before you could use it… Any way I have been doing some changes to their default settings… BUT BEFORE I DO ANY CHANGES I MAKE SURE I CONTACT THEM AND GET THEIR APPROVAL. Since we are doing NOCTURNAL with a 200 blood flow rate It is what my defalut is when you press STOP. I have been able to also set the FP rate as I know it will always be (19.6 ltrs divided by 7 hours= 2.8). Uf rate varies depends how much fluid we need to remove. then on the volume screen I have dialysate vol pre set at 19.6… Yes, we use 20 ltrs (NxStage suggested the 19.6 ltr number. (on 95% of the treatments all four bags are dry and the bubble in that line ends the treatment sometimes there is just a trace of dialysate in the bags…). This makes it faster and easier when getting the System One ready to hook up the patient. If you haven’t been trained doing this I would suggest that you contact your center and the next time you are in for your monthly check-up have them go over the process.

HemoHelper[/QUOTE]

HELLO HemoHelper
Thanks for infor,if the#"s you are talking on.And I’m sure that if and when the time comes for the preset in the machine to be change change will happen. So for these at least since 4/06 I had no real problems outside of human misstakes. And the most alarms I got happened in the at the start, since then any alarms I had have been minor that were solved within seconds. I plan to try nocturnal come spring, as to my center showing me things , the chance that would happen are slim. My center people have job issues, they don’t want the consumer to know as much or more than they do. Most people who have a good job don’t like to share what they know for the same reason. As to changeing preset that I have now the machine is working and the # the I have changed to see what happens are my real run #, solution rate, UF rate and BFS.

On your #26 to 31 if your center and you set them then that should be where your answers be. As for start up do you do the basic set up? If I understood your question was about air alarms?
bobeleanor

25

Bob;

Hey you best get with your center and make them show you these numbers… Why??? like i mentioned what happens if something goes wrong with your machine… You call NxStage and they say that your machine needs to be replaced. So the next day you receive this NEW MAchine… Who will be setting these default set-up numbers??? You will have to call your center and notify them that you had problems with the System One and a replacemant is sitting at your door step; who will come out to your location and install these defaults that you need before you do the next Treatment… I don’t know if all the preset numbers are the same until you do changes to suit yourself. But you see why it is important that they share these set-up default numbers.
You have a real problem if your center feels that sharing information on these machines that your life depends on is TOP SECRET. Hey If they feel as though showing and training you to maintain your system is a threat to their existence something must be done. I don’t believe that people are that selfish and think this protects their jobs. As a Manager I would always make sure that I trained every one to be replacable including myself. Any way before you can move on to the next level, you need to have someone trained to do your job. How else would you make any company successful.
I hope you do get to go on NOCTURNAL. It is the best treatment available on any machine. Why? Just think in a normal person they use the bathroom while they are awake and while sleeping just do nothing but sleep. But on nocturnal you are doing the opposite the machine is removing the toxins and extra fluid while you sleep. Just the opposite of the normal person. Any way after 5 years if treating my partner I know it is working. with End stage renal for 18years this past few years she has never felt better. Seeing her you would not think she has kidney disease. Everytime she run accross someone whom she hasnt seen for a while they always compliment on how well she looks and kinda wonder how she has been able to continue to survive while others with her situation are no longer around.
Anyway back to the 14 alarm… All the procedure to get the machine ready for the patient are the same. Yes, I remove the air from the blood lines (lines that you hook up to the patient) dialyzer with the snap an tap operation there is no air there. No problem there… It is just that I have air in the dialysate line… You have two lines coming out of the priming spike; it’s on the side with the large red clamp. Not that line but the other, the smaller line that has the MR PEANUT white clamp, and green clamp… In this line i get the bubbles that goes in and out of the cartridge… These bubbles goes into the cartridge and goes by the air sensor. Setting off the 14 alarm… Anyway because of the Dialsyate flow rate for nocturnal is much lower it isn’t fast enough to pull these bubbles down thru the tubing.
So until NxStage do something in the initial prime state I will always have these bubbles… Just don’t understand why other people on NOCTURNAL isn’t seeing this 14 alarm… In the mean time I will continue to add the extra step of extracting the bubbles for that is the only way I will be able to get a good night’s rest…

HemoHelper

26

Hemohelper;
When you chase the air in stage 23 do you also chase the air threw the dialysate lines. Turn the filter so that the lines are coming out facing up and turn the red end of the filter so that the air comes out of the filter into the dialysate lines. I have no problem chasing air threw both the patient lines and the dialysate lines during stage 23. Something seems to be wrong with your machine. I would get it replaced. Also about getting the machine replaced. NxStage would just ship the machine to your house??? When I got mine replaced I had to pick it up from my center. I am not sure about every situation , but I think it is pretty common that they send to the center not the patient. The default numbers are nice and all, but all we have set on default is out dialysate amount 25liters, blood flow 250, and something about my Flow Fraction that limits me from changing things to extermes. I can change my treatment times and flow rates to fit my needs. I like the freedom that gives me. Also I don’t think that raising the dialysate rate is going to have that much of an effect. When my machine was getting the #14’s we were only running six hour runs with a rate of 4.2 on the dialysate. Didn’t seem to much difference. We even raised it to 5.8 one day and we still got it. It had something to do with the cartridge we were using. So I think my problem was different then yours. Why have you not tried to get a replacement machine?? I have not seen you post any type of response to this suggestion. I would really like to know why you would continue to add an extra step and put your partner at risk. When an answer as simple as replacing the machine is available to you. No one seems to have the same problem you are having. This would lead me to believe that I was either making a human error or that the machine was faulty. It doesn’t sound like human error on your part, so why not replace the machine??? I hope you don’t take that the wrong way. I am just curious as to why you would keep adding a step to the hook up.
LSB

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[QUOTE=Leafsunbear;11495]Hemohelper;
When you chase the air in stage 23 do you also chase the air threw the dialysate lines. Turn the filter so that the lines are coming out facing up and turn the red end of the filter so that the air comes out of the filter into the dialysate lines. I have no problem chasing air threw both the patient lines and the dialysate lines during stage 23. Something seems to be wrong with your machine. I would get it replaced. Also about getting the machine replaced. NxStage would just ship the machine to your house??? When I got mine replaced I had to pick it up from my center. I am not sure about every situation , but I think it is pretty common that they send to the center not the patient. The default numbers are nice and all, but all we have set on default is out dialysate amount 25liters, blood flow 250, and something about my Flow Fraction that limits me from changing things to extermes. I can change my treatment times and flow rates to fit my needs. I like the freedom that gives me. Also I don’t think that raising the dialysate rate is going to have that much of an effect. When my machine was getting the #14’s we were only running six hour runs with a rate of 4.2 on the dialysate. Didn’t seem to much difference. We even raised it to 5.8 one day and we still got it. It had something to do with the cartridge we were using. So I think my problem was different then yours. Why have you not tried to get a replacement machine?? I have not seen you post any type of response to this suggestion. I would really like to know why you would continue to add an extra step and put your partner at risk. When an answer as simple as replacing the machine is available to you. No one seems to have the same problem you are having. This would lead me to believe that I was either making a human error or that the machine was faulty. It doesn’t sound like human error on your part, so why not replace the machine??? I hope you don’t take that the wrong way. I am just curious as to why you would keep adding a step to the hook up.
LSB[/QUOTE]

When I first had this problem I called my center and they had the field rep there at the clinic. He came over and i demonstrated to him the chain of air that was in the line at stage 23. He said that he would suggest to tech support that they have my machine replaced but nothing came of it… I think that he called them the next day and I had hoped that he would convey to them what was going on with my machine. I had thought he would go back to NxStage and report what he saw. While I demonstrated the process I was taught to remove the air in the system he said that I was doing it correctly. He also stated that he could not make the decision to replace my machine it had to be done by Tech Support.
As’ a user of a new product, using the machine for Nocturnal rather than dialy dialysis, I knew before we switched to Nxstage from Fresenius that there would not be much available user feedback of problems with the machines… By not having this machine changed, I figure that I could help NxStage try to resolve this problem by reporting to them what is happening when the alarm happens. Try to be their eyes and ears as I don’t think they can have a patient doing NOCTURNAL in their lab to see the actual problem… NxStage is a wonderful machine and the portability without the added burden of taking care of a Reverse Osmosis water system is just great. The added step is no big deal as it adds a few minutes to the process but the added rest is well worth the effort. Put my partner at RISK? What risk? As i see it the only risk is me not getting uninterrupted sleep. The patient sleeps thru the ordeal… Guess she have the confidence that I can take care of all problems with the dialysis when they happens. (Home for 5 years already)

PING ping PIng Darn got another 14 alarm and yes there goes the air bubbles… only 25 min into the treatment… May be another sleepless night…

Like I mentioned to Bob… You should seriously think about the default settings on your machine… Your center should be sharing these with you and also train you on how to set them. So when you had a replacement machine it was sent your center and you had to go get it??.. What would happen say if you were on a trip away from your area… would it mean that you would have to get back to your home town and go to the center to get your replacement… I don’t think so… You must be able to do these changes to make your machine portable (go anywhere/anytime). Hope your center operates 24hrs/7days/365days a year. Cause if you ever have a breakdown you can get help from your center… I know tech support could walk you thru the steps but you need to know what the numbers are…I know I will always keep a copy with me when I travel…(Added it to my user guide).

Know your risk factor
HemoHelper

28

Hemohelper;
I appreciate your insights. I will learn about these default numbers and how to set them. I also admire the being part of the solution position you are coming from regarding your machine. I also want you to understand that my situation is the juxtapox of yours. I am the patient and my partner is the helper. He also has to deal with me sleeping threw yell 21’s a lot at night. I really have handed over my life into his hands and he has willingly taken care of it. I do know that I try to return that same love and care to him in everyway I know how. about the what if the machine failed while traveling. Well I have always felt that whatever programming that needed to be done. I could have tech support walk me threw it. Maybe I hsould rethink and maybe that is just a fine way to deal with it. I do feel that adding a step to the connection process is a true risk though. I know it does not feel as such, but it is adding exposed time that otherwise would not be. I understand the idea of risk management. It seems that a lot of people like to yell at me about it all the time. I agree that your lost sleep does not make the situation any better. So how about we agree that the risk here is you losing sleep. Now isn’t that reason enough for a new machine? I understand that what decides who are when a person gets a new machine can be tricky. All though I think that you have an obviously defective machine and tech support has not offered you with a satisfactory solution to the problem. Therfor you should get another machine to replace the faulty one that does not seem to be getting resolved.
I really hope you understand that I am just trying to hold a constructive conversation and if at times I am not coming across right feel free to express your frustration with me. Just realize that this is an ongoing conversation and hopefully in time we will come to a full understanding of each others ideas and opinions. I have a huge respect for you. Knowing that you are your partners helper and that you do so much for her brings great joy to me. I understand cause I am on the otherside of that coin. I wish I could give my partner everything he could ever want and more. If karma is real I hope he has gained twenty lifetimes of good karma for all he does for me.
sorry I am rambling. straight to the point you and my partner amaze me.
Take care of yourself too.
Love and light;
LSB

29

Well last night we got a 14 alarm 6 hrs into treatment. Mind you we are on Purflow. So I looked up what it said to do and could not find any air bubbles any where reset everything and about 10 minutes later again 14. So I got up checked everything again. This happened 2 more times so called my center and let them know what was going on. Than called Nxstage got a tech within a minute and told him what was happening and what I did. He said that is what he would tell me to do. He than had me turn down the rate (top) number to 6. Thought that took care of it and said good night at 3am. 10 minutes later again # 14. I than decided to up the middle number to .25 (even though the guy said that would not do anything) hit treatment and low and be hold no more alarm. So I don’t know if that is the answer or not but the other thing I did this am was to clean the sensors with an eye glass cloth. Just as the book said. So we will see what tomorrow nite brings.
Pat

30

I am very glad I initially copied and pasted your post from ihatedialysis.com over to here, Hemo Helper, as I could see you were not getting too much of a response over there and I wanted to generate some help for your predicament. As you said, new machines don’t have ample support from other users at first, and for that matter, we don’t have that many home patients over here that are using NxStage, either, out of the 1000 NxStage users. But we have a few pro-active patients/helpers and I hoped if everyone here put their collective heads together a solution would turn up for you, and for us, too, should we encounter the same, or similar, problem.

The way I see it, the few machine companies for home hemo have a monopoly. They need our business, but we need them much more. One would think that NxStage monitors this board to see what patients think of their machine’s dependability. Wonder why it is taking so long for them to address Hemo Helper’s concerns? He has been a real gentleman trying to help them out. So, why are they leaving him in the lurch with this ongoing problem? It is one thing to provide customer service and it is another thing to REALLY provide customer service, checking back to make sure customer problems have been resolved.

One thing is for sure-good training is essential, and I think one must realistically be told ahead of time how often to expect alarms in the middle of the night. I read where Lynchburg said their nocturnal patients can expect an alarm once every 10 nights. That would be liveable, but what Hemo Helper is going through is not.

I hear what NxStage technical is saying to do to correct alarms. But the question should be, WHY are the alarms occuring and is there anything one can do to prevent them when it comes to set up technique? It sounds like either NxStage has not perfected the alarm problem when it comes to nocturnal txs, there is a problem with his specific machine or cartridge, or something has not been conveyed to him about ways to adjust the set-up. Having to call techincal support in the middle of the night for a problem like this should not be an ongoing thing for a patient or helper.

I am glad for the info. you shared, Hemo Helper, about the default settings. I had wondered about that and agree it is something that the patient should have a record of. I am of the school that the more the patient/helper knows about the machine/tx, the better. I am for anything that assists the patient/helper to become fully educated. I have had some medical people laugh and say one can’t trust info found on the net, but I told them I totally disagree. I will take info no matter where it’s from as long as it’s accurate, and I do check out ALL info whether I get it in person, or on the net.

As far as I’m concerned, real education is taking place here on this sujbect of alarms since this thread was started and that is what I like to see occur. And, it’s an interesting dynamic that when someone has a machine issue and is stuck at first, with everyone helping, so many good things come out of the mix for everyone. Like I said, I hope by helping Hemo Helper many more will be helped when/if the same sort of problems happen to them.

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Oh, Hemo Helper, I meant to add. The best thing of all in your coming to our group is to hear how well your partner is doing on nocturnal txs. That is quite a promising report to hear you say that she has been a renal patient for so many years and since she has done nocturnal txs she has seen such great improvement.

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[QUOTE=Pat Colongione;11499]Well last night we got a 14 alarm 6 hrs into treatment. Mind you we are on Purflow. So I looked up what it said to do and could not find any air bubbles any where reset everything and about 10 minutes later again 14. So I got up checked everything again. This happened 2 more times so called my center and let them know what was going on. Than called Nxstage got a tech within a minute and told him what was happening and what I did. He said that is what he would tell me to do. He than had me turn down the rate (top) number to 6. Thought that took care of it and said good night at 3am. 10 minutes later again # 14. I than decided to up the middle number to .25 (even though the guy said that would not do anything) hit treatment and low and be hold no more alarm. So I don’t know if that is the answer or not but the other thing I did this am was to clean the sensors with an eye glass cloth. Just as the book said. So we will see what tomorrow nite brings.
Pat[/QUOTE

Pat;
I am finding the chain of bubbles going in and out of the cartridge in the line between the heater and cartridge (green clamps). The user guide probable cause does not mention checking this line)…Check there…as the air sensor for alarm 14 is the sensor just below the elbow bend of the line going into the cartridge from the heater. Also I have noticed that if you turn UP the heater temperature you will get more bubbles visible at the heater air trap bag (window in Heater). Know some of these bubbles are traveling into the cartridge. So now I try to keep the temp set at midnight or two click past. Have also found out that if you turn the heater on and let it get up to temp than push on the air trap bag forcing the dialysate back towards the dialysate bags you get some of the air bubbles that is in the heater to come out to the air trap…

The solution that was suggested by the tech at NxStage is what they feel will solve the problem. The higher the dialysate rate the better chance the pump will be able to pull the bubble thru the system. But for some reason the fluid pump is not cabable of pulling the air bubble down thru the dialyste line and out to the waste line. Anyway that is what i am discovering. Also because of the design of the tubing (reduction from large to small tubing) there is a step like edge in the tubing that collects these bubbles.

Increasing the ultrafiltration (the movement of fluid across a semi-permeable membrane as pressure is applied is called untrafiltration) rate (2nd window) should NOT have any effect on the flow of dialysate. There must be another pump that is creating the pressure difference (TMP transmember pressure) in the dialyzer when you adjust the ultrafiltration rate. When you increased your rate something might have happened…You finished the uf before the hemodialysis. zero’s on 2nd window before the 1st window.

There are times that I get the 14 alarm and check to see that the bubbles are there and expect to have a sleepless night but the crazy machine does not alarm again until the treatment is complete. Go figure… I don’t understand why, because the bubbles are still there going in and out of the cartridge. But who is complaining…

Hope you are able to understand what I am trying to explain. And good luck tonight… How do you like the PUREFLOW? I’m suppose to be getting one soon… Please Check the line I mentioned in stagae 23… let it run for 15 minutes in 23 and see of you are getting a chain of bubbles going in and out of the cartridge in the line that has the green and white clip. (Small line paired with the RED clamp line on priming spike)

HemoHelper

33

Hemohelper, thanks for the info. But I do not use the heater because the Purflow is heated. So I attach the green line to the MLA-which is the line that comes off the Purflow. That line has three legs. I bleed 2 lines and use the third line to attach the green line to. I have been doing the same thing now for 6 weeks and this is the first time I had a problem with #14. I always do the snap & tap on the lines 3 times and each time I bleed the blue tail off the dialyiser. We normally run high rates sometimes above 7.4 because we use 60L.
Tomorrow night (SUN) will tel the tail.
As for the PurFlow I love it. It is so easy. In the morning after Ralph’s treatment all I have to do is discard the old bag and start a new one for the night. The batch takes 7 hrs to make so it is ready by evening when we run.
Because we use 60L a night, the Black box Purepak only lasts 2 weeks.
But this is all relative. The Freni was so much more work. The Nxstage and Purflow are a walk in the park.
Pat

34

[quote=Pat Colongione;11509]Hemohelper, thanks for the info. But I do not use the heater because the Purflow is heated. So I attach the green line to the MLA-which is the line that comes off the Purflow. That line has three legs. I bleed 2 lines and use the third line to attach the green line to. I have been doing the same thing now for 6 weeks and this is the first time I had a problem with #14. I always do the snap & tap on the lines 3 times and each time I bleed the blue tail off the dialyiser. We normally run high rates sometimes above 7.4 because we use 60L.
Tomorrow night (SUN) will tel the tail.
As for the PurFlow I love it. It is so easy. In the morning after Ralph’s treatment all I have to do is discard the old bag and start a new one for the night. The batch takes 7 hrs to make so it is ready by evening when we run.
Because we use 60L a night, the Black box Purepak only lasts 2 weeks.
But this is all relative. The Freni was so much more work. The Nxstage and Purflow are a walk in the park.
Pat[/quote]

That’s really great, very! I have a question for you…

When you do use the dialysate bags, do you still have the dialysate warmer with you or was that sent back to NxStage?

Finally, has Ralph notice any difference in the way he feels between bagged and PureFlow Sl?

35

We still have the warmer. Have used it a couple of times. But never had a 14 Alarm. The only difference between ours and those that not on nocturnal is that our cartridges come with a heperine line access so we can administer hepering during dialysis. I stop the hepering line an hour before treatment ends so there is no bleeding issue. This is not any different than on the Freni. I use the same rates etc.
Ralph says he does not feel any difference between the bags and the purflow.
By the way I have started my search for a telescoping IV pole that will attach to the Nxstage for travelingon a plane. Not to success ful yet but will continue to work on it. I talked to the EMT’s at our college and they were blown away about what I was asking. They suggested to contact medical supply companies. I am going to go to our locat EMT office in the next few weeks to seek their help. I just want to look at how their IV poles attach to stretchers.
Have a great day! We are off to our center’s Holiday Party today. Talk to you later.
Pat

36

Well everyone, ran last night with no problesm. So I really do not know what the change was since I did everything exactly the same. The only thing I did different was to clean the lens which they tell you to do once a month and described in the book.
Pat

37

[QUOTE=Leafsunbear;11331]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[/QUOTE]

Hi all;

This is HemoHelper…
They (NxStage) finally decided that the only thing that they could do to stop the Alarm #14 was to replace the System One… Installed the new machine after I set my old set-up numbers in the new machine… The new machine (ser # 6985) has the latest software installed… (4.5) the old machine (ser # 6456) had (4.3). Thought I’d include the Serial #'s and Software Version incase others might run across this problem in the future…
No such luck the first night it alarmed after about an hour or so… and did it again after another hour… The second night I thought the first night was a fluke so I didn’t do anything but prime and run… same problem it still alarmed… The third night I thought I would try extracting the air bubbles from the line going from the cartridge to the warmer… It use to work on the old machine… but no such luck… After reviewing Mel’s solution of increasing the fluid pump rate to 3.1 (MIN) I thought I might as well try this solution…
Had to change a few things with this rate… I wanted to make sure we processed the same amount of blood so I increased the blood flow rate from 200 (.2 X 60min X 7 hr=84 ltrs)to 220(.22 X 60 X 6.45=85 ltrs). Because by using the 3.1 fluid pump rate it decreased our run time from 7 hrs to 6.45
hours (20 ltrs divided by 3.1=6.45hrs). With these changes I was set to get a good night’s sleeeeeep.

ZZzzZzzzzz
slept like a bear…
I know it worked only one treatment but I feel very confident that this is the solution. there were bubbles but it seemed to pull it thru the system when it went into the self check mode (Yel #2). Can’t check it tonight as it is our night off… If I don’t post on this thread, then the solution of a faster fluid rate is a good solution for the #14 Yel alarm…
Guess Nocturnal users running a slow blood pump speed and and low fluid pump rate will constantly get this alarm… after three months of trying to get this problem resolved I hope this information Helps others…

Thanks again Mel for your Input.

HemoHelper

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I’m very glad to hear you got a new machine. It also good that you may have solved the problem.
LSB

39

Congratulations Hemo Helper for finally getting a good nite’s rest and what sounds like a solution to your 3 month problem with the #14 alarm! I knew it would get resolved and seems like Mel, smart guy that he is, had the answer early on. I don’t know if this has helped anyone else, but it sure has helped me!The last thing we want is to be awakened by alarms when we get to nocturnal length txs. We like to stay a step ahead of problems like this whenever we can. Enjoy your well earned peace and rest!

40

I agree with HemoHelper that bubbles are evident in the green line between the warmer and the cartridge.

As I’ve said elsewhere it appears the #14 alarm can be avoided by increasing the dialysate rate. We’ve been able to get through the night a few times alarm-free at 3.1 L/hour, but to do so consistently requires 3.4 or 3.5 L/hour. This does not eliminate the bubbles, but the higher rate seems to prevent them from accumulating at the air sensor and thus prevent alarms. To get the same amount of dialysis (kT/V) requires increasing the total amount of dialysate so that it will last for 8 hours and a corresponding increase in FF. I’m told that NxStage has referred this issue to their engineering department, but I’m not aware of another solution as yet.

Mel