Mel wrote: “We had #14 alarms last night even though we were running Qd of 3.7. I’m going to try a few other things tonight and see if we can get some sleep”
Oh no- I thought this problem was solved and we could go on to the next one. Not quite yet…
I did not get a scale from my clinic:(
[QUOTE=Heather1;12199]Hemo Helper wrote:"some time if she feels like cramps is coming I turn off the UF by changing the vol to 0. then the next night we try to make it up as her dry weight would be a bit more… So if you feel cramps are just about to happen turn the UF off and you can make it up the rest of the week… DO NOT GO THROUGH THE PAIN OF CRAMPS ever again… it might be you need to adjust the dry weight… "
About how often must you turn off the UF as patient is feeling close to cramping? Most on nocturnal talk like they rarely run into this, because it is a slower tx. But anytime a patient gains a little weight cramping is a possiblilty, so I have wondered how often this is a concern with those on noturnal? Seems like a caregiver should be closeby as the patient might not be able to wake up and handle turning the UF off??[/QUOTE]
Cramps was a problem when were using the Fresenius for some unknown reason when we first went on Nocturnal Home hemo-dialysis. Guess we were always trying to reach the UF goal. Then after a couple of nights of really bad cramps. The light bulb in my head finally lit… Why continue to have cramps… when we are doing it 6 nights a week if cramps are going to happen just turn of UF and you can get it off the next night… You know with that thinking life for my partner has been really great… On the Fresenius she use to reach over and turn the uf off without even waking me up… After looking at her, seeing if she was carrying any extra water you know the symptoms (swollen limbs, bags under your eyes etc.) if non if this is present it might be that you are really gaining weight as you do eat a lot better now that you are getting your blood cleaned daily… think my partner went from about 42 kilo to now at 49 kilo… she has finally stabilized there and if she eats anymore it will soon be 50 kilo…
As for the NxStage I am the caregiver and when she calls and complains of cramping I just change UF vol to 000 and go back to sleep.
Think we had one really bad experience while on the Fresenius before deciding that turning the UF off would be the best… Was awakened by a thump on the floor… Because of cramps my partnner got out of bed and fell on the floor while I slept. I sleep in a cot next to the machine… She didn’t want to wake me as she had taken quinine sulfate to help with the cramps and it didn’t help that night and wanted for me to get my rest…
How often we trun UF off? Not much averages to 1 TX in maybe 60 treatments. Guess beacuse we are not very aggressive when it comes to removing all the liquid from her in every treatment. remember this TOMORROW IS ANOTHER DAY… YOU CAN ALWAYS GET IT TOMORROW … WHO IS IN CONTROL NOW… IF YOU WANTED TO, YOU CAN CHANGE YOUR DAY OFF AND DO IT 8 DAYS IN A ROW AND THAN TAKE YOUR NIGHT OFF…YOUR OPTIONS ARE UNLIMITED… Anyway when you are in control of your treatments be as versatile as you can… We have not had any problem with this with our center/nurse. I just tell them that I did this and explain why and they seem to feel that we know what is best for us…
HemoHelper
[QUOTE=Mel;12192]HemoHelper,
We calculate just like you. Pre-weight-dry-weight + rinseback = calculated goal. On Fresenius we then enter a planned goal 100 ml less than calculated goal to allow for perspiration and transpiration losses. We usually hit the calculated goal with post-weight or come within 100 ml. With NxXtage if we do that our post-weight may be 300 ml below calculated goal so we set the planned goal 300 ml below the calculated goal. The machine is set not to automatically account for rinseback as I prefer to do that manually in our calculations.
We had #14 alarms last night even though we were running Qd of 3.7. I’m going to try a few other things tonight and see if we can get some sleep.
Mel[/QUOTE]
Mel;
My only salvation for #14 alarm has been extracting the bubbles in line at the cartridge (green clamp) before doing the line switching and running my dialysate rate at 3.1… It has worked atleast 90% of the time. Called NxStage and talked to Scott and they seem to think that the problem will be fixed with a release of a new cartridge… Probably 5 months or so… I am getting the chain of bubbles in state #23… so its coming from the balancing chamber when it goes thru some checks and balances… what’s funny is these bubbles seems to be there all time. even after I extract them. After the first yel #2 the check state (15 minutes into the TX) they come back…
I do not know why; sometime you get the #14 alarm and others you don’t… the bubbles are there all the time. I think even if you run at a faster pump speed it is never fast enough to pull them thru the system and when the #2 check state happens the bubbles get re introduced into that line again…What I do not understand is why more patients on nocturnal is not experiencing this alarm…
HemoHelper
[QUOTE=Heather1;12201]Mel wrote: “We had #14 alarms last night even though we were running Qd of 3.7. I’m going to try a few other things tonight and see if we can get some sleep”
Oh no- I thought this problem was solved and we could go on to the next one. Not quite yet…[/QUOTE]
Heather
Yeh I wish this would go away tooo…
But, NxStage is not sure how to fix it… They are planning to relaese a new cartridge 5 month or so… We are keeping our fingers crossed that this will be the real fix… Until then we will be trying different things to get better results. Yes, My new machine also alarmed with #14… Knew it would. because I still had the trail of bubbles in the line at state #23…
Can’t figure out why more people that are on nocturnal is not having this problem… Maybe they are, but are not on this forum so we don’t hear from them…Think I posted this problem on another forum and didn’t get any response so I switched to this group…
HemoHelper
We have been on nocturnal Nxstage since October. In all this time only had 1 #14 alarm. Just keep drawing up on Kidney with a syringe and putting blood back in and it finally stopped. Knock on wood things have been running pretty smoothly other than Pureflow sak problems. Nxstage takes care of them. I send the bad one’s back and they send me new ones.
We are very very happy with the Nxstage and Purflow.
Pat
[QUOTE=Pat Colongione;12239]We have been on nocturnal Nxstage since October. In all this time only had 1 #14 alarm. Just keep drawing up on Kidney with a syringe and putting blood back in and it finally stopped. Knock on wood things have been running pretty smoothly other than Pureflow sak problems. Nxstage takes care of them. I send the bad one’s back and they send me new ones.
We are very very happy with the Nxstage and Purflow.
Pat[/QUOTE]
Pat
By clearing the air in the dialyzer you stopped the #14 alarm… Don’t think it had anything to do with the air in the dialysate line… Two different circuits…
What dialysate rate are you running?
How long are your treatments?
What is your blood pump rate?
How many liters do you use per treatment?
What software is on your machine?
Want to compare your parameters to what we are doing… Maybe I can set our machine the same and get the same results… No 14 alarm…
Thanks
HemoHelper
HemoHelper,
As you noted NxStage is currently testing a new cartridge which will eliminate the short “down” segment just above the dialysate air dectector by moving the dialysate input to the cartridge to the bottom. Apparently, #14 alarms have been a common problem with nocturnal parients. I was told that going to nocturnal after mastering SDD is a common trend they perceive. As well it should be!
I’ve been taking about 1 ml of air out of the warmer outlet, but it is not a complete solution. I still see occasional bubble streams dancing back and forth. It seems to be a statistical phenomena whereby every now and then enough bubbles appear in the sensor to set it off – but sometimes you are lucky. I’ve run at 4.2 L/hour the last two nights – no #14 last night and only one the night before. The higher the rate the lower the odds of getting an alarm.
Mel
I’m glad they are addressing the root cause.
HemoHelper,
We run with 60L a night for between 8 to 9 hrs. depending on the night.
I do not know the softwar. How can I find out what it is?
Blood pump speed runs between 370 and 420.
Dialysate rate is between 7.3 to 8.1.
And the UF rate is between .35 and .43.
All these are based on each night and how much I need to take off Ralph.
I do not want to jinx us but things have been running pretty smooth other than a particular lot # on saks. I had 2 saks come with broken elbows, one with a hole in it, and one that would not pass conductivity. All the same lot.
Shipped them back and things seem to be worked out.
We do have to change the purpak every 2 weeks. I wish they would put another “handle” on the side. It would make it easier with arthritic hands to get it out of the purflow a little easier.
Pat
I never get the #14 and am on Nocturnal. I use 25ltr at 3.1 and a blood pump speed of 250. My FF is 23 and I am on for 8:30 hours. I wonder why I never get this alarm and you do??
LSB
[QUOTE=Pat Colongione;12319]HemoHelper,
We run with 60L a night for between 8 to 9 hrs. depending on the night.
I do not know the softwar. How can I find out what it is?
Blood pump speed runs between 370 and 420.
Dialysate rate is between 7.3 to 8.1.
And the UF rate is between .35 and .43.
All these are based on each night and how much I need to take off Ralph.
I do not want to jinx us but things have been running pretty smooth other than a particular lot # on saks. I had 2 saks come with broken elbows, one with a hole in it, and one that would not pass conductivity. All the same lot.
Shipped them back and things seem to be worked out.
We do have to change the purpak every 2 weeks. I wish they would put another “handle” on the side. It would make it easier with arthritic hands to get it out of the purflow a little easier.
Pat[/QUOTE]
Pat
Wow! ! ! you guys run rather high rates as to compared to what we are running. Maybe that is the reason that you are not seeing the #14 alarm… Your numbers are about what we were using when we were in training. Blood pump that high is not really gentle… We are suppose to run at only 200. When going to the dialysis clinic to have her blood cleaned mas was 350 on the Fresenius any faster would cause alarms… By the way she is using a cathater in her chest. Sounds like you guys are doing well. Keep up the good work. We are suppose to be the first one at our center to use the pureflow but it has been pushed out for a while… Guess they are still having minor problems that need to be recitfied before our center will get one for us to try…
You can tell what software is on your System One by watching the the top two windows on the machine when you turn it on… there will be 4 & 3, 4 & 4 or 4 & 5. There may also be earlier versions, I don’t know since I have seen only the 4 & 3 and 4 & 5. Also on the cover of your manual it will state what software is for.
[QUOTE=Leafsunbear;12320]I never get the #14 and am on Nocturnal. I use 25ltr at 3.1 and a blood pump speed of 250. My FF is 23 and I am on for 8:30 hours. I wonder why I never get this alarm and you do??
LSB[/QUOTE]
LSB
Wow… 8:30 hours on the machine thats a long time… My partner has been on home hemo for about 5 years and does 7 hours now 6:30 Hrs. You are processing a lot more blood (.25 X 60 X 8.5=127.5 ltrs) How many Treatments are you doing a week? We do 6 days a week.
I am wondering why you are not seeing the alarm either… But it is good news that some patients are actually using these machines for Nocturnal and not having any of the 14 alarm… You know since I increased our dialysate rate to 3.1 the frequency of the alarm has been reduced…Maybe by the 6th treatment of the week I’m soooo tired I just sleep longer before attending the Alarm… Nah Just kidding… But it is getting better.
By the way do you see the chain of bubbles that goes in and out of the cartridge in the line between the heater and the cartridge (green clamps)?
It happens about every 20 seconds if it is really quiet you will hear a clicking sound and the bubbles will dance out of the cartridge towards the heater…
This is what happens to our machine and eventually the bubbles get together and the sensor will sense it and 14 yellow alarm happens…
HemoHelper
Hemohelper;
The time on the machine is not bad for me. I sleep through most of the treatment and it gives my partner a chance to sleep. We do six treatments a week too. I also see the bubbles from time to time, but they just move on through the line. We did the #14 the other night because when I primed the green lines I didn’t get all the air out of the lines and it made it’s way into the heater unit and the reservoir at the top got a bunch of air in it. We just bleed the top and got the air out and reset with no trouble after that. I do hope you figure out why you are having the trouble.
Peace;
LSB
HemoHelper,
Remember we are using 60L a night because of his size. Using more Leaders makes it harder to slow things down. We we use the bags (45L) things are slowed down quite.
Our software is 4 /5 so I guess we have the newest?
All I know he is doing great! feels great! and I like how he is now better than on the freni. He did well on that and we thought he felt better than in center but he even feels better now.
Pat
[QUOTE=Pat Colongione;12330]HemoHelper,
Remember we are using 60L a night because of his size. Using more Leaders makes it harder to slow things down. We we use the bags (45L) things are slowed down quite.
Our software is 4 /5 so I guess we have the newest?
All I know he is doing great! feels great! and I like how he is now better than on the freni. He did well on that and we thought he felt better than in center but he even feels better now.
Pat[/QUOTE]
Pat;
Good to hear that your partner is doing well. As for us, she is doing well and feel about the same as when she was on the Freni. Which is a 1000 times better than going to a center to be dialized… It’s just that it is a lot easier on us caregivers with the NxStage… If you have some change $$$$ to spare you might want to buy some stock (NXTM) in NxStage…
HemoHelper
[QUOTE=Leafsunbear;12325]Hemohelper;
The time on the machine is not bad for me. I sleep through most of the treatment and it gives my partner a chance to sleep. We do six treatments a week too. I also see the bubbles from time to time, but they just move on through the line. We did the #14 the other night because when I primed the green lines I didn’t get all the air out of the lines and it made it’s way into the heater unit and the reservoir at the top got a bunch of air in it. We just bleed the top and got the air out and reset with no trouble after that. I do hope you figure out why you are having the trouble.
Peace;
LSB[/QUOTE]
LBS
When you prime the Dialysate do you get the window in the heater like the picture on Page 6-27 in the user manual? Just air in the corners of the window (dog ears)… If you don’t… when you bleed out the air at the top of the heater give the bag in the window a little push and all the air will get expelled and you will get the dog ears…
I would like to know what are some of your machine set-up settings… That is if your center has shared them with you or you know how to get into system set-up. By the way you need to know these settings if your machine was to have problem and they sent a replacement. You would have to check these settings before you start using the new machine. and change the settings that your center has set in the machine. If they have not shared or taught you how to do the changes get with them and make them show you how and give you the settings that is on your machine. It is in the manual. It is the chapter APPENDIX System settings.
Set-up #19 (Fluid pump rate before prime step 2.1) my setting = 150
Set-up #27 (Prime fluid pump rate) my setting = 100
Set-up #28 (UF pump rate during prime) my setting = 40
set-up #29 (Blood pump rate during prime) my setting = 360
Set-up #30 (fluid pump rate during recirculation) my setting = 40
set-up #31 (blood pump rate during recirculation) my setting = 320
As if any of these settings on your machine is different it might be the reason that we get the #14 alarm…AS I see the chain of bubbles before I do the line changes before you hook up… Just curious any way if anything is different then I will change my machine to what you have and see if this fixes the problem with #14 alarm.
HemoHelper
Hemohelper, Do you think it would do any good if you primed twice instead of once? I’m thinking this might get more air out of the dialyzer.
Marty
[QUOTE=Country Girl;12342]Hemohelper, Do you think it would do any good if you primed twice instead of once? I’m thinking this might get more air out of the dialyzer.
Marty[/QUOTE]
Marty;
I am pretty sure after my snap and tap there is little air bubbles in the dializer. I tap the dializer and get most of the air to pass thru it in both circuits (blood and Dialysate) The air problem happens in the line between the heater and cartridge. the bubbles are probably coming into the line when the machine goes thru some kind of check. as I hear a click and the chain of bubbles go in and out of the cartridge four times every 20 seconds… what is strange is why does the bubbles get pushed back up the line towards the heater… if the fluid pump is always pulling… but there are balancing chambers in the cartridge and they have a line that goes back to the input of the pump which is the line that is the bubbles dance in and out in…
I tried to do a second prime twice but no luck. the bubbles still come back after about 30 minutes into the treatment… Sometime the 14 alarm happens before I fall asleep. then won’t happen again the rest of the night.
When I get-up in the morning there are bubbles going in and out of the cartridge but no ALARM… Yeh; it is really crazy… I’m getting use to having my sleep interrupted.
HemoHelper
Hemohelper.
I will try and get you those numbers tomorrow. Sorry for not getting them sooner. I was not trained about them and so I need to do some reading first.
Peace;
LSB
[QUOTE=Leafsunbear;12364]Hemohelper.
I will try and get you those numbers tomorrow. Sorry for not getting them sooner. I was not trained about them and so I need to do some reading first.
Peace;
LSB[/QUOTE]
LSB
Make your center share these numbers (system set_up) with you… REALLY important because if your machine needs to be replaced and it comes In the mail… UPS; FDX and it is on a week-end and you can’t get your clinic to come out and put in those numbers you can’t run until it is checked and updated with your default numbers. Even worst is if you are away from home on VACATION… Travel is now an option for those on NxStage… You can’t run until it is updated. Sure tech support can help you get up and running only if the bad system is able to let you view SYSTEM SET-UP…
Within an hour after I reveived my replacement System One We were ready for the next treatment…
HemoHelper