Did the new cartridge that is supposed to correct the #14 alarm problem ever come out? It seems that where this thread left off, those who do nocturnal with a higher blood pump speed were not troubled by this alarm, but those who do noctunral with the typical low blood pump speed were the ones ones who were having the problem. Any solutions found?
Jane;
No the new cartridge is not available… Won’t be until later this year. I’m still having good nights sleep by extracting the air bubbles from the green clamp line in the cartridge before I connect it to the heater line. Yes, it is another step in the process of setting-up the machine before hooking up the patient. I have also increased the dialysate flow rate from 2.8 to 3.1. this has decreased out run time from 7 hrs to 6.5 hrs.
I have asked Nxstage to see if they can change the time between the self check (yel #2) alarm #14 happens about 2 minutes or less before the self check. Also asked them if they could have the dialysate flow rate increased or time the dialysate pump runs faster increased to see if it would pull the bubbles thru the system when it goes into Yel #2.
HemoHelper
Would it work to speed the blood flow and dialysate flow up for a minute right at the first of the treatment to “flush” out any bubbles? Then, slow it back down to your normal nighttime speed.
It seems the problem is the flow is too slow to carry the air bubbles on the downward path in the cartridge and they get trapped in the bend just before the sensor.
Has anyone tried this?
HemoHelper,
Would your method work with an 8 or 9 hr tx? What size syringe do you use to extract the air? What blood pump speed and other #s are you running?
billable,
That sounds like an idea- wonder if it would work.
I agree with HemoHelper that you need to know your System Settings even if you don’t change them so you can set them as required after receiving a new machine on a swapout.
Follow the procedure in Appendix A of the NxStage manual and record each setting on pages A-4 to A-7 (you can see each setting as you go through and don’t need to change it). There are 71 settings for 4.5 software. Then go through the same procedure after you get a new machine. I have suggested they furnish a sheet showing how a new machine is set when they ship it, but I don’t know if they are doing this yet.
Nx Stage doesn’t publish default settings to patients as they want the centers to be responsible for how each machine is set. If you want to know the default settings you’ll have to ask your center.
Mel
[QUOTE=Jane;13134]HemoHelper,
Would your method work with an 8 or 9 hr tx? What size syringe do you use to extract the air? What blood pump speed and other #s are you running?
billable,
That sounds like an idea- wonder if it would work.[/QUOTE]
Jane;
I think that by removing the air bubbles would work on any long treatments… if you are having the #14 alarm.
I use a 3cc syringe filled with atleast 1cc saline. my partner uses a cathater to dialyize so I use the 3cc syringe that I use to extract the heparin from her cathater.
- press STOP button
- Close red clamp at “T” on aterial line
- Attach 3cc syringe to red clamp “T” on aterial line
- open clamp and extract about 1cc of saline
- Close the rest of the clamps on the priming spike
- move the syringe from the red clamp line to the green clamp/white clamp line
white clamp to red line clamp
syringe to green clamp line from cartridge - Extract the bubbles from cartridge
extract and tap the line to get the bubbles into the syringe even tap the cartridge and
get more aor bubbles out…
Hope this hepls…
#'s
blood flow rate = 220 Was 200
dialysis flow rate = 3.1 Was 2.8
time = 6hr 27 min was 7 hours…
I increased the blood flow rate to make sure that we processed about the same amount of blood when we were running 7 hours…
Yes, I thought of running the dialysis flow rate higher like using the flow rates for short daily then switching to Nocturnal. But have not tried it yet… will have to, if my method of extracting the bubbles stop working or get the #14 alarm later in the treatments…
What is strange is the chain of bubbles are in the line going in and out of the cartridge most nights but for reasons unknown … not every treatment we get the 14 alarm. Not complaining… so go figure…
HemoHelper
[QUOTE=Mel;13136]I agree with HemoHelper that you need to know your System Settings even if you don’t change them so you can set them as required after receiving a new machine on a swapout.
Follow the procedure in Appendix A of the NxStage manual and record each setting on pages A-4 to A-7 (you can see each setting as you go through and don’t need to change it). There are 71 settings for 4.5 software. Then go through the same procedure after you get a new machine. I have suggested they furnish a sheet showing how a new machine is set when they ship it, but I don’t know if they are doing this yet.
Nx Stage doesn’t publish default settings to patients as they want the centers to be responsible for how each machine is set. If you want to know the default settings you’ll have to ask your center.
Mel[/QUOTE]
Mel;
When training on the use of NxStage System One did you review/be trained on how to change these default settings??? Don’t know why all that are going home to do their treatments are not getting this training… as I stated if you have not had this chapter in the manual reviewed to you by your trainer, on your next visit to your center make them share this information…or ask them whom will come to your home/vacation at Disneyland and set these defaults if and when your faulty machine gets replaced???
HemoHelper
HemoHelper,
Thanks much for explaining your technique. Did you figure this out yourself? Does your training nurse and NxStage approve and find it to be a safe procedure? I am not doing noturnal txs yet, but am very glad to get this info so I can practice it in case we need to use it.
Re #'s, how would I figure what #s to use with a 8 or 9 hr tx.?
Are you getting any #14 alarms at all now? Yes, that is strange the way the bubbles are always there , but don’t always cause a problem. Sometimes, I am very sure I see a pattern in other aspects of the tx only to see the pattern I’ve watched do something different eventually. Dialysis is unpredictable that way.
[QUOTE=Jane;13158]HemoHelper,
Thanks much for explaining your technique. Did you figure this out yourself? Does your training nurse and NxStage approve and find it to be a safe procedure? I am not doing noturnal txs yet, but am very glad to get this info so I can practice it in case we need to use it.
Re #'s, how would I figure what #s to use with a 8 or 9 hr tx.?
Are you getting any #14 alarms at all now? Yes, that is strange the way the bubbles are always there , but don’t always cause a problem. Sometimes, I am very sure I see a pattern in other aspects of the tx only to see the pattern I’ve watched do something different eventually. Dialysis is unpredictable that way.[/QUOTE]
Jane;
I have told the nurse at the clinic of my bubble extracting procedure and she has not asked me to STOP. I asked them (NxStage and my clinic) to figure a way that I could run nocturnal and not get the #14 alarm. No good ideas from either. If you plan on doing this PLEASE use Medical Aspetic technique (use procedures that help to reduce the number of bacteria and hinder transfering bacteria from one place to another).
Mel has an idea that might be the way to go… When we were in training and running short daily TX’s we did not see the 14 alarm… So what he suggested is to run/set-up the machine to run short daily treatments and after 30 minutes or so change the settings to nocturnal… with the dialysate flow at the higher rate it might pull all the bubbles thru the machine and send it down the drain… I know that the bubbles are coming from within the machine… Probably from the balancing chambers in the cartridge. there is a line that goes from the chambers back to the inlet of the pump… Don’t know why the bubbles are being pushed out of the cartridge back towards the heater (every 20 seconds)… when the pump only goes one direction IT PULLES FLUID INTO THE CARTRIDGE so why or what is causing it to push bubbles towards the heater. NxStage did not explain to me why this is happening. They may be working on this problem but think there is such a small population of patients that use the System One for Nocturnal that the priority for this probles is very low… Think I was the first one that mentioned to them of this #14 alarm.
With the Extraction of the bubbles I have been getting my sleep… It happens now about once a every 15 treatments…
#'s for a 8-9 hr treatment…
at our center the blood flow rate for nocturnal is 200 (think that that is what they are reccomending for Nocturnal; it should be a milder/gentler treatment). Don’t know that any of your rates/volumes are so I can not tell you what to expect…
what I did…
check your volume of blood processed…
blood flow rate divided be 1000 times 60 times time on machine
example: blood flow rate = 200 (ml/minute) (divide by 1000 times 60 for ml/hr)
Time on machine = 7 hrs
200 divided by 1000=.2 times 60=12 ltr/hr times 7 hrs =84 ltrs/hr
so if you are running 450 blood flow rate for 3.5 hrs then you are processing 94.5 ltr
now if you run 200 blood flow rate for 8 hours then you would process 96 ltr which is pretty close…
now for the dialysis flow rate…
volume if dialysis to be used divided by time
example: 4 ea 5 ltr bags of dialysate…
run time = 8.0 hrs
20 ltr divided by 8 hrs=2.5 dialysis flow rate
Hope this helps…
Hemo helper
HemoHelper,
I can’t recall whether training included the System Setting appendix or not – but since it’s in the manual and easy to do I assume NxStage thinks patients should know about it. It is important when you exchange machines and helpful at other times.
I tried briefly increasing the dialysate rate to about 6 (which requires running the blood flow up), but it didn’t solve the bubble problem. We’ve gone to 30 L of dialysate which allows an 8 hour run at a dialysate rate of about 4. I still get a #14 alarm every second or third night. I’m looking forward to the redesigned cartridge which I think wrill eliminate that short vertical segment before the dialysate pump where the air gets trapped. I’ve tried pulling the bubbles out of the cartridge with a syringe, but they don’t pull when the pump is stopped. It’s not clear to me why you put saline in the syringe – are you pushing it in rather than pulling out?
Mel
[QUOTE=Mel;13202]HemoHelper,
I can’t recall whether training included the System Setting appendix or not – but since it’s in the manual and easy to do I assume NxStage thinks patients should know about it. It is important when you exchange machines and helpful at other times.
I tried briefly increasing the dialysate rate to about 6 (which requires running the blood flow up), but it didn’t solve the bubble problem. We’ve gone to 30 L of dialysate which allows an 8 hour run at a dialysate rate of about 4. I still get a #14 alarm every second or third night. I’m looking forward to the redesigned cartridge which I think wrill eliminate that short vertical segment before the dialysate pump where the air gets trapped. I’ve tried pulling the bubbles out of the cartridge with a syringe, but they don’t pull when the pump is stopped. It’s not clear to me why you put saline in the syringe – are you pushing it in rather than pulling out?
Mel[/QUOTE]
Mel;
I put saline in the syringe to help remove the air bubbles… If you attach the syringe without any saline and try to extract the air when you push the plunger back down there will still be air in the tubing… with the saline the air bubbles end up in the syringe. when I extract the air I tap the line and the air bubbles float up close to the syringe then I push in the plunger a little and extract again and the bubbles end up into the syringe…
As I stated You need to extract the bubbles before you hook up the patient…
- Attach syringe to the aterial line “T” (next to cartridge)
- Extract about 1cc of saline. Close red clamp at “T”.
- Close all the clamps on the primming spike lines (2 blue,2 yel, 2 red and red/green)
- very carefully move the syringe to the line coming from the cartridge (green clamp) and attach the white clamp line to the red clamp line at the “T” that the syringe was attaqched to.
- Then do the bubble extracting…
extract the plunger and hole it back and tap the line so the bubbles goes up to the syringe. two or three times, then while holding the syringe up above the cartridge pump the plunger on the syringe while tapping the cartridge where the line comes out at. this gets more bubbles to come out. theen extract a few more times and most of the bubbles should be out of the system…
Yes, once the machine is running you will not be able to use the syringe to extract any bubbles… you can’t pull back on the syringe… so you must extract before you connect the patient… And if you do get the #14 alarm after extracting the bubbles you might try running the machine as if you were doing short daily… Change the blood flow rate up to 300 + (Bottom window) will allow you to increase the dialysate flow rate (top window) to a higher rate and pull the bubbles thru the system… You might have to run it for 30 minutes. then switch back to the lower rates that you use for nocturnal… Check the line comming out of the cartridge going to the heater and see of the bubbles did get pulled thru the system. It (the trail of bubbles) happen about every 20 seconds…
Knock on wood … I have been running for about three weeks and have not seen the #14 alarm. But if I do I will be doing this… to see of the bubbles get pulled thru the system…Cause there is no way to extract them from the system once you have started. I think when you press STOP the clamp between the balancing chambers and the pump segment closes and making it imposible to pull back on the plunger on the syringe.
hope this hepls
HemoHelper
I do not seem to have any problems with the #14, Are you “guys” using a hepering line cartridge? I have that type because we do nocturnal and I do not have any problems with bubbles.
Pat
[QUOTE=Pat Colongione;13217]I do not seem to have any problems with the #14, Are you “guys” using a hepering line cartridge? I have that type because we do nocturnal and I do not have any problems with bubbles.
Pat[/QUOTE
Pat;
What cartridge are you using?
I am using CAR-161-B.
What is your dialysate flow rate? (Top window setting) our setting is 3.1
What is your blood flow rate? (Bottom window) our setting is 220.
How many hours do you run? our run time is 6hr 27 min
What is your dialysate volume? we use (4 ea 5ltr bags) = 20 ltr
Think you mentioned somewhere in another post that you are using 60 ltrs of dialysate.
If so you are probably running higher blood flow rate and also your dialysate flow rate is probably higher that 3.1… if this is so then I can see why you are not experiencing the #14 alarm. a higher dialysate flow rate would probably pull the bubbles thru the system.
when we run short daily we do not get the #14 alarm… (blood flow rate = 350 dialysate flow rate = 6.0 +).
Also what is your Filtration Factor (FF) our max setting is 30. We run at 24-26 FF
I Thought the reason for doing nocturnal was to take advantage of the slower blood flow rate. (200 cc/min) blood flow rate which would make it a more gentle dialysis.
HemoHelper
For me, the purpose of doing nocturnal would be to not waste 3 hours a day, 6 days a week sitting here staring at the little green and red numbers. We get up at 5:00am and the BEST I can do is to get to work by 9:00. If we could hook up right before bedtime, wake up the next morning, unhook and be ready to start the day, that would be much less wasted time.
(Wasted isn’t the best term to use since this is the reason my wife is alive today, but I think you know what I mean.)
Hi HemoHelper,
Yes we are using the 161B
Rate -depends on how much I need to take off of him-Remember he is a large guy.
Blood flow rate varies also
We run for 8 hrs. Some times 7:57
Dialysate volume is 60L- this makes everything else change depending on
Out Factor is 35
BFrate is 330- 450
If he is taking off 3K like last night,
Top window is 7.9 to 8.0
middle window was .42 (3.0/8) would need .38 to cover 8 hrs. I usually up it a little
Blood pump speed last night was 400.
I did get a 14 alarm last night but noticed I did not catch the bubles in the top of the dialyser fast enough. As soon as I clearned them, everything was fine.
When I need to take off less than 2K all settings are reduced.
But the 60L makes it really hard to keep the BFR slower than 300.
When he was on the Freni we ran at 300.
His number are great, so we have no complaints.
Pat
[QUOTE=Pat Colongione;13225]Hi HemoHelper,
Yes we are using the 161B
Rate -depends on how much I need to take off of him-Remember he is a large guy.
Blood flow rate varies also
We run for 8 hrs. Some times 7:57
Dialysate volume is 60L- this makes everything else change depending on
Out Factor is 35
BFrate is 330- 450
If he is taking off 3K like last night,
Top window is 7.9 to 8.0
middle window was .42 (3.0/8) would need .38 to cover 8 hrs. I usually up it a little
Blood pump speed last night was 400.
I did get a 14 alarm last night but noticed I did not catch the bubles in the top of the dialyser fast enough. As soon as I clearned them, everything was fine.
When I need to take off less than 2K all settings are reduced.
But the 60L makes it really hard to keep the BFR slower than 300.
When he was on the Freni we ran at 300.
His number are great, so we have no complaints.
Pat[/QUOTE]
Pat;
THANKS FOR THE RESPONSE…
Just as I thought. Your dialysate flow rate is high (7.9-8.0) with this rate it should pull the bubbles thru the system…emimating the 14 alarm… when we first started out rate was 2.8… with the pump running so slow boy did the 14 alarm drive me crazy…
Clearing the bubbles in the dializer (blue clamp) should have nothing to do with the 14 alarm… WHY??? when you extract the air from the dializer it is in the blood circuit… the14 alarm is air in the dialysate side of the cartridge. and the air sensor for #14 alarm is in the line with the green clamp. it is about 2 inches in the cartridge. … There are two different fluid paths… if you look at the dialyzer blood is going in one end of the dializer and out back to the patient. That is the blood circuit. the other tubings carry the dialysate in and out of the dialyzer…this removes excess fluid and the toxins from the blood and send it down the drain. (You will notice that there is air trapped in the dializer next to the blue clamp by the white fibers) it is air in the dialysate side of the dialyzer…I don’t think you can extract this air pocket…
When my partner was on the Freni her blood flow was at 200…
Ran last night without extracting the air from the cartridge but ran the first 6 minutes at higher rates as though we were doing short daily… it was partially successful… only one 14 alarm all night. Think I need to run with the higher flow rates past the first yel #2 (Fluid balance system check underway)think it is about 15 minutes into the treatment. think thru the initial balance check air is introduced into the line from the balance chambers. Will post results if it is successful for a week or longer. Know that extracting the air bubbles from the cartridge works…
HemoHelper
Hi all;
After trying to run the System One for the first half hour at a faster dialysate flow rate without extracting the bubbles and still having the #14 alarm. I am convinced that this will not work. Trying this procedure for a week and having encountered the #14 alarm every night makes me feel that the only way to have a restful night sleep is extracting the air bubbles before hooking up the patient.
With the dialysate pump running at 6.0 for 30 minutes I thought it was the solution as the bubbles were not present in the dialysate line (Green Clamp). They appeared after I switched to the settings for nocturnal. (slow blood flow (220) and lower dialysate flow rate of 3.1…)So guess I will continue to extract the air bubbles and get my nightly sleep…
HemoHelper
Hi all;
Think the solution for the air in the dialysate line in the cartridge (ala ALARM #14)…
Switch to using Pureflow SL… Yes I have been using the Pureflow dialysate system. for about three weeks and have not had one alarm #14… With the pump on the pureflow pushing dialysate into the cartridge the bubbles that were in the line at the green clamp are no longer a problem… It just pushes them thru the system…
Wonderful sleeping nights without having to attend the #14 alarm…
HemoHelper
That is good to hear. How do you like the pureflow compared to the bags?
Jane;
The pureflow is a wonderful addition to the dialysis treatments… there are a few draw backs though…
- It takes 7+ hours to make a batch of 60 ltrs of dialysate… You don’t have to be there all seven hours but… if something goes wrong… (needs to be tested for chlorine after the batch is made; if it fails; you dump it and start over with a new PAK {unit that makes the tap water purified} the PAK takes 2+ hours to be ready for making a batch of dialysate… and another 7+ hours before you can get started with your treatment… So if you are on nocturnal like us it is a day that is skipped/day off changed… and we are using 20 ltrs a treatment so it is good for three days… there is also a time limit before the batch is not usable… you have to use it before the 72 hours is up… that includes the time 7+ hours to make the batch…
- the Pureflow SL makes a nice stand that the System One sits on…
- the supplies used for the pureflow takes up less space… about 60% less
- supplies need to be ordered/deliverd once a month…
- PAKs should last about 12 weeks/3 months… To make sure that I don’t have to dump a batch of dialysate I might put a charcoal filter in line with the water in to remove the chlorine and check it there before I make a batch and if it is high just replace the charcoal filter and PAK and not worry if the batch will pass the chlorine test… Since we have been doing nocturnal at home for 6 years the water system with the Fresenius that we were on had chlorine/chloramine check before we could use the RO water system… and let me tell you we did have problems from about December til March (rainy season in CALIF) it seems that the city spiked it then because of runoff getting into the water supply… It was within the limits but the City knew that they would get a call from me when ever it went up…
The bags are still used for travel or emergencies… or if the Pureflow is down… The bags are more versitle. right now if we were to pick one or the other it would be a hard choice…
think both are reliable solutions. I like the fact that I get to sleep nights without the 14 alarm and not having to carry 20 ltrs of solution upstairs 6 times a week… but I like to have the freedom of getting my partner treated at our convience not tied to the 72 hours per a batch… Guess if there is not enough time to run the 7 hours of nocturnal we could use the System One for a short daily for one treatment …
Pureflow SL is here to stay so I best get use to it…
HemoHelper