I would be interested to know what others are using for a flow fraction, # of bags of therapy fluid, bps, dialysate flow rate and average length of time on the machine? Also, what are you getting for a kt/v?
Has anyone found a way to get a more efficient tx by adjusting the peramiters?
[QUOTE=Jane;13757]I would be interested to know what others are using for a flow fraction, # of bags of therapy fluid, bps, dialysate flow rate and average length of time on the machine? Also, what are you getting for a kt/v?
Has anyone found a way to get a more efficient tx by adjusting the peramiters?[/QUOTE]
Hi Jane,
We run on nocturnal. We use 60L on the Pureflow a night. If we have to use bags we use 45L (9) bags. That is what we use to travel. Our FF is 35, our BPS is usally between 370 to 420 depending how much I need to take off Ralph and the length of time. We usually dialysse 8 hrs a night. We are usually on by 9:15 and off at 5:15. Our clinic says our Kt/v Is excellent.
We draw bloods tonight and tomorrow for pre and post and mail them out tomorrow. We should have info on either Fri or Monday and I will than post that info.
Pat
Flow fraction = 30
Therapy fluid = 20L – PureFlow
BFR = 500
Dialysate flow rate usually 8.0 if UF is 2.0, else it will be higher, after UF is done = 9.0
Average length of time on the machine = 2:30 hrs
kt/v last month = .57
NxStage 2/06
In-center 3/03
FF=30
Dialysate=15L (Pureflow)
BFR=450
Dialysate flow=usually between 75 and 8 depending on UF settings
Kt/V=haven’t done labs yet
Jane;
We are on nocturnal for 7 hours…
Her Blood flow rate is 200
FF = 24 to 26
Dialysate flow rate is 2.8
Use 19.6 ltrs per treatment
dont know what her KT/V is; but after doing nocturnal for 5 + years on a Fresenius machine and switched to the NxStage last November. Her blood work has been about the same. She feels like a million bucks and you would not think she has had end stage renal disease for 17 years… if you met her.
As you know we were having problems with the #14 alarm… So I tried a lot of variations trying to eliminate that alarm and get a full nights sleep…
So I did a lot of changing of the Dialysate flow rate, time, and Blood flow rate. Always letting my clinical nurse know what was going on and finding out that it is always best to get some treatment done. You can vary the time but make sure you process the same amount of blood… the formular is:
blood flow rate X time X 60 divided by 1000 = ltrs processed.
example: 200 X 7 Hrs X 60 divided by 1000 = 84 ltrs
so if you want to run for say 5 hours:
200 X 5 hrs X 60 divided by 1000 = 60 ltrs…
to process the 84 ltrs that you normallly would have if you ran for 7 hours, you need to increase the blood flow rate…
84 X 1000 divided by 60 divided by 5 hours = 280 blood flow rate
280 X 7hrs X 60 divided by 1000 = 84 ltrs
As for calculating your dialysate flow rate:
total vol of dialysate divided by time = dialysate flow rate
Example: 19.6 ltrs divided by 7 hrs = 2.8 dialysate flow rate…
running for 5 hours you need to adjust the dialysis flow rate accordingly.
19.6 ltrs divided by 5 hrs = 3.92 dialysis flow rate…You would run a little longer than the planned 5 hours maybe about 10 minutes longer… If you wanted to have it stop at 5 hours you need to change the total vol to 19.5 ltrs…(19.5 divided by 5 = 3.9)
Any way those are the formulars that I use to vary our runs… using the Pureflow that has time restriction to use the 60 ltrs within 72 hours of the start of making the batch of dialysate. Sometimes the last treatment to use the batch has less than our standard 7 hours. Because we went out and didn’t return in time (Party Hardy). or Had important things to do in the morning and decided to run a shorter treatment. It is ways that one can make use of the home treatments to suit your situations. We usually (95% of the time) do the 7 hours thing but it is nice to get the treatments done on our own schedules… when we have better things to do… you know what I mean…
Hope this helps with your interest in varying your treatments…
Another thing you should do if you are running daily treatments… 6X a week…
If you are feeling like cramp is around the corner and you still have time remainding don’t suffer the pain of CRAMPS… turn the ultrafiltration/weight to remove (middle window in the volume screen) to ZERO. and take it off the next day…
HemoHelper
Always so helpful, Hemohelper. I will be filing this info to study out and will have questions when I get to the point of nocturnal txs which should be soon. You should be congratulated for figuring out ways to make txs fit into your lifestyle instead of the other way around. This is the way it should be- oh yes I know what you mean : )
I have forgotten- previously did you say why your partner does nocturnal txs for 7 hrs as opposed to 8? And when you are running 7 hrs at 200 why is your FF 24-26 instead of one set rate?
As far as cramping, I have gotten very good at knowing bodily signals so I don’t cramp. I am doing SDD, however, and if I see that I can’t go to the end, I turn the UF off for the last .1, usually, or .2 at the most. I have wondered how often those on nocturnal have a problem with cramping as it seems like it would be more difficult and scary to awaken to a cramp and have to scramble to turn the UF off.
You have provided info on how to vary the length of txs while getting the same efficiency, but I was wondering if anyone has figured out ways to increase the efficiency of txs, such as by using more therapy fluid per tx. But from what you say, your partner is feeling so well it doesn’t get much better. Glad to hear she is feeling so great!
[QUOTE=Jane;13775]Always so helpful, Hemohelper. I will be filing this info to study out and will have questions when I get to the point of nocturnal txs which should be soon. You should be congratulated for figuring out ways to make txs fit into your lifestyle instead of the other way around. This is the way it should be- oh yes I know what you mean : )
I have forgotten- previously did you say why your partner does nocturnal txs for 7 hrs as opposed to 8? And when you are running 7 hrs at 200 why is your FF 24-26 instead of one set rate?
As far as cramping, I have gotten very good at knowing bodily signals so I don’t cramp. I am doing SDD, however, and if I see that I can’t go to the end, I turn the UF off for the last .1, usually, or .2 at the most. I have wondered how often those on nocturnal have a problem with cramping as it seems like it would be more difficult and scary to awaken to a cramp and have to scramble to turn the UF off.
You have provided info on how to vary the length of txs while getting the same efficiency, but I was wondering if anyone has figured out ways to increase the efficiency of txs, such as by using more therapy fluid per tx. But from what you say, your partner is feeling so well it doesn’t get much better. Glad to hear she is feeling so great![/QUOTE]
Jane:
Her treatments has always been 7 Hours… Guess when we started nocturnal on the Fresenius it was determined that 7 hours would be OK for her body size and weight… (dry weight 46 Kilo). The FF varies when you have an increase in flow rate of ultrifiltration.
As far as cramping on nocturnal it usually happens close to the end of the treatment… But One night when she was on the Fresenius she started to cramp and didn’t wake me and got out of bed to stand by the machine… to relieve the cramping… But I was rudely awakened by the noise of her passing out and crashing to the floor… that was the last time she has had severe cramps… since then she has called me and inturn I have turned off UF… and made up the missed volume of H2O the next treatment…
When we were in training for NxStage. By changing the volume of dialysate and checking her blood we ended up with the 20 ltrs / treatment. According to NxStage’s chart, her body size and weight 15 ltrs of dialysate should be what would be needed to have good blood results. But we had to increase it to 20 ltrs to get blood work equal to what she was getting on the Fresenius… According the her DR… the Fresenius is like the industral strength dialysis machine… So to get better blood test results I’d say you need to increase the total volume of dialysate used… You might talk to your clinic and see if they would let you use 5 ltrs more per treatment for a month and see what results you have on your blood tests…
Hope this helps
HemoHelper
FF 26
Distalate 20L Pureflow
Treatment time 2:45 to 3:00
Blood flow 500
ktv 1.45
[QUOTE=HemoHelper;13778]Jane:
Her treatments has always been 7 Hours… Guess when we started nocturnal on the Fresenius it was determined that 7 hours would be OK for her body size and weight… (dry weight 46 Kilo). The FF varies when you have an increase in flow rate of ultrifiltration.
As far as cramping on nocturnal it usually happens close to the end of the treatment… But One night when she was on the Fresenius she started to cramp and didn’t wake me and got out of bed to stand by the machine… to relieve the cramping… But I was rudely awakened by the noise of her passing out and crashing to the floor… that was the last time she has had severe cramps… since then she has called me and inturn I have turned off UF… and made up the missed volume of H2O the next treatment…
When we were in training for NxStage. By changing the volume of dialysate and checking her blood we ended up with the 20 ltrs / treatment. According to NxStage’s chart, her body size and weight 15 ltrs of dialysate should be what would be needed to have good blood results. But we had to increase it to 20 ltrs to get blood work equal to what she was getting on the Fresenius… According the her DR… the Fresenius is like the industral strength dialysis machine… So to get better blood test results I’d say you need to increase the total volume of dialysate used… You might talk to your clinic and see if they would let you use 5 ltrs more per treatment for a month and see what results you have on your blood tests…
Hope this helps
HemoHelper[/QUOTE]
I have yet to fully understand all the mechanics of NxStage. I read the entire manual but found it to be unclear in places. A NxStage tech told me they think its vague too and hope to write another one. I’ve noticed when I’m putting in my numbers, the FF shows lower that my machine is set for. But then once the tx begins, I think it shows what it is set for. I’ll have to pay closer attention to that my next tx and see what it reads. I always use the same bps, but my UF is different every tx.
Re cramping, I’ve read where so many people on nocturnal say that a cramp is rare as the blood pump is running so slow. But that has never made sense to me, because if one get’s too close to one’s dry weight it can always happen I would think. So, turning off the UF is the only answer I would agree. About how often does this occur for you? It may not be that you are making up missed volume, but just that your estimated goal was too high by a little ( i.e real weight, not fluid weight ).
When you went to 20 liters did you also adjust your input FF rate? There is a formula for figuring kt/v with NxStage. Mine is always around 2 something, but a couple of times it was just under 2. For SDD, they want it to be 2 something as that shows one is getting a good clearance. Don’t know if the same formula is used for nocturnal, but have read the clearance is much higher. I feel great with the clearance I get, but look forward to seeing if I will feel even better with nocturnal…I did try using 5 liters more for about 3 weeks. It made my txs 20-45 min.s longer and I did not feel better, actually felt worse while on my txs. But when I did this, they did not adjust my FF, so I don’t know it that affected how I felt…I am not clear on how various model machines compare. I only know that when I was on a FR in-center, the peramiters used made me feel lousy during tx., but with NxStage I feel so much better. Don’t know if its the machine or the peramiters used and daily txs that make the difference.
Jane,
Keep in mind that the actual FF is just the ratio of the dialysate rate to the blood flow rate. The FF that is set in to the machine is the maximum FF allowed, not the actual FF which can be lower. If you increase the dialysate volume for a given treatment length you should proportionally increase the max FF set into the machine (with permission up to .35 – usually called just 35) if you want to process the same blood volume over the same period. We typically use FF 31, blood flow 210, dialysate flow 3.8 and time about 8 hours with 30 L of dialysate. Any lower dialysate rate may produce #14 frequent alarms. The forthcoming 171B nocturnal cartridge should eliminate that requirement, providing more flexibility.
Mel
[QUOTE=Mel;13786]Jane,
Keep in mind that the actual FF is just the ratio of the dialysate rate to the blood flow rate. The FF that is set in to the machine is the maximum FF allowed, not the actual FF which can be lower. If you increase the dialysate volume for a given treatment length you should proportionally increase the max FF set into the machine (with permission up to .35 – usually called just 35) if you want to process the same blood volume over the same period. We typically use FF 31, blood flow 210, dialysate flow 3.8 and time about 8 hours with 30 L of dialysate. Any lower dialysate rate may produce #14 frequent alarms. The forthcoming 171B nocturnal cartridge should eliminate that requirement, providing more flexibility.
Mel[/QUOTE]
Mel;
WOW you process a lot of blood running 8 hours at 210 blood flow rate… about 100 ltrs per treatment…
The solution for the #14 alarm is to have your center switch you from BAGS to the Pureflow SL. Since we switched 4/18/07 I have NOT had to deal with the 14 alarm… With the Pureflow there is a pump that pumps the dialysate to the cartridge rather than depend on gravity to flow the dialysate into the cartridge. Guess with the pump it pushes the bubbles thru the system and those sleepless nights are gone… But, I will have to deal with it when I use BAGS, when we do any traveling…
HemoHelper
[QUOTE=Jane;13781]I have yet to fully understand all the mechanics of NxStage. I read the entire manual but found it to be unclear in places. A NxStage tech told me they think its vague too and hope to write another one. I’ve noticed when I’m putting in my numbers, the FF shows lower that my machine is set for. But then once tx begins, I think it shows what it is set for. I’ll have to pay closer attention to that my next tx and see what it reads. I always use the same bps, but my UF is different every tx.
The FF set on the Nxstage is the MAX Filtration Factor set in System Settings…(APPENDIX A) in the manual (Parameter #1). It is important that you have your center share with you these system settings that your machine is set at…and train you to change the system settings… Why??? if your machine gives you trouble and they overnight to you a new machine. You need to change the the settings that the your center uses before you can safely use the new machine… Don’t know how the NxStage calculates the FF.
Re cramping, I’ve read where so many people on nocturnal say that a cramp is rare as the blood pump is running so slow. But that has never made sense to me, because if one get’s too close to one’s dry weight it can always happen I would think. So, turning off the UF is the only answer I would agree. About how often does this occur for you? It may not be that you are making up missed volume, but just that your estimated goal was too high by a little ( i.e real weight, not fluid weight ).
Cramping Happens when the dry weight is surpassed… not how fast the blood pump is running… Cramps does not happen often… when it does I usually check to see if there is any swelling of the ankles… if there is no swollen ankles and after a couple of nights of turning UF off I increase my partner’s dry weight and assume that because the treatments are making her feel better and she is eating more she is gaining weight… Her dry weight was 44.5 kilos whan we started Nocturnal 6 years ago and it has ben as high as 49 kilos.
When she was on the Fresenius We use to run think it was called profile where the machine took off the liquid early in the treatment and less at the end and it reduced the cramping… But this is not available on the NxStage. Better yet is if you are doing daily dialysis then by turning UF off you can it up the next day…
When you went to 20 liters did you also adjust your input FF rate? There is a formula for figuring kt/v with NxStage. Mine is always around 2 something, but a couple of times it was just under 2. For SDD, they want it to be 2 something as that shows one is getting a good clearance. Don’t know if the same formula is used for nocturnal, but have read the clearance is much higher. I feel great with the clearance I get, but look forward to seeing if I will feel even better with nocturnal…I did try using 5 liters more for about 3 weeks. It made my txs 20-45 min.s longer and I did not feel better, actually felt worse while on my txs. But when I did this, they did not adjust my FF, so I don’t know it that affected how I felt…I am not clear on how various model machines compare. I only know that when I was on a FR in-center, the peramiters used made me feel lousy during tx., but with NxStage I feel so much better. Don’t know if its the machine or the peramiters used and daily txs that make the difference.[/QUOTE]
When we went from 15 to 20 ltrs we did not change the FF settting in system settings. the center has some sort of formular t determing what this number will be for each patient.
If you want to keep the same time you may need to have your center approve the changing of the Maximum FF in system setting… if you were using 20 ltrs in 3hours and increased it to 25 ltrs in 3 hours. your dialysate flow rate rate would be 20/3=6.7ltrs/hr and
25/3= 8.3 ltrs/hr…( top window) … if you cannot adjust it up that high then the FF might have to be changed to allow you to increase it. (25/6.7= 3.7 hrs)
Think KT/V is the same for SDD and Nocturnal. Think you are feeling better because you are getting more treatments. SDD = daily 6X/week??? verses 3x in center … 3 times a week just does not get the blood clean enough and because of your diet restrictions it is hard to get enough nutritions from what little you can eat and drink… Now doing SDD bet you are walking away from the table full… Gaining weight are you???
HemoHelper
[QUOTE=Mel;13786]Jane,
Keep in mind that the actual FF is just the ratio of the dialysate rate to the blood flow rate. The FF that is set in to the machine is the maximum FF allowed, not the actual FF which can be lower. If you increase the dialysate volume for a given treatment length you should proportionally increase the max FF set into the machine (with permission up to .35 – usually called just 35) if you want to process the same blood volume over the same period. We typically use FF 31, blood flow 210, dialysate flow 3.8 and time about 8 hours with 30 L of dialysate. Any lower dialysate rate may produce #14 frequent alarms. The forthcoming 171B nocturnal cartridge should eliminate that requirement, providing more flexibility.
Mel[/QUOTE]
Thanks Mel, this explains a lot. So, a question I have is, if one uses a greater dialysate volume, adjusting the FF higher, does this provide a more efficient tx as in even better clearance and noticeable feelings of wellness?
Also, I see you use 30L for nocturnal txs. How many liters did you use for SDD?
And, I see you figured out your own solution for the #14 alarms.
Hemohelper,
I will re-read Apendix A first chance I get. I did get the system settings from my nurse thanks to your advice, but she has been too busy to train me on how to set them. So, will get to that next. It seems that another alternative, until I get trained, is having NxStage technical or training nurse walk me through the set up on the phone, should I ever need this done, since I’ve got the #'s now.
Did you mean that when you were on the FR doing nocturnal txs, you used a UF profile? I had heard profiles were not necessary for nocturnal txs as the blood pump is running so slowly allowing fluid to be released from the tissues into the bloodstream.
I am amazed at how incredible I feel doing SDD on the NxStage. After about 30-40 min the intial fluid is removed and I feel like the fluid build-up/pressure is off of me. And then I can feel stages of more fluid removal feeling better with each stage. By the time the tx is over, I feel like a new person. This is the total opposite of the way I felt with in-center txs. BUT, in one unit I was in, the machine peramiters/solutions gave me decently good txs, although not as great as I feel with SDD. So, my conclusion is, machine peramiters/solutions as well as time/frequency make a big difference in how the tx is tolerated. I believe there could be ways to make SDD and SND even more efficient/comfortable.
See what you mean about the FF setting.
Regarding gaining weight, I’ve gained about 5 pounds since doing SDD txs. It is wonderful to be able to more freely eat more of the phos and K foods and is only natural to gain some weight after being so severely restricted, previously. I am somewhat surprised to see the weight gain, however, as I still do not eat anywhere near what I consumed pre-dialysis. I can only eat 2 full meals and some fruit inbetween. I never eat lunch, because if I do, it completely knocks my appetite out for supper. And I also have some kind of problem, that as soon as I eat supper, I feel very full ( sort of like someone feels when they are stuffed from Thanksgiving dinner, although I just eat a moderate supper) and do not feel well for a short time until I do my tx and get dialyzed again.
When I was pre-dialysis eating was so different. I often had a milkshake or smoothie drink when I felt like it… Or if I was in the mood for melon, I would eat a whole half of cantelope or a large amount of watermelon at a sitting…until I was full. Never again ate like that since being on dialysis, even on SDD, yet gain weight now.
I think part of it is aging, less active due to bone issues, so much time spent searching for answers for improved dialysis txs… But I am about to embark upon a whole new eating and exercise regime. I think one reaches a point where the metabolsim changes and healthy habits are essential. We can eat more of the previously forbidden foods now, but that is not a license to go hog wild. I feel full after I eat a meal, but feel hungry inbetween and wish I could eat lunch like everyone else. I am just very glad to be able to eat more of the things I like and hear it gets even better with nocturnal txs. But low fat eating and exersise must become a way of life for me now.
I’ve lost a lot of time due to all the effort I must put into improving my txs. I never got very good education from my unit and have had to do all the leg work myself. Each time I nail down an area, I feel that much more free and able to concentrate on healthy eating and exercise.
Jane,
I’m not sure my wife felt much different with more dialysate. Logically, more dialysate with with a higher FF should provide better dialysis, but I’m an engineer, not a doctor so there is undoubtedly more to it that I don’t understand. I think how you feel is primarily related to frequency of dialysis. The effect of the amount of dialysate used relative to blood processed is more subtle and I’m not sure there is yet general agreement in the nephrology community. The studies NxStage describes as being in progress may provede some answers. Our Fresenius machine in nocturnal mode has an FF of about 150 compared to 20-35 for a NxStage machine.
We started on SDD at 20 L and moved up to 25 and then 30 on nocturnal. We both hated SDD and much prefer nocturnal. I’m convinced 6x nocturnal is the gold standard and the key to a long happy life for dialysis patients.
Mel
Mel;
Think your increase from 20 ltrs to 30 ltrs was probably to make it possible to run at a higher dialysate rate to eliminate the dreadful #14 alarm… Guess the best way to check if the increase volume does any good is to have you run for a week and draw blood and compare the results and see what if anything is helping get better blood results… If you haven’t checked out the #14 alarm … I posted a result that using the PUREFLOW cures the #14 alarm… Haven’t seen it since we started using it (4/18/07)…
Jane you are feeling better because you are being dialized more often. Think short daily is a lot better than in center treatments of 3X/week. as Mel has stated Nocturnal is probably the Best you can get without a transplant… Nocturnal treatments is considered a more gentle treatment because of the low blood pump flow rate… and because of the length of the treatments you will probably process more blood and because of this remove more toxins from the blood. When were in training doing Short Daily Dialysis we were processing about 74 ltrs of blood and now on nocturnal we are processing 84 + ltrs per treatment. If you think about it being on nocturnal dialysis is like being like a normal person… If you were normal you would be up and using the bathroom during the daylight hours and sleep at night without having to go to the bathroom… on nocturnal the machine is cleaning your blood and flushing the toxins down the drain at night and during the day you have no need to use the bathroom… That is why; I like Mel, think nocturnal should be the GOLD standard for dialysis…
My partner is fast asleep during her treatments so I don’t think she notices any changes like you are experiencing… For her, about five minutes after I hook her up to the machine she is sound asleep… on most nights
Get your center to OK doing nocturnal… You will find that you will feel even better than you do now. Have no fear the NxStage is capable of doing a good treatrments without alarms all night… after you get use to sleeping with the machine hooked up… Maybe my partner is comfortable and has no problem getting comfortable and not worry about having accidential disconnects if because we are using a cathater…no needles can come disconnected. Guess they are leak detectors that patients that have to use needles use to alarm if there is any fluid leaks…
HemoHelper
HemoHelper,
Yes, the reason we increased dialysate to 30 was to solve the #14 problem. We still use the Fresenius 2008K at home and NxStage only when we are away so unfortunately, the PUREFLOW is not an option as a solution. Because we only use NxStage a week or two at a time we rarely get good comparative lab data, but I’m fairly sure we would not see any difference in the standard lab parameters between the two machines running nocturnal. But it has not yet been established, at least to my knowledge, that there are not some subtle differences that won’t show up except in controlled long term patient results. As you know the rule with most dialysis machines is to run the dialysate at twice the blood flow rate. If you could get the same results at one-quarter to one-third the Blood rate why don’t they do it and save a lot of money?
We must be close together. Our home dialysis nurse works out of the El Camino Hospital Dialysis Services facility located in the Eastridge Shopping Center! We’re about 15 miles west.
Mel
Mel,
Yes, we are close by…
We are out of Milpitas Wellbound New center opened about Nov 2006. We live in Milpitas CA. For a while I thought you were using Wellbound in Menlo Park… I talked to the nurse in charge there and she mentioned that there was someone else there that was experiencing the 14 alarm…
We were using the Fresenius 2008K for about 5 years. Wellbound would only let us use one machine so we switched to the NxStage. Mainly for the portability… Will be doing some traveling. Already went to LA for two weeks for the Christmas Holidays. now we are on our way to Colorado for a couple weeks.
Why don’t you guys switch to the NxStage? It is easier to set-up and run… Nocturnal on it is Okay. uses less WATER… Think the city of Milpitas is wondering what is going on… My water usage droped down to normal and they don’t hear from me, telling them that the Chlorine in the water is High, did they switch the source of water?.. there is no checking of the water and doing the disinfecting. Only negative is now I have to buy my water to drink rather than take it out of the RO system… I also miss the waste water from the RO system as I used it to water my plants. Had a drip lines to my plant.
There are other advantages for the NxStage, Ever have a problem with the Fresenius that can’t be fixed??? especially on a long week-end… Had a problem and parts weren’t available so my partner had to go into the clinic and get dialized… Had our NxStage replaced and by 10AM UPS had delivered a new machine and I was up and running within an hour…
HemoHelper
1 ) With as much as 84-100 liters processed a tx are there any issues with vitamin loss? I am referring mainly to B12, folic acid and zinc? Also, has there been testing for high homosysteine?
Is there any noticeable difference in wellness processing 100 liters vs 84?
What perameters were used to get 74 liters processed on SDD? I get less processed.
4 ) Re the rule of running the dialysate rate at twice the bps, is that necessary with NxStage and are you doing it?
5 ) What cartridge # does the NxStage take for nocturnal and are the lines longer?
6 ) What is the model name/# of the heparin pump you use for nocturnal?
Once one has been trained for SDD with NxStage, how many additional hrs. would it take to be trained for nocturnal?
How many txs do you do per week?
9 ) How much more cost is involved in doing nocturnal with NxStage as compared to SDD?
From everything I’ve heard about nocturnal and from how greatly improved I am with SDD, I don’t doubt that nocturnal is the gold standard. My unit is working on giving me the opportunity. It still seems like I’m dreaming that I’m free of the harsh in-center txs, comfortably dialyzing at home.
[QUOTE=Jane;13838]1 ) With as much as 84-100 liters processed a tx are there any issues with vitamin loss? I am referring mainly to B12, folic acid and zinc? Also, has there been testing for high homosysteine?
Don’t know
Is there any noticeable difference in wellness processing 100 liters vs 84?
I doubt if any is discernable
What perameters were used to get 74 liters processed on SDD? I get less processed.
4 ) Re the rule of running the dialysate rate at twice the bps, is that necessary with NxStage and are you doing it?
No, NxStage FF is 31 which means dialysate rate is less than one-third the blood rate
5 ) What cartridge # does the NxStage take for nocturnal and are the lines longer?
161B, to be replaced shortly by 171B
6 ) What is the model name/# of the heparin pump you use for nocturnal?
Medfusion 3500
Once one has been trained for SDD with NxStage, how many additional hrs. would it take to be trained for nocturnal?
I had no additional training – just did it (but I was experienced with nocturnal on a different machine).
How many txs do you do per week?
6
9 ) How much more cost is involved in doing nocturnal with NxStage as compared to SDD?
I don’t see why there is any more cost using a NxStage machine – other than the heparin pump and some heparin.
From everything I’ve heard about nocturnal and from how greatly improved I am with SDD, I don’t doubt that nocturnal is the gold standard. My unit is working on giving me the opportunity. It still seems like I’m dreaming that I’m free of the harsh in-center txs, comfortably dialyzing at home.[/QUOTE]
In my view the additional benefits from going from SDD to nocturnal are almost as great as those going from in-center to SDD.
Mel