Hi everyone. It’s me again - after another long break…
I have a issue with my recent txs on the System One and I am looking for some advice. Recently, I have been getting the “24” alarm during my tx. According to the manual, the “24” means that the arterial line is not getting enough pressure to run at the appointed speed (I run with a BFR of 400).
I haven’t had any problems with my fistula for a very long time now, and my getting the “24” alarm has me thinking about what could be the culprit.
My nurse says that it means my access is having problems and has scheduled an arteriogram for me. She is positive that there is a problem with my fistula that is just starting to brew and she wants to catch it before it gets worse.
I really don’t want to get an arteriogram unless I absolutely need it. I think it will put an undue amount of stress in my fistula.
The thing with the “24” alarm for me, is that I don’t get it on every tx, and I can make it go away for a while if I just adjust the “layout” of the tubing. I use buttonholes, so I don’t imagine it is the placement of the catheter.
Has anyone else dealt with a fairly regular “24” alarm?
Does it sound like I need to get an arteriogram to stop the progression of something bad that may be happening to/in my fistula?
[quote=estonb;11390]Hi everyone. It’s me again - after another long break…
I have a issue with my recent txs on the System One and I am looking for some advice. Recently, I have been getting the “24” alarm during my tx. According to the manual, the “24” means that the arterial line is not getting enough pressure to run at the appointed speed (I run with a BFR of 400).
I haven’t had any problems with my fistula for a very long time now, and my getting the “24” alarm has me thinking about what could be the culprit.
My nurse says that it means my access is having problems and has scheduled an arteriogram for me. She is positive that there is a problem with my fistula that is just starting to brew and she wants to catch it before it gets worse.
I really don’t want to get an arteriogram unless I absolutely need it. I think it will put an undue amount of stress in my fistula.
The thing with the “24” alarm for me, is that I don’t get it on every tx, and I can make it go away for a while if I just adjust the “layout” of the tubing. I use buttonholes, so I don’t imagine it is the placement of the catheter.
Has anyone else dealt with a fairly regular “24” alarm?
Does it sound like I need to get an arteriogram to stop the progression of something bad that may be happening to/in my fistula?[/quote]
Yes, I have dealt with those 24s and the problem on my end was that I had the arterial line pushed, and bent/kinked by my blanket or the needles itself has moved a bit and is hitting the vessel walls. All I would do is check the lines and move the arterial needle a bit…wiggle it a bit and the 24 would stops…
I asked patient who is on NxStage if he gets the #24. He said yes, often- just a kinked line. The alarm clears immediately after he straightens line. Did you ask your nurse why she thinks it’s an access problem vs a kinked line? Have your pressures changed? Does the way you tape your lines or leaning arm against chair cause them to kink?
Yes i have a catheter and i got the 24 alarm 21 times while ding treatment today. My lines wasnt kinked so l kept resetting it. Finally i started messaging where the catheter go in my chest and up near my neck and it went away. Anyone else has had this problem
I’m having the same problem. Frequent red 24 during treatment. We are fairly new to HHD, red alarms scare me. We just had the permacath replaced and the alarm seems to be positional. I have tried repositioning his head, massaging the catheter as someone suggested but the pressures still remain very erratic -172 to -434. Any suggestions would be greatly appreciated.
Cheryl, I am so sorry that I am just seeing and replying to this now. Has the issue with the catheter been resolved? If I saw this a month ago, I would have told you that my guess is that you’re correct about the catheter being positional, especially since it’s a new catheter with immediate dysfunction. Hopefully by now, your team has worked this out. Sometimes, a catheter can be run with lines reversed. Sometimes, they can try declotting it and that works. Sometimes, lowering the speed is all that’s needed. Sometimes, absolutely nothing at all is done and it just works one day because life is weird. Otherwise, it’s another exchange, and I’m sorry if that was the case. This is a completely random armchair thought, but I’m curious anyway… does he happen to be a taller guy? Maybe the type who was once bigger than he appears now, or is bigger when he stands up than he looks from a bed? I’ve had so many questions about positional catheters that have gone along with that particular body type. Makes me wonder almost if some broad-shouldered tall men end up with a too-short (?) catheter because the size estimation is off in a more upright position that you’d actually treat in versus how it gets placed.
The old catheter was clotted so it really needed to be replaced. The new catheter is not working that well either. Red alarm 24’s all through treatment finally had to abort Monday’s treatment after 30 min. Tuesday’s treatment was all yellow 24’s so I was able to complete treatment. Yesterday, all red 24’s from the start. Tried reversing the line and that did not help, however the nurse in center suggested putting the line back to red to red and it worked. I had also put him into trendelenberg, so maybe that helped. Needless to say, Im so frustrated and hope Im doing right for my husband. His fistula is not matureing as fast as I would like and will probably need to be revised again. The nurses tell me that it will be easier with the fistula, I hope so. About his height, he was 6’ but now is 5’ 10". Any advice you can offer would be greatly appreciated. Thanks for listening!
How many treatments would you say you guys have had to either shorten or abort entirely in the past month because of the catheter issues? This doesn’t sound like anything you’re doing wrong, but if every treatment you’re running at home is stressful, hairy, and start/stop with the 24s, he’s just not getting very good reliable treatment… and you both are probably about to implode from stress. That is awful. This has been going on all month! Can the nurse caring for him attempt to use the new catheter themselves and run a full treatment with it? That would probably be my first action-- to bring both of you in and have you demonstrate the problem. Is the catheter clotting, the fistula taking its sweet time, and the need for trendelenberg all because of low blood pressure? If so, how low is it running? Does the catheter work better with a better blood pressure? What’s the usual blood flow rate? Honestly, as much as you’re looking forward (as messed up as that sounds) to get the fistula going, he should have a reliable working access (ANY reliable access is better than none!) 30 days ago! I am so sorry you’re still going batty over this! Are you able to smoothly push/pull with a syringe when prepping the catheter? Which side is better or do you always get choppy flow? Can he feel the abrupt stop when you fall off into the -400s? If so… it’s probably sucking up against something. Have they checked terminal catheter position at radiology? You’re on Nx, are you using paper flow sheets or the iPad? If you are on Nx2Me, call your center and please ask your nurse to pull up your treatment records and see how many times you are having these pressure alarms. Ask if they can SEE the reason for your stress, and please ask them to find a solution. Monday he got 30 min, Tuesday he got a full treatment but with pressure warnings, and now another day of being unable to run treatment. Your center really should get you guys in for a back-up/respite treatment to make sure he’s stable and so they can set up whatever has to happen next. Keep us posted!
Also, Cheryl (I can’t get you off my mind, so I had to come back to say more!) and to anyone else reading-- PLEASE KNOW that it is ABSOLUTELY a MEDICAL EMERGENCY when a person who needs/wants dialysis cannot get treatment because they do not have a functioning access. If anything in your intuition tells you that it needs to be taken up a level and you may be heard better in an ED with immediate lab results, you do not need approval or permission from anyone. Just go. I teach people emphatically to trust their “Jimmy Cricket” voice. If yours is telling you something, listen to that. Much love.
I only had to abort one treatment. Yesterday had a perfect run. That was his first in awhile. His KT/V is good. I’m hopeful for a good run tomorrow. My nurses have been wonderful and very supportive. The new meds hes taking seem to be finally working bp maintained over 100-120 systolic throught treatment. So things might be improving. D’ont want to say and jinx it. Thank you for your suggestions.
Experiencing a “24” alarm during dialysis could be related to tubing positioning or needle placement. Try checking for kinks in the tubing and discussing your concerns with your healthcare team. If adjustments temporarily alleviate the issue, it might not necessarily indicate a significant problem. However, consult with your healthcare team to evaluate the need for an arteriogram, weighing the risks and benefits. They can provide personalized guidance based on your medical history and observations during dialysis sessions.