[quote=Pat Colongione;13576]Gus,
As I stated on the Nxstage message board.
Yes, I read your post aboiut that. I understand what your saying.
Thing is some of us like myself only use 15-20liter per night. The
PAKs would fail after 2-3 batches. However, right now I have been
using a new Control Unit that replaced my old one, so it will be a
matter of time till I see the results, so I will report back at end of month.
My pak only lasts 2 weeks because I use 60L a night.
So basiclly I use 720L before mine gives out. I also run for
8 hrs a night or 96 hours. Don’t know if that will help but I have
it down to a science now.
Also my drain line was giving me problems partly because I had about
10’ rolled up behind the Pureflow before in went another 10’ into
the drain.
Well last week-end I pulled all the extra through the wall and cut
to only what I needed. Put some clorox solution into the line and
low and behold!! Walah!! no alarm.
Pureflow is the best!!!
Sorry for the cross over but thought both worth passing on.
Pat
I too have extra drain hose rolled up and need to cut it…now and then
I need to flush that drain line with chlorine and some water…
[/quote]
Pat, thanks for your concern! I know this will be fixed…
Bill, our center has us test once a month with the new pak. They have figured out to “trick” the control box to get the pak to “pee” and we send it off for lab work along with our regular blood work.
It is working beautifully.
If you want the directions I will give them to you.
Pat
[QUOTE=Bill Peckham;13526]No I think the PureFlow is a good system there are just some unanswered questions that my provider has and point of fact my provider cuts no corners, dots every ‘i’, etc. It would help if there was more for me to link to in the way of official comment. It would also help if I could point to the aami guidelines but I’m going to bed (tomorrow is the Breakfast of Hope fund raiser featuring Issac Hayes).
I am continuing to use the PureFlow until the supplies I have - about a month’s worth - is used up. It is a good system that preforms as advertised, my provider is committed to daily home hemo using the System One. But until everyone’s concerns are accommodated, including people who have a narrow interpretation of current guidelines,my provider will provide the System One with bagged dialysate.
As has been often pointed out, this is new technology and it has to be used in the context of existing rules and regulations. A strict reading of current regulations would lead to the conclusion that each time the PAC is changed the change constitutes a new water treatment system. This is a legalistic reading which requires official comment. As new technology there are also novel components and materials that should be vetted completely.
I would put this news in the context of my provider meeting a number of challenges over a short period of time. Aksys went out of business at the same time the home program was commiting to doubling in size over the next three years. We now have I believe over 30 people on the System One after starting the year with I think 7. There’s nothing wrong with taking some time to digest all the changes.
I’ll be using the PureFlow for the next month and by the time I run through these supplies all the questions may be answered.[/QUOTE]
[quote=Pat Colongione;13580]Bill, our center has us test once a month with the new pak. They have figured out to “trick” the control box to get the pak to “pee” and we send it off for lab work along with our regular blood work.
It is working beautifully.
If you want the directions I will give them to you.
Pat[/quote]
Now this sounds interesting, something we’re not doing over here. Perhaps this is the solution to Bill’s provider?
More details about this would be good. Questions like “If not tested, what can happen?” or “What exactly in the water needs to be tested?”
When we were using the Fresenius and RO water system. I had to check once a month after disinfecting the water system (with renalin) for bacteria growth… Had to take samples at various locations in the system… I had an incubator to grow the bacteria and check it 12 hours and 24 hours… If there were too many I would have to disinfect the water system again and if it did not pass contact them and not use the water from the RO system… and quarterly they would come out and take a water sample and send it out to a lab for analysis…For 5 years my water system was never faulty… during this time the only place that I noticed any large amount of bacteria was in the drain line from the RO.
Being that the PAK is used to get untrapure water to make the dialysate, it’s function is the same as the RO water system that we used with the Fresenius… So I think they are basicly doing the same thing. Checking for bacteria…
I have a problem with using the drain line on the Pureflow to remove the waste from the patient also… (attaching the cartridge drain line to the pureflow) Yes, you now have only one drain line removing waste… But what is sitting in the drain line day after day… I would imagine that there are a lot of bacteria growing there… No way to flush this line out… Maybe after a while NxStage will update the pureflow so it will flush this line after each use… When we were using the Fresenius my drain would get this white lard like substance build up in the pipes… used liquid drain cleaner to get it cleared about once every other month. Talked to the techs at the dialysis center and they gave me a gallon of DRAIN GEL. what they use at the clinics to keep the drain lines clear of organic material…(white lard like material)… Have been using NxStage for a few months and will check to see if we are getting the same build up in the pipes…
When we were using the Fresenius and RO water system. I had to check once a month after disinfecting the water system (with renalin) for bacteria growth… Had to take samples at various locations in the system… I had an incubator to grow the bacteria and check it 12 hours and 24 hours… If there were too many I would have to disinfect the water system again and if it did not pass contact them and not use the water from the RO system… and quarterly they would come out and take a water sample and send it out to a lab for analysis…For 5 years my water system was never faulty… during this time the only place that I noticed any large amount of bacteria was in the drain line from the RO.
Ah okay, I can now remember doing this myself…use to use a Cobe Century 2 in-center dialysis machine. I used Formaldehyde to disinfect once per month, also did cultures once per month…tedious tasks indeed, espcially the chemical!
Being that the PAK is used to get untrapure water to make the dialysate, it’s function is the same as the RO water system that we used with the Fresenius… So I think they are basicly doing the same thing. Checking for bacteria…
That makes sense, but with the PAKs in there temporarily I don’t think we’d need to mess with any chemicals. I simple bacterial test kits for home would be nice…
I have a problem with using the drain line on the Pureflow to remove the waste from the patient also… (attaching the cartridge drain line to the pureflow) Yes, you now have only one drain line removing waste… But what is sitting in the drain line day after day… I would imagine that there are a lot of bacteria growing there…
I bet it is, but shouldn’t pose a problem? I mean would that stuff return back to the dialyzer?
No way to flush this line out… Maybe after a while NxStage will update the pureflow so it will flush this line after each use… When we were using the Fresenius my drain would get this white lard like substance build up in the pipes… used liquid drain cleaner to get it cleared about once every other month. Talked to the techs at the dialysis center and they gave me a gallon of DRAIN GEL. what they use at the clinics to keep the drain lines clear of organic material…(white lard like material)… Have been using NxStage for a few months and will check to see if we are getting the same build up in the pipes…
Time will tell, am sure its no BIG threat to our current setup, but knowing the facts and solutions to this problem would be quite helpful. I probably would suggest to Nxstage an external pump for the drainline that sits between the Pureflow Sl and drainline…something compact.
There is no threat that the waste will get in contact the dialyzer circuit unless you are careless and get cross contamination by touching the waste line by accident and not disinfecting properly before continuing with setting up the System One. Since there is that bacteria growth in the drain line; if it somehow leaks it woud be easy to get this cross contamination.
[quote=Pat Colongione;13580]Bill, our center has us test once a month with the new pak. They have figured out to “trick” the control box to get the pak to “pee” and we send it off for lab work along with our regular blood work.
It is working beautifully.
If you want the directions I will give them to you.
Pat[/quote]
Hi Pat - CMS has published guidance that seems to follow your unit’s protocol herehttp://www.cms.hhs.gov/SurveyCertificationGenInfo/downloads/SCletter07-34.pdf
The one piece that seems to be missing is how exactly to draw the sample - could you run through your procedure?
Bill I would be happy to give them to you.
Remember we test monthly from the MLA’s and quartly from the purepak. We test more purepak if we need to use more than one pak in a three month time.
The MLA’s you just need to take the water and let it run into a “clean catch” cup if you know what I mean.
Must use mask and gloves and be carefull not to touch anything. Than draw up the tube and label.
Now for the Pure Pak.
Water Culture
use mask, gloves and be carefull not to touch anything.
Open large dark blue clamp (batch started)
Press Go
Follow prompts
Open door
Remove sterile adaptor (keep end clean, touch nothing)
Press go to get stream to get culture
Press and Hold stop (pause)
Press and Hold stop
To drain stop
Press stop (to drain)
Go to drain
Press and hold stop
Drain cancelled
Push stop
Has to do final flush (keep end clean, touch nothing) Blue line needs to remain open
Must wait for final flush to complete
Unload go through motions
Open door/close door
You should end up in stand by
It is real easy.
Hope this helps.
It sure is a pleasure to help you.
You always help me.
Pat
hi Jane,
I was the first in the Tampa Bay area to use the pureflow and at the beginning I was ready to give it up. after they did an update on software on the control unit, I have not had any problems. My Paks last longer, where they were lasting only 2 or 3 weeks, now they are lasting 2 to 4 months.
dannylee
[QUOTE=Pat Colongione;14529]Bill I would be happy to give them to you.
Remember we test monthly from the MLA’s and quartly from the purepak. We test more purepak if we need to use more than one pak in a three month time.
The MLA’s you just need to take the water and let it run into a “clean catch” cup if you know what I mean.
Must use mask and gloves and be carefull not to touch anything. Than draw up the tube and label.
Now for the Pure Pak.
Water Culture
use mask, gloves and be carefull not to touch anything.
Open large dark blue clamp (batch started)
Press Go
Follow prompts
Open door
Remove sterile adaptor (keep end clean, touch nothing)
Press go to get stream to get culture
Press and Hold stop (pause)
Press and Hold stop
To drain stop
Press stop (to drain)
Go to drain
Press and hold stop
Drain cancelled
Push stop
Has to do final flush (keep end clean, touch nothing) Blue line needs to remain open
Must wait for final flush to complete
Unload go through motions
Open door/close door
You should end up in stand by
It is real easy.
Hope this helps.
It sure is a pleasure to help you.
You always help me.
Pat[/QUOTE]
Pat,
I am confused??? It seems as though you are using MLA’s with the PureFlow. I connect the Pureflow directly to the cartridge (Green Clamp). we are using Cartridges CAR-171’s They do not come with MLA’s. It might be easier to test the dialysate at the MLA’s by using a sterile10cc syringe connected to the MLA’s rather than using a “CLEAN CATCH” draw the fluid and squirt it into the test tube, then discard the syringe and use a new one for the next test. Use the port that you use to get the air out of the MLA’s.
To everyone using the pureflow. How do to get rid of used paks?
They have some weight to them. I have trash rules on weight.
thanks
bobO[/QUOTE]
Bob;
Try to make a deal with your center to have them discard the PAK’s in their trash…
You would have to take it with you to the center for your monthly check up.
I will be doing this…
I am confused??? It seems as though you are using MLA’s with the PureFlow. I connect the Pureflow directly to the cartridge (Green Clamp). we are using Cartridges CAR-171’s They do not come with MLA’s. It might be easier to test the dialysate at the MLA’s by using a sterile10cc syringe connected to the MLA’s rather than using a “CLEAN CATCH” draw the fluid and squirt it into the test tube, then discard the syringe and use a new one for the next test. Use the port that you use to get the air out of the MLA’s.
HemoHelper[/QUOTE]
Hemo Helper SORRY- I reallly ment the line that comes off the sak that we attach the Green to Green to (the dialysate)
Sorry.
Pat
Try to make a deal with your center to have them discard the PAK’s in their trash…
You would have to take it with you to the center for your monthly check up.
I will be doing this…
HemoHelper[/QUOTE]
HI HemoHelper
I was told that in no way to bring used paks back to center. They also have set limits on weight.I have three used pak set off to side of house.I guess I may have to pay extra.
Thanks HemoHelper