My clinic is trying to get it’s home program up and running, and one of the snags we’re running into - not hugely, but I want to nip this now - is how the bicarb is handled for overnight runs.
The clinic’s guy in charge of water quality, Yuri, is trying to tell me I’ll have to get up in the middle of the night to switch the bicarb hose to a second jug because bicarb doesn’t come in big enough jugs. Later, when speaking to my husband about plumbing, Yuri told him that I should just do 3 hour treatments because the bicarb would be too much of a hassle. :?
Now I know this is all bull puckies but I don’t know what the answer is. Do you all get your bicarb premixed from somewhere in large jugs? Or do you mix your own in a large jug (which you got from where?), and do you have to disinfect the jug after each use (per Yuri)? :?:
I hope to be seeing my neph in clinic tomorrow and plan to tell him his water guy is trying to subvert this new home hemo program with bad, ignorant information. :evil:
Do you remember me saying how excited I was to be a part of this new program? Well, scratch that - these folks don’t know what they’re doing and it’s starting to seriously worry me! :shock:
I get my bicarb pre-mixed in an 8 litre jug. This is delivered to me along with the 4 litre acidified jugs. I can assure you that this easily lasts for a standard 8 hour treatment, and even for 9 hours if need be. Of course, this is for nocturnal which runs at the usual dialysate pump speed of 300.
Others in this forum have to mix theirs themselves, so, I’ll let them explain that to you.
Thanks Pierre! Does the bicarb jug need to be disinfected/sterilized?
No. I just open it and stick the bicarb wand into it. After the treatment, I simply empty what’s left of the bicarb into the drain. I throw the empty jugs in the plastic recycling bin.
Glad to hear you are very determined to not let this get on top of you.
Once again, down here in Aussie land we like to do things differently. We are supplied with bicarb in a “bibag” which we simply snap onto machine (hope pic is clear enough) below blue and red wands and it fills up with water during initial test. The 950g bag last way past 8 hours for Nocturnal. There is a smaller bag for shorter runs. As Pierre says 300ml flow rate for long runs.
Bags are supplied by Fresenius and bags are thrown out afterwards. Dialysis is not at all environmentally friendly which took me a while to get my head around!
We mix our own bicarb with RO water. The bicarb comes in a container like a milk carton only much smaller and it is mixed with 8 liters of RO water. To run 8 hrs. we use 1 carton plus 122 grams. with 9.5 liters of water. We rinse our bicarb jugs out each day and bleach them once a week then rinse. This will last 9 hrs.
When we first started we were given 2 jugs. We made 8 liters of bicarb in each jug by adding 1 carton of bicarb and RO water. Then we would pour the bicarb from 1 jug into the other jug to fill it up. this would last way over 9 hrs.
It would be nice if we could get premixed bicarb like Pierre, but our center won’t go for it because of the cost.
I am just guessing here why Yuri would tell you that. I wonder if they intend for you to use premixed bicarb but are supplying it in smaller containers than what Pierre uses?
My initial question to him had been whether we’d be using pre-mixed jugs or if I’d be mixing my own. That’s when he said we would use pre-mixed because otherwise I’d have to get up and mix the second batch in the middle of the night. Then he said I’d have to get up anyway to switch the hose to the second jug. When I suggested that I should just use a bigger jug, he got flustered and said he didn’t think I would want to/be able to check it for balance before and sterilize it after every use, and it’d be too heavy/too much work for me.
He doesn’t understand that the extra effort, though not as hard as he’s making it, will be worth it. Add in his encouragement that I do conventional instead, and he really just doesn’t get it.
Thanks guys - I’m printing your explanations to show to my nurse.
If I had to guess I’d say Yuri hasn’t factored in the lower dialysate flow rate used by nocturnal dialyzors.
Even if you figure in the 300 flow rate for nocturnal if you are mixing your own it will take over 1 jug to meet an 8hr treatment. The jug holds enough for more but you can only make 8 liters with 1 box of the mix. Thus you need to add more water and more mix either by measuring it out. Or mixing 2 full jugs and pouring some from one jug into another.
Up here in Maine, my husband does 8 hour nocturnal treatments. Once a month, Fresenius delivers supplies, including lots of premixed bicarb in 1 gallon jugs (4 jugs per box). We have a 5 gallon jug (furnished by Fresenius) inwhich we pour 5 gallons of bicarb. As Pierre said, that is more than enough for the 8 hr treatment.
Before each treatment, we empty the jug of any old bicarb, rinse it out with tap water, then rinse it out with purified water (from the water treatment system), and as we pour out the purified water, we test it with a residual clorine strip as a safety precaution. This is how we were trained.
Initially, we were told to clean the bicarb jug by adding a little bleach along with the tap water, before rinsing it out with the purified water. We don’t have to do that anymore (per our nurse). We were also furnished a 5 gal jug for the acid (it’s a red gasoline jug). We don’t rinse that one out, just keep adding acid as needed.
All those jugs must add up to be a pain in the neck for storage and mixing. Give me the 950g nice compact bibag to clip on any day, is it only the Freni that has the capacity to clip these on??
I think it must be Beachy. I went for a bone scan yesterday & met another guy, Ken & his wife, who were on training with me. I was talking about the bigger 950kg bibags for the longer dialysis & got a blank look. I forgot they don’t have them on the Gambro beasties.
It’s enough having to mix the 2 5liter A412s into the 10liter tank & then the potassium chloride, without fiddling with bicarb too!
are you saying you use 2 x 5 Part bottles per Nocturnal?? I don’t get it?? If you have the dialysate flow running at 300ml instead of 500ml then you shouldn’t be going through more than 5 litres. I always have a bit left from this bottle anyway to kill a few weeds in the morning.
Also can’t they change your Part A prescription to one with more potassium already in it. Mine is a No.2884 with 214.8g Sodium,Potassium 5.2g,Calcium 6.7g,Magnesium 3.6g, Glucose 34.7g. My nurse calls in “Dialysate Lite” as I wanted the one with less glucose! LOL
Man, your home hemo programs sure are making it hard for you guys. Me, take acid and bicarb jugs out of box. Take to machine. Put wands in. That’s all there is to it. When done treatment, pour leftover bicarb and acid in toilet. Here, even though we use Fresenius systems, the acid and bicarb jugs come from Baxter.
The only downside is that these boxes have to be stored, but it’s actually fewer boxes than PD patients get. Bicarb jugs are 8 litre, 2 to a box. Acidified is 4 litres, 4 to a box.
Of course, with home hemo, you never know when they might change things for budgetary and supplier reasons. So, I can only hope they don’t. I’m really excited because we just got new drain bags - Fresenius instead of Baxter
Also can’t they change your Part A prescription to one with more potassium already in it. Mine is a No.2884 with 214.8g Sodium,Potassium 5.2g,Calcium 6.7g,Magnesium 3.6g, Glucose 34.7g. My nurse calls in “Dialysate Lite” as I wanted the one with less glucose
We read where someone said that all the glucose in the solution could lead to diabetes. Anyone else up on this?
Think someone also said that it is possible to get glucose-free solution.
Pierre, What is a drain bag?
We do have it more time consuming than you when we have to deal with mixing the bicarb, rinsing jugs, backwashing and disinfecting our RO’s. Maybe if centers in the states handled things the way you do in Canada, NxStage wouldn’t be getting so much attention.
Back in the years between 1987-1999 I did home dialysis witha conventional dialysis machine…similiar to this one…only that it was the brown version…
All I remember from that time is how cumbersome it was maintaining it…I to used the manual bicarb mixing…rinsing it with tab water then with R.O. water…
Both the dialysis machine and R.O. was very noisy that you can even hear them with closed doors…
Even worse is that the dialysis machine did not have volumetric control so constant dryness was a problem…
Another thing was the disenfecting once a month with Formalydehyde…crazy stuff here…
Marty@ NxStage deserves the support, without it we the people would not see these great changes, transition towards whats coming ahead in the years. Its all about change. If you take a look at the history of dialysis on this site you will see what am talking about here…
I totally congratulate NxStage for pushing the envelope towards smaller, portable and easy hemodialysis.
But, I also think that the newer conventional dialysis machines have made great strides towards user friendliness and ease of use. Compare a Fresenius 2008K to some of the machines people were still using even as late as the 1990’s and you will see what I mean. Completely computerized controls and indicators, very logical touch screen controls panels, extremely precise ultrafiltation, etc. have made both in-centre and home hemodialysis much easier. If you can surf the web or you can successfully use word processing software, you can operate a modern dialysis machine, once you know how. It’s very straigthforward and uncomplicated today. Im sure the latest Baxter, Gambro and other machines are just as good. Aksys is also an attractive system. I’ve only been on hemodialysis since 2002, but having had kidney disease since 1977, I’ve seen what dialysis was like before.
To answer Marty’s question about drain bags…
This is a squarish clear plastic bag with two connectors at the bottom: one for the arterial line, and one for the venous line, each with its own clamp, plus a third clamp to close the bag. It hangs from the IV pole. When I prime the system with saline, about 800ml of saline ends up discarded into the drain bag (almost a whole 1 L saline bag). Then, after recirculation, just before putting the needles in to start treatment, I flush saline into the arterial segment for 5 seconds and then 200ml into the venous segment - both of which end up in the drain bag. This makes priming dead simple and it also serves to rinse the whole blood circuit with saline without having to dump anything. Once this is done and I’m ready to go to needles, I disconnect the arterial and venous lines from the drain bag and close each of them with a syringe needle, until I connect them to my needle lines.