Howdy, I have a question for Nxstage users. I have not had a chance to contact Nxstage directly, hopefully i will be able to address that tomorrow. (4-9) Beginning tomorrow I will be doing dialysis at 4;30am. 5 days. I am wondering if anyone has any experience or knowledge of just how much I can set up the evening before. Do I do the complete set up in the morning, or is ther a point in the set up, prime cycle or program cycle that I can leave the machine and let it be until my designated run time? Any information you have would be greatly appreciated. Thank you
Theoretically, you can setup to the point of removing air from the lines and cartridge after the prime. However, the prime takes 18 minutes, and you still need to get your supplies ready, weigh yourself, get any meds like heparin ready and take your sitting and standing blood pressures. Quite frankly, when you get halfway proficient, all of that gets done within the 18 minutes it take to prime. With PureFlow, the setup even takes less time and I find myself waiting anywhere from 5-8 minutes before I can take out the air. If you’re using dialysate bags, you could hang the bags and saline the night before without any problem. It only takes about 3 minutes the connect the MLA to the dialysate bags and put in the warming bag. So it really doesn’t seem like you gain anything by priming the night before.
Rich Berkowitz
NxStage 2/06
In-center 3/03
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When we hung the bags too much ahead of time, we had the experience that the heaviness of the bags caused the plastic to tear through at the hole where they are hung. So, hang bags ahead of time at your own risk! It has been some time since this happened to us, so can’t remember how many hours the bags were hanging before they broke though. I love the idea of efficency in any way possible, but this did not work for us. You might ask NxStage if any other patients are hanging their bags the night before. You could also test it out and see how it works for you. It could be that there is a period of time that they will hold up, but will tear through if one goes beyond that point. NxStage is always changing the materials of various of the tx components, so the bags could be sturdier or less sturdy now. Also, can anyone answer pabblo’s question from the standpoint of aseptic technique. When we asked NxStage if it was ok to set up the day/night before, certain of their techs answered by saying, “It would be up to your training nurse/unit protocol”. That type of answer made us feel like it might not be a fully safe thing to do.
Pabblo;
We run nocturnal 6.5 hours 6 day/wk.
I do a partial set-up early in the evening (5-6 PM) and finish the set-up before I hook my partner on for her treatment (11:30 PM — Midnight and later if we have something happening)
I hang the dialysate bags and salline.
Then install the Warmer Disposable and thearpy MLA…
Attach the dialysate bags to the MLA.
Break the spikes in the dialysate bags.
Remove the air from the dialysate lines and heater.
Hang the waste line and attach one end into my drain…
At this time I also get ready my supplies for taking her off when the treatment is over…
She uses a cathater so:
fill flush syringe with saline
fill syringe with Heparin for her cathater.
end caps, tape, and other supplies needed.
When you wake up at 4 AM… You could turn on the System One, install the cartridge and spike the Priming spike into the saline. Turn the heater ON… While the machine is doing its 18 minute set-up you could be getting other things done…
I have also set-up the System completely… Just before hooking the patient up… Had to go out for an emergency… Machine is in state #23… Just turn OFF the machine and left for 6 hours… Came back turned the machine on and after a while pressed Treatment and machine did a few checks and returned to state #23… checked for and removed air from lines and continued with treatment… if you have a problem at this point you could do a reprime. Turn OFF the machine, locate the saline bag lower than the machine, Open the door, remove the cartridge and when the the saline is back in the bag turn on the machine install the cartridge, close the door, hang the saline bag, the press the fill button and let the system reprime…
Can’t figure why you would like to run at 4:30 AM… Think I would rather run in the evening and sleep in in the morning… anyway that is why doing your treatments at home makes the best use of your available time for dialysis…
HemoHelper
I solved the problem of the falling therapy bags by doing this. My cycler sits about 12 inches from the wall. I secured a perforated angle iron (about 3ft long, available at most hardware stores) to the wall using screws into the studs. Then I hung the bags from the angle iron using S hooks. Instead of using the hole in the middle at the top of the bag, I used the 2 holes at the corners. It works quite well, The bags are much easier to hang, and the machine is much less apt to meet a terrible death by crashing to the floor when being moved.
The machine can be set up as much as 12 hours(I think it is 12, I haven’t thought about this in a while) in advance. It isn’t going to automatically disintegrate at the 12 hour mark. It is just that they had to have a limit in order to get the process approved by FDA. It is my understanding that this is really to accomodate those people using this in an acute setting where you may want to set up in advance, then bring in the patient later.
I have set up the night before, get to where it is time to input the parameters and shut the machine off. Turn it back on the next morning, hit treatment key, then enter parameters. Then, hook up and hit treatment again. I do this occasionally the night before because we get up around 5:00 and start our treatments. It doesn’t really go any faster, I just don’t have to think as much when I first get up.
We also threaded all 3 holes in the bag onto the IV pole if I was setting up the night before (use pureflow now, so it doesn’t apply).
Hey
Yes you can set the machine up all the way, start up kit and take off kit. My time line is always changing . I was told that you can set up at least 48 hrs ahead of time. As for your bags I just double hook them on the ends of IV pole.
bob
[QUOTE=billable;13249]The machine can be set up as much as 12 hours(I think it is 12, I haven’t thought about this in a while) in advance. It isn’t going to automatically disintegrate at the 12 hour mark. It is just that they had to have a limit in order to get the process approved by FDA. It is my understanding that this is really to accomodate those people using this in an acute setting where you may want to set up in advance, then bring in the patient later.
I have set up the night before, get to where it is time to input the parameters and shut the machine off. Turn it back on the next morning, hit treatment key, then enter parameters. Then, hook up and hit treatment again. I do this occasionally the night before because we get up around 5:00 and start our treatments. It doesn’t really go any faster, I just don’t have to think as much when I first get up.
We also threaded all 3 holes in the bag onto the IV pole if I was setting up the night before (use pureflow now, so it doesn’t apply).[/QUOTE]
Don’t know why the NxStage techs told me to ask my trainer about the ok-ness of setting up the night before. Maybe the techs were just newly trained and didn’t know this info yet. I usually ask more than one to see if each one says the same thing. One told me it was ok and the others said check it out with your unit.
When completely setting up the tx hrs ahead of time, do you ever have to go through the snap tap air removal process again prior to getting on the tx?
[QUOTE=Jane;13256]Don’t know why the NxStage techs told me to ask my trainer about the ok-ness of setting up the night before. Maybe the techs were just newly trained and didn’t know this info yet. I usually ask more than one to see if each one says the same thing. One told me it was ok and the others said check it out with your unit.
When completely setting up the tx hrs ahead of time, do you ever have to go through the snap tap air removal process again prior to getting on the tx?[/QUOTE]
Jane
I’ve doing nxstage for just over a yr. . And as long as you do the whole set up , snap and tap etc. You are good to go. Once I set up the machine the night or day before I don’t even turn it off. Just do everything as if you were going on .
bob
[QUOTE=bobeleanor;13259]Jane
I’ve doing nxstage for just over a yr. . And as long as you do the whole set up , snap and tap etc. You are good to go. Once I set up the machine the night or day before I don’t even turn it off. Just do everything as if you were going on .
bob[/QUOTE]
Thanks for telling me this ,Bob. I was thrown off by conflicting info I got from techs. Incidentally, does it matter if the machine is unplugged following tx.? I prefer mine unplugged with fan noise off.
I see some conflicting information on this thread. I have been told that I can have the machine set-up 'til the priming ends up at #23. At that time I can turn the machine off and keep it that way for up to 24 hours. All you have to do is turn the machine back on, hit the treatment button and the machine will return to that #23 position. You still must snap and tap, put in your numbers etc. I have also been told (by tech support) that it is important to snap and tap just before you go on because air can get into the lines during that unattended time.
If you are concerned about the bags, hang them from both corners of the bag - one hole hanging cannot handle the weight for several hours.
That’s my understanding as well. Prime to 23 and before snap and tap.
Rich Berkowitz
NxStage 2/06
In-Center 3/03
Hi Folks
That is the Big problem in dialysis. I wanted and still do want the ISO to step and get the centers across the country to have one set of rules. I have left davita and started with a new company. And found , just like on this board that rules change from center to center. This makes things very bad for the consumers of medical serivces.
But the people who run this board don’t that every center should have the same gudes lines. I guess that why dialysis folks are treated the way they are? Where would we be with set strandards.
Ex. The waste line post that was on here , my first center rules one use and toss. No matter how clean you think you might get your waste line after using it the chance of germ growth is there. I was and still am 100% behind this and my new center had rules that said wash and reuse. I said thanks ,but no thanks.
Jane You can shut down at any time (unplug ) you just have to recall where you left off. If you stopped at 23 Then you pick up at 23. If you do your whole set up kits and all your set Like I was saying I’ve been for a yr. The first two weeks I had problems ,but since then the only problem I’ve had was time. I;m now in a center to do night time dialysis.
bob
Regarding Bob’s point of germ growth in the wasteline, what are others doing? Neither my trainer nor NxStage mentioned anything to me about germ growth in the wasteline and the necessity to change the line completely out each tx… I would change mine out every tx if an inadequately cleaned line presented a risk. What exactly is the risk?
Regarding unplugging the machine, I meant do others unplug after txs or do you keep it plugged in all the time with fan running? But also, it’s interesting to know that if the machine is completely or partially set for the next tx, the machine can be unplugged as long as one comes back to the point he left off at.
And though some are saying they’ve been told its not good to set up past the 23 and should only do the snap tap air removal just prior to getting on the machine due to possible air build-up, Bob says he’s done the whole set up way ahead of time many times with no problems. So, which is it?
Regarding standardized rules, I think that would be good if the rules were the best possible measures in the first place, but often the rules stink, so that’s when I want my staff or myself to be able to think/act outside of the box. There’s nothing worse than when the nurse/tech says, “But the rule says” when the rule is nothing but antiquated practice. But it would be nice if dialysis had a complete renovation and sensible protocols were put into place which would enhance the tx. rather then cheat the patients on true care.
Look in your system One user’s guide in section 4, page 10. At the bottom of the page, it tells you the procedure to use if you want to stop the machine and move it to another place. this is done after you get the “23” reading in the top window. They have this step prior to “snap and tap”, but I haven’t had any problem doing the snap and tap the night before.
Again, I was told that FDA approval is for up to 12 hours, but again, that is because that was the time tested in the clinical trials seeking approval. I am sure that the time it is safe to use after setup is much longer. However, I don’t know why you would set up much more than 12 hours in advance…
Thanks to everyone for you time and energy and willingness to help out. This is a wonderful place to get information and opinions. For the curious, I switched to 4 am runs to spend more time with my family. I have done evenings since last May and have missed plenty of good times. My wife was willing to put me on and then go back to bed (in the next room), and then about the time she normally got up to got work, she would take me off the machine. We made a flow sheet in MS Word that mirrors the one my center uses and I use the computer to record what she used to do by hand. In the three days so far we have done this we are pretty sure this is the way it will be for the near future. Thanks again. Paul
[quote=Jane;13245]When we hung the bags too much ahead of time, we had the experience that the heaviness of the bags caused the plastic to tear through at the hole where they are hung. So, hang bags ahead of time at your own risk! It has been some time since this happened to us, so can’t remember how many hours the bags were hanging before they broke though. I love the idea of efficency in any way possible, but this did not work for us. You might ask NxStage if any other patients are hanging their bags the night before. You could also test it out and see how it works for you. It
I had the problem, with bags failing but only when I didn’t hang both corners. Once I hung both corners no more problems. I believe you have 18 hours after your cartridge is primed before you have to prime another cartidge.
Erich
[QUOTE=Jane;13245]When we hung the bags too much ahead of time, we had the experience that the heaviness of the bags caused the plastic to tear through at the hole where they are hung.
Just loop through all 3 holes and this solves the problem. I do it and have had no problem. It is mentioned in the book.
Charles