There are several methods of blood return. Which method were you trained to use in your home program? Which method do you feel is safest and most efficient?
As usual, this depends on the machine you use. You do what you are trained, and if you think there might be a better way you discuss it with your center and get their thoughts.
Although you are at home, it is important that you do as you are trained. You really don’t want to ruin it for others in the future.
Cathy
new NxStage user, getting my machine home Tuesday or Wednesday and able to walk in a little before 10 and leave by 2:15 and do a full dialysis, set up and clean up!! Numbers so far have been fine, get new pre and posts tomorrow. Ioh and getting muscles from lifting all the dialysate bags, can’t say I don’t exercise now lol)
Also happily having normal b/p and heartrates for the last 4 days, hoping that it stays this way!!
Cathy, Should would appreciate it if you would keep us informed. I would like to know how you feel about doing 6x a week instead of what you were doing on the Freni. Also would like to know if you feel any different or the same.
Hey, that’s great to hear!.. 
Btw, if you were given 6x a week and miss a day during that week you can do the 5th day longer…just add another BAG and adjust the machine to run longer…
I’m trying to understand the advantages, truly I am…
Cathy, you say “walk in a little before 10 and leave by 2:15 and do a full dialysis, set up and clean up”. Unless I can’t tell time, that’s 4 hours and 15 minutes. It doesn’t seem like that much of a time saving at first glance. What do you mean by a “full dialysis”?
Other than skipping getting the water supply and R/O ready (which doesn’t take that long anyway), what did you do with the Fresenius that you don’t do with the NxStage? It must still have to prime its blood circuit somehow, and it must go through some kind of test cycle, doesn’t it? It’s still plastic tubing and a dialyzer, so it must need some kind of recirculation, if only to ensure that no air bubbles remain? I don’t know, I’ve never seen one.
Pierre
Pierre,
I don’t know alot about the NxStage as I don’t use one either. On of the NxStage Trainers told me it was 18 minutes to test and prime.
Speaking for myself. It’s not just the time involved in actually doing something with the Fresenius it’s the time involved “thinking” about what needs to be done. Your setup is somewhat easier than mine, I believe. But I have to think about when I am going to draw the RO water to make bicarb. I have to think about changing the acid clean to heat disinfect. I have to think about backwashing the salt tank, I have to think about changing filters. I have to think about the rejection rate of the RO. I have to think about which day is chemical rinse. I have to think about what day I am going to do an acid, base and minnecare clean of the RO (good 4 hrs.) nothing but pushing buttons and I can do other things during cycles but I am still thinking about dialysis duties.
I think what appeals to me about the NxStage is that once you are off the machine there is nothing else to “think” about relating to dialysis until the next treatment time. No cleaning cycles, no ro, no filters, no backwashes, no acid jug to fill, no bicarb to make no water to test.
None of these tasks are that time consuming and yes you can do other things it’s not the tasks that bother me it’s the constant thinking is tomorrow chemcial rinse, 3rd Sat of month clean the RO, is it time to change the filters, is it time to do a backwash. So rather I am doing something or not I am still thinking a day or even a week ahead as to when I have to do something.
Our home unit is planning on starting a “daily” program on the Fresenius Machine instead of NxStage and I think they are crazy. (If you don’t consider the cost)
As Cathy’s post shows she already has 4 hrs in and the treatment is over now she can get away from dialysis. Our Fresni patients will be acid cleaning, heat cleaning or chemical rinse. Changing filters, backwashing,
RO mainteance no it’s not a big deal and you can do other things but you can’t stop thinking about things until there done. Sure I can do an acid clean and go in the kitchen to make breakfast but I can’t forget I have to do the heat disinfect next.
The couple of reason I stay with the nocturnal and Frensenius are:
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I don’t have to run dad 6 treatments a week so we do get a couple of days off.
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He doesn’t have to watch his diet or fluid at all.
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For me the time I was there while he was actually dialyzing would be a waste. Sleeping isn’t I have to do it and I can do it as easily at his house as I can my own.
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Dad also prefers to sleep through his dialysis time and he can do that when dialysis time is bed time.
I’ll be honest I don’t think too many patients will sign up for or stick with a daily program with the Fresenius hopefully they will get the program started and time will tell.
I’m not advocating for either machine here. I’m just stating my opinion on why I think the NxStage has the advantage over the Fresenius and why for us nocturnal has it over daily.
Hi Marty
Your stuff is definitely way more involved than what I have to do. Maybe that’s why i have difficulty seeing what the attraction of NxStage is other than tranportability. As I said before, my acidified and bicarbonate jugs are just sitting there in boxes, and I only have to take the jugs out and bring them to the machine (not much different than hanging big dialysate bags if you ask me - and it may actually be simpler - just unscrew the cap and plop the wands in). My acid for acid clean is just plain table vinegar that comes delivered in 5 litres jugs (4 per month). When one is done, I just open a new one. I don’t have to backwash anything, I have no filters to change, etc. Once a week , every dialysis machine in the city gets a chemical rinse instead of a heat disinfect (which isn’t much different than a regular heat disinfect, since the Alcavis is just sitting there in a little container on the side of the machine - and it only needs to be replenished by pouring in fresh Alcavis to the fill line ever few weeks), and once a week on the off-day, the R/O gets disinfected (On mine, this is so simple I won’t bore you with the details. It takes less than 5 minutes).
I think that if home dialysis providers did a better job at simplifying things for their patients, it wouldn’t matter as much what machine is used. I think there’s plenty of room for simplification even with existing systems. For me, it seems like there isn’t that much outside of the actual dialysis. When I hear your description, I can understand how you would be attracted to a simpler system.
Pierre
The set up you have Pierre is much easier, bicarb mixing takes time because you need to use r/o water and can’t pull it until right before your treatment. There are definitely easier r/o systems than the Zyzatec, but that is the one I have and to be honest I hate it.
I don’t save that much time getting ready, but it is much more relaxing, everything I have to do is done in just a few minutes.
The beauty is two fold (for me three), one: I can get “away” from the machine in about 10 minutes after end of treatment. I clot extremely quickly and as long as I don’t do anything with my arm I can get up and move around. There is no requirement to do anything with the machine then. I can easily wait til the next morning (if I run at night) or a couple of hours and then clean up and hang bags for the next run.
Two: IT IS PORTABLE, I can travel. This is very important to me and I have my first trip already planned for spring break.
Three: For me, I get to run faster so my treatments are shorter. For whatever reason my pressures are MUCH lower on NxStage. Supposedly their lines are “smoother” giving less resistance, all I know is that my pressures at a 450 bfr are 140-200, while on the Fresenius they were 180-200 at a 350 bfr.
For me the lack of the r/o and the maintenance it required and the extra tests and time to get the r/o water for the bicarb, just pleases me. Maybe in 18 months I will be sick and tired of the NxStage, but that is life.
I don’t know why my b/p and heartrate is so much better this week, but we are talking SUBSTANTIAL changes right now, and that makes me feel better. I am also sleeping much better but that may have to do with daytime runs vs. nighttime, so I can’t attribute that to the NxStage yet. I will keep everyone posted (whether you like it or not lol!!).
Cathy
Pierre, I think your right they could simplify things for us. I used a timer this morning and timed how long it was before I was free. Acid Clean was 18 min and 26 seconds. During which time I bleached the machine the stands I use and wiped off my heparin bottles and betadine. I immediately went into heat disinfect it now 25 min and 51 sec. During the 6 min of heat disinfect before I can draw RO water I made the bed and got out the acid to fill my acid jug. We have to put acid into a jug for the machine and a jug for cleaning. Our acid comes in 1 gal. jugs. Now I can use the RO water. I rinsed the trays I use for needles etc. the cup on the side of the machine the prime runs in. and
my bicarb jug. It is now 30 minutes if I were to rinse the bicarb jug twice which I usually do it would be 37 minutes. This does not include the time it takes to get off the machine (I figure that would be the same either machine). Now sometime today I will go back and backwash my water softener. If tonight were not my night off, I would also run the RO sometime this afternoon for at least 5 minutes then fill the bicarb jug 7minutes then test the water for hardness and chlorine. 15 minutes total.
I don’t fill the jug with RO water right before treatment because if I do the water is so cold the bicarb takes forever to mix. We were told bicarb can’t be used after 24 hrs. so about 1:00 I draw the water at about 4:00 I put in the bicarb and shake the jug periodically to make sure the bicarb is mixed. At about 7:30 I start the setup. Maybe if they run the daily program with the premixed bicarb patients won’t find it such a hassle, I doubt they will get much break on the water maintenance. Do you have a water softerner, carbon tank, or a 5 micron filter before your setup? In all honesty if for some reason I had to go to short daily, I would stay with our current unit and drive the 550 miles once a month and use NxStage rather than drive 200 miles round trip once a month and continue with the Fresenius.
The NxStage sounds great and I can see how Pierre’s set up works well for him. Yes, home patients need a system that is functional and not over-stressing. We want to get those txs done and not be thinking about it every minute of the day or tied to endless duties. So, if the machine companies are listening…and I’m sure they realize these things and are working on it.
Would appreciate it if others could answer my orignal question that began this thread about blood return and what method you use.
Jane, Are you a dialysis patient or someone who as a caregiver is interested in giving home dialysis txs? I would guess that you are otherwise I can’t imagine why you would be interested in hearing about blood return from home pts… I only know how blood is returned on the FMC machines. I’m interested because I hope to do hd at home, but with the Nxstage machine. Lin.
Pierre, Also our Fresenius machine gets a quarterly inspection. I don’t necessarily have to be there when it done but the guy does like it if I am just in case he has a question or needs something. When the machine has a breakdown it’s not a big deal but I’m am tied to being home waiting for the call to set up a day and time for him to come to repair the machine then the time spent while he is there. Doesn’t happen often but it does happen. With NxStage just call and get another machine sent. Throw in a couple of RO leaks. Or a RO repair which requires a minne-care clean before I can use it again and more time. Yes, I handle all this and on a scale from 1 to 10 I would rate the hassle about a 3, 4 on somedays. The work I do about 1. As Cathy said she can get “away”. The saving grace for me is that I don’t feel as though I spend any actual dialysis time because we’re sleeping and I get more (days nights) off than those on daily. I can’t imagine daily patients putting in the dialysis time and all this other stuff and sticking with it without burn-out. Hopefully our home center will use the RO you use and the Bicarb and Acid setup you have. If your running at a flow rate of 300 how long does your bicarb and acid last? Can you get an 8 hr. treatment?
Lin writes:
Jane, Are you a dialysis patient or someone who as a caregiver is interested in giving home dialysis txs? I would guess that you are otherwise I can’t imagine why you would be interested in hearing about blood return from home pts… I only know how blood is returned on the FMC machines. I’m interested because I hope to do hd at home, but with the Nxstage machine. Lin.
I am a patient just like you who has waited a long time to get into a home program (asked every doctor I had, but all said no) and will finally be given the opportunity to enter a home program soon! I am interested in tx. techniques, because I have observed that in-center staff perform tx techniques in a variety of ways. For ex., on the FR, I have seen techs return blood about 3-4 different ways. That has made me wonder which technique is best. May be that one style is better/safer than others (i.e. not opening system). So, I am just wondering what methods of blood return patients are trained to use at home and if it varies from machine to machine or even unit to unit?
In-center I have always stood my ground to be a partner in my care and been respected for it as in staff supporting my tx choices. As a future home patient, I plan to do the same. Of course, I don’t just demand things…I have always talked over my choices with my docs and gotten their ok.
Yes, running the dialysate at 300 as we do here for nocturnal, there’s plenty of dialysate to last 8 hours. I’ve done it many, many times. There’s some to spare, but 8 hours is about the practical limit. After the treatment, I just pour what’s left out into the toilet and later, when I’m going down to the ground floor anyway, I dispose of the jugs in my apartment building’s plastic recycling bin.
Everything I have to do for all this is a breeze when I think back about my 2-1/2 years on conventional hemo in-centre, and even my 3-4 months on short daily. The way I feel now is like night and day compared to that. I can’t envisage any circumstance where I would willingly and permanently switch to short daily as opposed to daily nocturnal… and that’s just talking 2 hour short daily treatments, not the conventional length daily treatments many people on this forum seem to do. Now that would really burn me out if I had to spend 3-4 hours on dialysis day after day. I’m glad Bill and others can do what they want, but I just know I couldn’t handle that - there’s just no way.
The ability to do car or RV travel is undeniably a big attraction with the NxStage. I have no money to travel anyway, but even if I did, I wouldn’t be prepared to give up nocturnal hemo just for that. As it is, I can easily be satisfied with day trips or even the occasional weekend in say, Montreal or Toronto, or even a night in New York city, no problem at all. I could even fly somewhere if I wanted to for an overnight stay. In better days, travel to me used to mean far, but I’ve grown to appreciate what we have reasonably close-by, like the Thousand Islands, Lake Placid, etc. And then there’s still the ability to arrange for in-centre dialysis somewhere else. Spending a couple of weeks somewhere on vacation and doing 3 treatments a week during that time is something that I could easily handle for short stints like that. I think it might even be easier to do that than to lug a 70 lb dialysis machine and its supplies around.
The big difference between you and I, Marty, is that I’m doing this for myself. Much as I admire you for committing to that for you father, it’s a different perspective. You are really about as full-blown a caregiver as can be. That’s hard, and I think there’s potential for burnout over the long run. I think that in that situation, as the caregiver, I would be looking for a vacation from home dialysis completely every once in a while. Do you ever get a break with your Dad going in centre for say a week? You’re a saint, and I really mean that, but even saints need a break every now and then.
Pierre
Pierre writes:
Everything I have to do for all this is a breeze when I think back about my 2-1/2 years on conventional hemo in-centre, and even my 3-4 months on short daily. The way I feel now is like night and day compared to that. I can’t envisage any circumstance where I would willingly and permanently switch to short daily as opposed to daily nocturnal… and that’s just talking 2 hour short daily treatments, not the conventional length daily treatments many people on this forum seem to do. Now that would really burn me out if I had to spend 3-4 hours on dialysis day after day. I’m glad Bill and others can do what they want, but I just know I couldn’t handle that - there’s just no way.
From everything you’ve written, Pierre, about your metamorphosis from in-center dialysis to SDD, and finally nocturnal, I really identify with your opinion. It goes to show that ppl are very different as to what type of tx they are comfortable with. I hope to experiment with both SDD and nocturnal, but the way you describe nocturnal, nocturnal and it’s benefits appeals to me far more than any other other arrangement. I love the idea of having at leaste 6 out of 7 days free to live my life sleeping only when I would normally be sleeping anyway. I can happily live with that. I think I would get burnt out from the other type arrangements, too.
Pierre writes:
The ability to do car or RV travel is undeniably a big attraction with the NxStage. I have no money to travel anyway, but even if I did, I wouldn’t be prepared to give up nocturnal hemo just for that. As it is, I can easily be satisfied with day trips or even the occasional weekend in say, Montreal or Toronto, or even a night in New York city, no problem at all. I could even fly somewhere if I wanted to for an overnight stay. In better days, travel to me used to mean far, but I’ve grown to appreciate what we have reasonably close-by, like the Thousand Islands, Lake Placid, etc. And then there’s still the ability to arrange for in-centre dialysis somewhere else. Spending a couple of weeks somewhere on vacation and doing 3 treatments a week during that time is something that I could easily handle for short stints like that. I think it might even be easier to do that than to lug a 70 lb dialysis machine and its supplies around.
I will be so happy just to be able to return to a normal diet and experience better energy, I could care less about travel. Like you, I can find more than enough fun things to do right around where I live. Again, I understand that everyone has different needs in this respect. I have done plenty of travelling in my lifetime, so it is not a pressing need I have. But the NxStage is great for ppl who want to travel or visit family if they don’t mind lugging the 70 lbs and supplies. In this country, Pierre, one never knows what he is going to find when he travels to another unit, so lugging the 70 lbs is a good alternative unless one can somehow verify that the unit one will use in his travels is a good one.
Pierre, I have never taken a break and won’t. My dad is 82 and doing so well I couldn’t put him through in-center treatments just so I could take a break. Besides this is what a break means. It means having someone run the RO everyday and some one cleaning the Fresenius every other day. I am not in anyway prepared to give up nocturnal and even though it sounds as though I am complaining, I’m not. We do live quite nicely with the way things are. The time I spend with both my mother and father the nights we run dialysis are a blessing. I am sure the day will come when I will be extremely greatful we had the time together. Time I might not have taken if it weren’t for the responsibility I take. I just am concerned about this because our home unit is going to start a “daily” program with the Fresenius and I really can’t see that. I’m not really even involved as I won’t switch from nocturnal. I was just thinking of the patients who might get into a daily program.
Glad we had this discussion though, when I go back for clinic visit I’m going to hit them up on getting us premixed bicarb. I’ll be trying a RO in April similar to yours in that you only squirt something in it once a week. See if that changes my thoughts on RO’s.
Don’t be surprised if I ask you questions again on down the road. If our home center asks for input when they start the daily program with the Fresenius I’m going to gear them toward premixed bicarb and probably ask you questions to see if what your doing is easier.
Here’s another thing. You bleach once a week. We started out bleaching once a week but patients had bad cultures so they switched it to 2 times a
week. Now mind you 2 years and I never had a bad culture but I should follow the rules. By the way do you minne-care your Fresenius machine any time to make sure there isn’t any bacteria growing in the water line to the machine? We never used to do this either and I never had a bad machine culture but because some patients did they added this to the list.
Now if you really want the best machine it’s called “Marty” rather you do daily or nocturnal you just walk in hold out your arm and when it’s done your done no set up time or anything else. (Just Kidding)
Jane I think you’ll get an answer to the rinseback question when you specify the machine your talking about and how you do it so we have something to compare with.
Jane, I’m glad we’ve both finally will be able to give it a whirl! I’ve been in two units now using both Braun and FMCK machines and return was pretty much done the same way. It seemed in the first unit that it varied slightly depending on who was taking care of things. In the unit I’m at now they squeeze the saline bag, but that to me is not a big difference. I’m curious too on what method home pts. use on different machines, or is it all the same? When will you start training and will you have to travel far? I guess we’ll both find out how blood is properly returned when we go through training. Good luck to you. Lin.
I can well understand your preference, and that the NxStage would not be an improvement in your situation. Good for you! 
But, my husband has been self-employed for almost 30 years. His business requires him to travel, sometimes to be gone for a month. Unless he can get a NxStage, he cannot work. The director at the unit in Atlanta has assured us that one week’s notice will be sufficient to get us there for training on the NxStage. With 15% function, and extreme fatigue, it will probably not be long. He has not worked since last October and he hates being “homebound” – he loves his work.
My husband has worked full time since he was in high school. He graduated from high school but didn’t go to college because he was already making a lot more more money that most of his teachers – unfortunately he was in a profession which was much like being a buggy whip maker when Ford started his assembly line – so in hindsight he should have gone to college. 
When he started his current business it was also quite profitable, but again it is a business which is now in it’s declining years. We couldn’t sell it for a plugged nickel, but he can still make a good living, as long as he is able to travel. As you can imagine we see the timing of a “portable dialysis machine” as nothing short of a miraculous coincidence – my husband will probably be starting dialysis on a NxStage less than 2 years after they became available and will be able to go back to work – still making $$$ and loving what he does.
That was me above – maybe I’ll be logged in this time.