I Hate Dialysis Message Board
Dialysis Discussion => Dialysis: Home Dialysis - NxStage Users => Topic started by: kporter85db on April 11, 2014, 07:08:19 PM
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I started using the System One S yesterday. It looks exactly the same as the System One except for the logo i n the upper left of the screen.
The really interesting thing is the new Pureflow SAC. My 50L SAC #406 has larger tubes, two inline filters arranged parallel to each other and an new return line from the chicken foot to the SAC.
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Are there any differences in the functionality so far? How fast do you run the dialysate? Do you FEEL any differences at higher speed dialysate? Anything at all you can tell us about your experiences would be interesting.
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From what I have heard from NxStage, there is no difference in the hardware. I was asking them in reference to changes to the pumps that might help the air issue.
I am interested in how Nx2Me works. they are rolling it out slowly. I think it will be a significant difference in setting up and monitoring the machine and treatment. Anyone using it yet?
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I am interested in how Nx2Me works. they are rolling it out slowly. I think it will be a significant difference in setting up and monitoring the machine and treatment. Anyone using it yet?
Nx2Me sounds like a more polished version of a systgem I wrote for my own use.
I started NxStage about 6 weeks ago, and the clinic I use is still working with paper logs. I wrote a web application to enter and store the data from the machine as well as my vitals, and the RN at my clinic grabs my logs from my web site - much easier than paper logs and the home support nurses get the data more quickly.
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There are two parts to Nx2me. One is automatic logging. The other is machine control. You can graph your pressures and make changes from your tablet. Not sure if there is a remote control component, not being supported, I can't get much information from NxStage.
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Are there any differences in the functionality so far? How fast do you run the dialysate? Do you FEEL any differences at higher speed dialysate? Anything at all you can tell us about your experiences would be interesting.
I finally had enough experience to answer these questions.
There is no real difference in functionality except for the obvious dialysate flow rate. Of course there are a few different programming parameters. One interesting but somewhat insignificant difference is that the default programmed value for the volume screen timeout is 60 seconds, the other machines I have had defaulted to 10 seconds.
We've been running the dialysate at 14.5 or so. I was using a 40 liter SAC running for a treatment time of around 3 1/2 hours 5 days a week. I am now using a 50 liter SAC running for a treatment time of 3 hours 4 days a week. The goal is to eventually go nocturnal four days a week or maybe EOD.
I don't feel anything different during dialysis and I feel physically the same on my shorter treatments as I did on my longer 5 day treatments.
I know it sounds crazy but going from 5 to 4 days a week I feel like I have doubled my free time. I look forward to doing nocturnal.
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Question: Can you run at low blood flow rates (example: 350 or 380) on the new S cycler? Or do you have to run at a higher BFR since you are doing more volume?? The reason I ask, is that we do home hemo using the System One cycler and we've just been told by our center that we might be getting the new S cycler and I don't know yet if we have to accept it or can tell the Neph that we just want to stay on the System One cycler...we don't want to have to use higher blood flow rates.
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Question: Can you run at low blood flow rates (example: 350 or 380) on the new S cycler? Or do you have to run at a higher BFR since you are doing more volume?? The reason I ask, is that we do home hemo using the System One cycler and we've just been told by our center that we might be getting the new S cycler and I don't know yet if we have to accept it or can tell the Neph that we just want to stay on the System One cycler...we don't want to have to use higher blood flow rates.
I would really love to be able to run 60 liters in a 4.5 hour session. However, at present, the 140 mmol saline levels are too high from me to increase the volume since that gives me a noticible salt load.
Baxter is promoting their new machine in Europe as "high dose." that is a direct reference to NxStage which has used their low volume system for years. I am not a fan of the NxStage low volume theory and from the beginning doubled my dose from 20-40 liters. The NxStage System One 1 shoudl be the standard option for all NxStage patients. We further need to abandon the standard of a weekly Kt/V of 2.0. The Baxter machine is not High Dose when compared to the in-center home machines and the Baby K. Only when compared to NxStage. It is an Achiles heel for NxStage and developing the System S I believe is in direct response to the Baxter machine.
You can access the NxStage calculator and review treatment options on this ap. The more the better is likely the best way to go.
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On a side note. With running a higher volume of dialysate, is your aluminum level high?
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I'm running a System One S machine as well. I run my distillate flow at 18 Lph and Blood flow at 420. I've notice no difference between this and the non "S" unit I was using I'm using the 405 SAK (40 liters), 6 days a week. I'm trying to switch to a bigger SAK so I can do it less days per week.
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I'm running a System One S machine as well. I run my distillate flow at 18 Lph and Blood flow at 420. I've notice no difference between this and the non "S" unit I was using I'm using the 405 SAK (40 liters), 6 days a week. I'm trying to switch to a bigger SAK so I can do it less days per week.
Why are you running your blood flow so fast? 420 really stuns the heart and can damage the fistula. Also at 18 LPH at 40 liters you are only dialyzing about 2 hours and 15 ,minutes? If that is true then you are really going very short on your time. Just my opinion but it seems a bit off.
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It had been suggested to me to go to 6 day's. The theory was that it would allow me less hours per day. For a number of reasons I chose not to go that route. I have however lowered my blood flow rate from 500 to 450. It added roughly 20 min to my treatment time. Given the opportunity I will drop it down to 400.
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Anybody have a Model S machine through a Davita At Home Clinic?
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Why are you running your blood flow so fast? 420 really stuns the heart and can damage the fistula. Also at 18 LPH at 40 liters you are only dialyzing about 2 hours and 15 ,minutes? If that is true then you are really going very short on your time. Just my opinion but it seems a bit off.
When I first got the "S" unit, it was shipped to my clinic (1st one my clinic had seen). So I started using in in-center so that we could all learn how to use it. 420 was the number my nurse was using when I was in-center, so I just keep using it. I've done 2 sets of labs since I've been on it and everything seems good.
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Why are you running your blood flow so fast? 420 really stuns the heart and can damage the fistula. Also at 18 LPH at 40 liters you are only dialyzing about 2 hours and 15 ,minutes? If that is true then you are really going very short on your time. Just my opinion but it seems a bit off.
When I first got the "S" unit, it was shipped to my clinic (1st one my clinic had seen). So I started using in in-center so that we could all learn how to use it. 420 was the number my nurse was using when I was in-center, so I just keep using it. I've done 2 sets of labs since I've been on it and everything seems good.
The problem with high blood flows is a LONG TERM problem that shows up later as you continue to stun the heart and flog the fistula . Its a "wear and tear" issue that in time causes a lot of damage. In Australia where they go far slower they dont see the fistula damage we see in the US. . Even my nephro talked about it the other day as some American docs are seeing the light. He talked about stunning the heart and LVH .
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The problem with high blood flows is a LONG TERM problem that shows up later as you continue to stun the heart and flog the fistula . Its a "wear and tear" issue that in time causes a lot of damage. In Australia where they go far slower they dont see the fistula damage we see in the US. . Even my nephro talked about it the other day as some American docs are seeing the light. He talked about stunning the heart and LVH .
I asked my nurse, and she said she wants me to run it a little higher than normal right now because my fistula is under developed. I had the fistula done in late Oct. then in Jan. my vascular surgeon moved the vein and brought it closer to the surface. But it's still a bit deep. We started canulation in April, and it is not easy to hit even by a nurse who has worked in dialysis for 30 years.
I played with the numbers today (on dialysis as I type) and the lowest I can run blood flow while at 18Lph is 400... and keeping the FF at 80 or lower.
PrimeTimer:
I checked at 350 - max 15.5 Lph, at 380 - max 17Lph... this is with FF80
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The problem with high blood flows is a LONG TERM problem that shows up later as you continue to stun the heart and flog the fistula . Its a "wear and tear" issue that in time causes a lot of damage. In Australia where they go far slower they dont see the fistula damage we see in the US. . Even my nephro talked about it the other day as some American docs are seeing the light. He talked about stunning the heart and LVH .
I asked my nurse, and she said she wants me to run it a little higher than normal right now because my fistula is under developed. I had the fistula done in late Oct. then in Jan. my vascular surgeon moved the vein and brought it closer to the surface. But it's still a bit deep. We started canulation in April, and it is not easy to hit even by a nurse who has worked in dialysis for 30 years.
I played with the numbers today (on dialysis as I type) and the lowest I can run blood flow while at 18Lph is 400... and keeping the FF at 80 or lower.
PrimeTimer:
I checked at 350 - max 15.5 Lph, at 380 - max 17Lph... this is with FF80
In your circumstance you are doing what the nurse asked for a specific reason, so obviously that is more important for now. Hopefully in the future it will mature the fistula and you can back off.
In terms of the FF, IT IS IRRELEVANT. It is a totally useless number created by Nxstage. Even the company is now backing off on it other than as a general guide. We just ignore it completely on ours. I set it to go up to 100 but run fron 40 to 70 at various times. All that matters on Nxstage is the volume of dialysate and the time on machine. We just go for 3.5 hours at 30 liters. It aveerages out to a dialysate speed of about 8.4 . I dont look at the FF.
I did a post on that earlier.
Time to Dump the Flow Fraction
« on: April 23, 2014, 12:08:43 PM »
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I was interviewed by some senior staff at Nxstage and they asked for any recommendations I had on their prescriptions. One recommendation I had was to dump the flow fraction forever . I told them it is a confusing concept and basically useless . I think they heard me and basically agreed.
What really matters on Nxstage is number one, the volume of dialysate . That is the most important part of the prescription and really determines how much dialysis you will obtain. The second most important part of the prescription in my opinion is the time on machine. The longer the better. I always try to run the dialysate speed slow enough to get at least 3.25 hours per treatment and some days go for 3.5 hours. This is in line with Dr. Agar's thinking of minimum of 17 hours per week or 10% of total time. (this is at 5 days per week). I dont care what the flow fraction is. I just set the dialysate speed to give me what ever time I decide on . The only other aspect of the prescription that is important is the blood speed. I will never go over 340 . Again I follow Dr. Agar and what he preaches about slower speeds . He is against going over 350 due to clear evidence increasing speed above 350 causes damage long term to the fistula and heart. There is just no reason ,on Nxstage especially, to go faster. Its the volume of dialysate and time on machine that give the proper clearances , not speeding up the blood.
The flow fraction is irrelevant and we just rest the backround setting on the machine to 100% max. flow fraction (you can even go higher) , so it is no longer a factor at all. I dont even look at it. It is a meaningless number.
I beleive in the future they will probably do away with the whole concept.
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I never knew anything about the FF on my original Nxstage machine, but when I got the new model I started getting all sorts of crazy error codes during treatment. When I called nxstage (during treatment) we adjusted my distillate and blood flow until the errors stopped. The Tech then told me that my FF was to high the way I was setting it up. /now I keep the FF under 80 and don't have any problems, if I make the FF closer to 90 I start getting errors again.
Not to argue or even disagree with you obsidianom, just sharing my experience. ;D
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Obsidionom, are you saying that FF can be totally ignored? In that case what would you recommend setting it at? 0?, 50, 80? It has to be set to something, so what?
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Obsidionom, are you saying that FF can be totally ignored? In that case what would you recommend setting it at? 0?, 50, 80? It has to be set to something, so what?
The FF is not really something you "set" it is a result of the setting of Blood Flow Rate and Distillate Flow Rate. So once you set those two the FF will be whatever it happens to be. So I believe Obsidionom is saying don't worry about the FF, worry more about the Blood and Distillate flows.
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I guess I wouldn't mind going a little longer each nite to do more volume but certainly wouldn't want to increase the blood flow rate any higher than 350-380 and work my husband's heart (and precious fistula) even harder than it's already being pumped at. So now I wonder if in order to do 30-40 liters of dialysate on the new S cycler if a patient will be forced to increase their blood flow rate just to keep up with the added volume and be able to complete their treatment in a reasonable time. Would not be good to have to stay up all hours of the nite doing dialysis...I believe they call that "nocturnal" and that is a whole other ballgame!
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I'm 43 with a wife, a 12 year old daughter, and a 7 year old son (at home). I can't imagine doing any longer on my machine than necessary.
1hr setup + 3 .5 hr dialysis + .5 hr cleanup X 6 days a week
+ misc. time dealing with supplies/boxes/appointments/ect
I never knew how time consuming it would be, and with two kids at home, I have very little spare time as it is.
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Pod,
I hear ya.
For the common issues you mention, I'm inching my way to doing nocturnal.
Gotta get my dear wife on board however LOL.
-Dan
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Obsidionom, are you saying that FF can be totally ignored? In that case what would you recommend setting it at? 0?, 50, 80? It has to be set to something, so what?
Yes, ignore it. We do. I just set it on the backround settings at 100 AND dont ever look at where it actually is during treatment. All that matters is volume od dialysate , time on machine and blood speed.
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I guess I wouldn't mind going a little longer each nite to do more volume but certainly wouldn't want to increase the blood flow rate any higher than 350-380 and work my husband's heart (and precious fistula) even harder than it's already being pumped at. So now I wonder if in order to do 30-40 liters of dialysate on the new S cycler if a patient will be forced to increase their blood flow rate just to keep up with the added volume and be able to complete their treatment in a reasonable time. Would not be good to have to stay up all hours of the nite doing dialysis...I believe they call that "nocturnal" and that is a whole other ballgame!
The blood speed has nothing to do with time on machine . The time is based solely on the amount of dialysate and the speed of the dialysate. I still advise blood speed of no more than 350 as per Dr. Agar and his writing on not flogging the fistula. If you want more volume dialysate you simply speed up the dialysate. PERIOD. we do 30 liters in 3.5 hours. That works out to about 8.5 liters per hour speed. If you want to go to 40 liters you could increase the dialysate speed to 12 liters per hour for example and that would take 3 hours and 20 minutes. The blood speed can stay the same always. We run 340 blood speed.
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I'm 43 with a wife, a 12 year old daughter, and a 7 year old son (at home). I can't imagine doing any longer on my machine than necessary.
1hr setup + 3 .5 hr dialysis + .5 hr cleanup X 6 days a week
+ misc. time dealing with supplies/boxes/appointments/ect
I never knew how time consuming it would be, and with two kids at home, I have very little spare time as it is.
I hear ya! And then there's inventory and ordering and deliveries and...lab days! I take my husbands labs for him and even spin them in a mini-centrifuge they gave us and then run them downtown to the center to ship out to the lab. There is definitely a lot to it but still, I think doing home hemo is better/safer/gentler and I know I can help make my husband more comfortable than the center can and of course, we get to dialyze at the hours of our choosing. Can't go without saying tho that I miss our old normal life we had. Still trying to adjust to this new life and it's no picnic.
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Why are you running your blood flow so fast? 420 really stuns the heart and can damage the fistula. Also at 18 LPH at 40 liters you are only dialyzing about 2 hours and 15 ,minutes? If that is true then you are really going very short on your time. Just my opinion but it seems a bit off.
When I first got the "S" unit, it was shipped to my clinic (1st one my clinic had seen). So I started using in in-center so that we could all learn how to use it. 420 was the number my nurse was using when I was in-center, so I just keep using it. I've done 2 sets of labs since I've been on it and everything seems good.
The Kt/V usage for dialysis in many ways is a unique American practice. The other developed nations recognize that middle molecule clearance, those molecules that are the true culprits of uremia, is much more important than urea, which is a small molecule easily cleared quickly. We know that TIME on dialysis is perhaps the most important element of dialysis despite the American academic nephrology's continued resistance to these concepts.
The proof is in the pudding as some say. We still have the worst outcomes in the entire world although it has creeped down slightly over the last few years, if you believe their statistics that is. Long and slow dialysis gives the best outcomes. Japan runs many at 250 ml/min and has the best survival in the world for dialysis patients.
I try to run at 350 at most. If I ever get the System S, I would run higher volumes at a lower blood flow rate. Short, fast dialysis is not a winning strategy in the race to live a normal lifespan.
http://www.hemodoc.info/2011/01/short-daily-dialysis-can-be-too-short.html
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In center it's turn the chair over as often as possible. Time is money.
For home hemo it's do it as cheaply as possible. Consumables cost money.
Money rules the world.
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If you are concerned about too much time devoted to dialysis, set the machine up for your desired sleeping time, start treatment, get in bed and let the machine serve as your alarm clock to get up in the morning. Nocturnal dialysis not only gives you superior results compared to any shorter schedule, but also takes the fewest waking hours out of your day. For most people, it works and is well worth a try…
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Nocturnal is only just getting a foothold in our area. Only one center is offering or going to offer it. I think they are still trying to recruit patients. For now it will be in center only.
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How do you keep the needles in your arm while sleeping? I sleep in my recliner during treatment sometimes, but if I move my arm to much, the Arterial and venal pressures go crazy.
I loved doing dialysis on my catheter.
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The pressure issue is the problem with me doing extended. My arm has to be exact angle, exact position or I get problems. Not conducive to a good night's sleep. Extended as not worked for me because of this, and with my current fistula and it's location, I don't believe that it ever will.
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We didn't ask for it but we are getting the new NxStage "S" Cycler in two weeks. We are being told that we will be using SAK's 402 for 30 Liter treatments, 5 days a week. (Right now on the System One Cycler we do 30 Liter treatments for approx 3.35 hours 5 days a week at a Blood Flow Rate of 350-380). We are being told that we can remain at a Blood Flow Rate of 350-380 and 30 Liters but that the new "S" cycler will run the volume of dialysate faster thus, shorter time on the machine (and according to others comments here, that seems to be true). BUT...I am still confused or rather, a little bit suspicious about the new cycler running dialysate faster without requiring the blood flow rate to also be adjusted to a "faster" rate to avoid alarms. Or, is this really true...faster dialysate rate but same slow blood flow rate?? By the way, of course, we do understand that more time on the machine means more dialysis and more dialysis is always better but that's a separate issue for us right now (husband has been getting very good labs with his current treatment plan).
Anyways, I can give NxStage a call but am hoping to hear from one of you first...your thoughts and/or answers or experience with the new "S" cycler. Thanks.
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You can run faster dialysate and get better clearance in a given amount of time, but probably less than if you run the same amount of dialysate slower. The real way to improve is to run the dialysate faster and use the extra time to allow for a larger Rx. If you simply increase the speed to lower the time, and do not increase your total dialysate volume, you are probably getting less effective treatment. There is some evidence to suggest that total time is very important, and you don't get a free lunch even though may have the same Kt/V running the solution at a higher speed.
One catch - the faster rates are supported only by the PureFlow. You will need an Rx than runs at a slower rate for your "bag contingency plan".
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We didn't ask for it but we are getting the new NxStage "S" Cycler in two weeks. We are being told that we will be using SAK's 402 for 30 Liter treatments, 5 days a week. (Right now on the System One Cycler we do 30 Liter treatments for approx 3.35 hours 5 days a week at a Blood Flow Rate of 350-380). We are being told that we can remain at a Blood Flow Rate of 350-380 and 30 Liters but that the new "S" cycler will run the volume of dialysate faster thus, shorter time on the machine (and according to others comments here, that seems to be true). BUT...I am still confused or rather, a little bit suspicious about the new cycler running dialysate faster without requiring the blood flow rate to also be adjusted to a "faster" rate to avoid alarms. Or, is this really true...faster dialysate rate but same slow blood flow rate?? By the way, of course, we do understand that more time on the machine means more dialysis and more dialysis is always better but that's a separate issue for us right now (husband has been getting very good labs with his current treatment plan).
Anyways, I can give NxStage a call but am hoping to hear from one of you first...your thoughts and/or answers or experience with the new "S" cycler. Thanks.
If you are doing well with current prescription , why change anything. Just use the new machine at the same settings as the old one. Going faster with the same volume dialysate gains nothing and probably loses some effectiveness.
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You can run faster dialysate and get better clearance in a given amount of time, but probably less than if you run the same amount of dialysate slower. The real way to improve is to run the dialysate faster and use the extra time to allow for a larger Rx. If you simply increase the speed to lower the time, and do not increase your total dialysate volume, you are probably getting less effective treatment. There is some evidence to suggest that total time is very important, and you don't get a free lunch even though may have the same Kt/V running the solution at a higher speed.
One catch - the faster rates are supported only by the PureFlow. You will need an Rx than runs at a slower rate for your "bag contingency plan".
Simon Dog: Interesting you mentioned Kt/V may end up being the same on the new S Cycler. My husband spent 5 days in the hospital last month for a staph infection and so was only dialyzed twice there that week (compared to our 5 x week schedule at home) and we just got his labs for last month; his Kt/V shows an "improvement" of 2.24. The month before that (with no infections/hospitalizations) was 1.96. Weird... Thanks for the tip about bags because I was just about to call and ask NxStage why they aren't sending us new bags with the new SAK's to use for their new S Cycler. Gee, I am sooo glad that our clinic alerted us about all this (not)!
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We didn't ask for it but we are getting the new NxStage "S" Cycler in two weeks. We are being told that we will be using SAK's 402 for 30 Liter treatments, 5 days a week. (Right now on the System One Cycler we do 30 Liter treatments for approx 3.35 hours 5 days a week at a Blood Flow Rate of 350-380). We are being told that we can remain at a Blood Flow Rate of 350-380 and 30 Liters but that the new "S" cycler will run the volume of dialysate faster thus, shorter time on the machine (and according to others comments here, that seems to be true). BUT...I am still confused or rather, a little bit suspicious about the new cycler running dialysate faster without requiring the blood flow rate to also be adjusted to a "faster" rate to avoid alarms. Or, is this really true...faster dialysate rate but same slow blood flow rate?? By the way, of course, we do understand that more time on the machine means more dialysis and more dialysis is always better but that's a separate issue for us right now (husband has been getting very good labs with his current treatment plan).
Anyways, I can give NxStage a call but am hoping to hear from one of you first...your thoughts and/or answers or experience with the new "S" cycler. Thanks.
If you are doing well with current prescription , why change anything. Just use the new machine at the same settings as the old one. Going faster with the same volume dialysate gains nothing and probably loses some effectiveness.
obsidianom: We didn't ask for the new cycler. I only found out that we are getting it because a courier happened to call to say he had a delivery for us. Since we already received our monthly inventory, I called the courier to ask what exactly he would be delivering. He said the boxes read "SAK 402" on them. That prompted me to call NxStage and sure enough, they said we would be getting the new S cycler and it requires the new SAK's. So then...that prompted me to call our clinic and sure enough, it was "oops, we meant to tell you". Needless to say, I am disappointed in our clinic for not discussing this with us ahead of time so that WE could make an informed decision. The nurse said the new cycler might shorten the treatment time so that it might take off some of the burden since we dialyze my husband after work (we are up til late at nite). Well, this all sounds wonderful but not if it's going to affect my husbands health! I have so many questions and of course, we will have to wait to see how his labs turn out after 30 days but I agree with you, shorter treatment time means only that; shorter treatment time. Does not necessarily equate to "better" dialysis. I already know we do not want to even attempt 4xweek. Anyways, after I made some phonecalls, delivery of the new cycler and SAK's won't be for 2 more weeks. We live in a small apartment and since we just got our monthly inventory... well...
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Well I have to say, I have been on the "S" u it since the beginning of May. So that is 2 months worth of labs on the new machine that I can compare with the old machine. The "S" machine seems slightly more effective than the old machine. And I am running the same basic prescription, only with faster distillate and bloodflow rates
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Labs are basically useless in this case. Kt/V is a useless number as it measures urea clearance and by now we all should know that is useless. I reality there is no one test for adaquacy for dialysis. Yes we measure phosphorus and potassium etc. . The real toxins are not easily measured. So labs are not a great measure of dialysis adaquacy. Urea is easily cleared and is not really toxic.
In the end we have to go by clinical feel as much as anything. To truly test the adaquacy would require much more sophisticated tests and cost.
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Prime timer, the other issue is your dialysate. You are using only 30 liters. My tiny wife who weighs 55 kilos uses 30 liters. So unless your husband is that small, I am betting you are not using enough volume. That may explain the numbers. My wifes Kt/V (for all its worth) is over 3.0. That is with 5 days on nxstage at 3.5 hours , blood speed 340. Anyone bigger than my wife should be on higher volume, especially males.
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Prime timer, the other issue is your dialysate. You are using only 30 liters. My tiny wife who weighs 55 kilos uses 30 liters. So unless your husband is that small, I am betting you are not using enough volume. That may explain the numbers. My wifes Kt/V (for all its worth) is over 3.0. That is with 5 days on nxstage at 3.5 hours , blood speed 340. Anyone bigger than my wife should be on higher volume, especially males.
My husband is 56 yrs old, 6 feet tall, dry weight 100 kg, Type II Diabetes with Stage 5 ESRD. Perhaps you and Simon Dog's suggestion to use any time we uh, "save" on the new S cycler to put towards actually doing more treatment. For example, right now we run 3.35-3.50 hours. If on the new S cycler we end up finishing 30 liters in 2.50 hours, maybe we could increase his volume to 40 liters and run 3.50 hours (and of course, stay on the 5xweekly schedule). It will be interesting. Right now, on our current treatment plan he is feeling good and able to work fulltime. He says he feels his best right after treatment but we finish late at nite so usually just unwind watching tv or reading and then off to bed. But he's able to be up early in the morning for work and he's very active. He says he really doesn't want to do more than 4 hours of treatment at a time because it's awfully hard for him to sit that long in his recliner and I can certainly understand that.
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You are WAY under treating him. I ran your numbers and conservatively you are low.
I cant give direct advice but if it were me at his size I would either do 40 liters at 11.4 liters per hour (old system machine) for 3.5 hours or on the high speed machine 50 liters at 3 hours , speed 16.7 liters per hour.
So with the high speed machine I can cut half hour off time and add dialysate to get good treatment.
Bottom line, 30 liters is way to little dialysate. That is why you saw the numbers better on the bigger hospital machine.
If my tiny wife uses 30 liters , a large male should be WAY more.
CHECK THE ONLINE CALCULATOR and talk to your team about this.You can do better now
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You don't need a system S to run 40 liters in 4 hours. I run that since 2009 on the regular System One right now.
I would like to go to a higher dialysate, but the sodium levels are too high for me in the dialysate and I get a salt load whenever I go to 45 liters which I also have done on the regular System One. In fact, I ran 47 liters once in about the same time as the 40 liters with an FF of 55%.
If you have the System S, it can go up to 18 Liters per hour. Running it at 15 liters per hour, you could easily do 60 liters in 4 hours. That will come close to approximating in-center machine clearances. That was my goal but the sodium levels are simply too high.
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You don't need a system S to run 40 liters in 4 hours. I run that since 2009 on the regular System One right now.
I would like to go to a higher dialysate, but the sodium levels are too high for me in the dialysate and I get a salt load whenever I go to 45 liters which I also have done on the regular System One. In fact, I ran 47 liters once in about the same time as the 40 liters with an FF of 55%.
If you have the System S, it can go up to 18 Liters per hour. Running it at 15 liters per hour, you could easily do 60 liters in 4 hours. That will come close to approximating in-center machine clearances. That was my goal but the sodium levels are simply too high.
Hemodoc: You bring up sodium levels. This concerns me as my husband has high blood pressure. He does 30 liter treatments right now and we are being told that he will continue doing 30 liter treatments on the new S Cycler. But...if we do more volume to get better dialysis (for instance, 40-45 liter treatments), then if I understand correctly, this would mean he would be getting more sodium (in addition to more aluminum) if we stay with the Pureflow SAK's? Or does the issue of increased sodium apply to the pre-mixed bags as well? This whole issue surrounding aluminum levels (and now sodium) is pretty scary and I would hate for my husband to have to go back to doing in-center just because we couldn't handle continuously hanging 30 or more liters of bags every day.
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Dear Prime Timer,
Both Pureflow SAKS and the Bags have 140 mmol of sodium. My Plasma, or blood sodium runs around 135 which means I get an increase of salt with each treatment. For me, going too 45 liters was a bit too much.
140 mmol may be tolerated by you at 40 liters, not sure how you handle sodium.
Not sure why you would stay at 30 liter treatments. Are they going to run it faster? Reducing time is not a good survival strategy and is a uniquely American strategy. Other nations use longer sessions and have better outcomes.
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I am hoping this week to have some answers on the sodium issue. We tested my wife pre and post dialysis for sodium. I should have the results Tuesday. It will be interesting to see if her sodium rises during dialysis. My wife is the perfect test case for Nxstage as she is on a formula diet and intakes the exact same nutrients and electrolytes daily. Nxstage asked me to test her and we did it.
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I want to write that everyone should look seriously at whether they are on the correct dose of dialysate. With the new speedier system S it is possible to get a higher dose of dialysate at same times as lower dose at slower speeds.
Nxstage has informed me that i am the person that they found has used the on line calculator MORE THAN ANYONE . PERIOD. I actually had a long conferance call with the person who designed the calculator . He asked for my input. So I have a lot of knowledge of the system.
I will add that when i do any calculations, including for my wife I do it with a Kt/V of 3.0. I dont buy the lower numbers as good enough. I wont settle for less than this for my wife and we are getting it consistantly with the calculator and on blood work.
As I have written numerous times , my wife uses 30 liters , 5 times per week and she is only 55 kg. (tiny).
I ran numbers for me at 77kg and 5ft 6 in. I am small male. I found my numbers came to 40 liters at 3hr 50 min or 50 liters at 3 hour 10 min.
I also ran the same numbers for a female of the same size. A woman requires less dialysate due to less muscle mass.
With all this , I have studied the calculator and I dont think any decent size male should be below 40 liters and many of you should be at 50 liter s, at 5 days per week. Women should be at 30 to 40 liters. With the new faster machine you can get these volumes at same time as lesser volumes by running the same blood speed(I use 340) and speeding up the dialysate.
I beleive many of you out there are under treating. Check the on line calculator or have your team run numbers for you. Dont settle for a kt/v of 2.5 . That is barely adaquate dialysis. More dialysate gives better clearances and health. We saw a big improvement in my wife when we went from 20 to 30 liters. Time on machine is still important but volume is most important.
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obsidianom, you do realize that the average person does not have access to the nxstage dosing calculator. You must be a licensed RN or MD to get access.
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Have your doctor or nurse run the numbers for you. Its easy and takes a minute. Its worth doing it.
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When the registration for the dosing calc. asks for your "medical number" put your phone # in. It worked for me.
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I never knew anything about the FF on my original Nxstage machine, but when I got the new model I started getting all sorts of crazy error codes during treatment. When I called nxstage (during treatment) we adjusted my distillate and blood flow until the errors stopped. The Tech then told me that my FF was to high the way I was setting it up. /now I keep the FF under 80 and don't have any problems, if I make the FF closer to 90 I start getting errors again.
Not to argue or even disagree with you obsidianom, just sharing my experience. ;D
Pod99966: Are the alarms on the new "S" cycler the same as the alarms on the System One? For example, does the "S" cycler have a "Red Alarm 11" and does it mean the same thing as getting a "Red Alarm 11" on the System One? Or is there a whole other set of alarms that come with the new manual that we will have to learn? Thanks in advance.
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yes the alarms are the same... from what I've seen so far.
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In my discussion with NxStage about the differences between the two machines, the only difference is the dialysate flow and volume. Everything else is identical.
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yes the alarms are the same... from what I've seen so far.
Thanks, Pod and Speedy. The nurse that will be coming to help set it up and train us here at home is new at this too, so I am preparing a list of items/questions to bring up with her before she heads over. For instance, don't forget the manual or any pieces/parts! Would be a real bummer...
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One bit of trivia - the higher flow rates on the 1S can only be used with the Pure Flow, not bags. I don't know if this is because of flow rate or greater total volume.
It means patients using the higher flow rates need a "bag friendly" Rx as well in case they have to fall back to bags due to Pure Flow problems.
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I have used the 1S with bags at max flow. But shhhhhhh, it's a secret.
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I have used the 1S with bags at max flow. But shhhhhhh, it's a secret.
:bump;
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One bit of trivia - the higher flow rates on the 1S can only be used with the Pure Flow, not bags. I don't know if this is because of flow rate or greater total volume.
It means patients using the higher flow rates need a "bag friendly" Rx as well in case they have to fall back to bags due to Pure Flow problems.
Thanks for the trivia. I think... :stressed;
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I have used the 1S with bags at max flow. But shhhhhhh, it's a secret.
Thanks. I got the info regarding "pure flow only" with high flow on the 1S from NxStage phone support.
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Trauma and drama...
Ok, we've been using the new S cycler for the past 3 nites now and...pretty much runs the same as the System One cycler did. Has a few new settings to enter upon setup but the manual walks you through them. By the way, anyone else on the new S receive a new Ultrafiltration Chart to help you decide how much/how little fluid to remove and what the setting should be set at accordingly?? I love the old chart our nurse gave us for the System One so I hope they will be giving us one for the new S when they tell us what my husbands new prescription will be. Some nites we take more off, some nites less. Having the chart helps, as I do not want to have to log onto the computer every nite to look it up. I'd rather keep a chart handy with our treatment sheets. My husband was prescribed the new SAK 402's but until those arrive, NxStage said we can continue using SAK 302 but...at the same lower speeds that we had used on the System One. Everything seems to be going okay except that I notice that about halfway thru a treatment, we get a "New" Yellow Caution 53 alarm telling us "Low Fluid Temp". No action required. What's interesting, is that our Pureflow heater is set at 13 (quite warm) and because of 100 degree weather, it's been 78 degrees inside our apartment, even with the air conditioner on! So why the new S cycler is telling us the fluid temp is too low when we are sweating indoors, I don't understand. But, we only get the YC53 once and it goes away and nothing else becomes of it. So far, everything seems to be running smoothly on it, with the exception that right from the get go tonite, he had very high venous pressure 290 and we were still only at a blood flow rate of 200! It didn't alarm but nonetheless, that is quite high for him. We suspect his fistula is acting up again. Was not an easy needle stick tonite. He had an angioplasty 3 weeks ago and we are feeling the same signs/symptoms as before, so off we go to the vascular surgeon tomorrow! We tried to run him as long as we could tonite, staying at a Blood Flow Rate of 200 but when the venous pressure got up to 322, I said "enough" and made the decision to do early rinseback and get him off the machine. I did not want to end up with cascading Red Alarms and risk losing the whole circuit of blood, the man has enough to worry about (and so do I!). So, won't be surprised if he needs another angioplasty tomorrow but then maybe we'll get to come home and get back to singing the praises of doing home hemo again by tomorrow nite. We shall see...
As for other things with the S cycler, altho trivial, I don't like the "Troubleshooting" section in the new manual. It lists all the different kinds of alarms (red or yellow) and possible triggers and remedies but not as easy to understand or (in my opinion) as thorough as the alarms section in the old manual for the System One, so be careful when you get alarms. Don't just rely on the old manual.
As for not using bags at the new higher flow rates/volume on the S cycler, my guess is that this is a safety issue (I think the manual discusses it) and that they want the dialysate to be allowed to pass thru a warmer and actually be warmed up to a certain temp to avoid dangerous effects to the tubing, the dialyzer and membrane and to avoid hypothermia and hemolysis to the blood. If the fluid is passing thru at a fast rate, it probably doesn't have a chance to be warmed up to a safe temp rushing thru a warmer bag or warmer, altho I wonder if a person could use bags that they know are already very warm from a source other than the warmer before hanging them. ??? Anyways, guess if we ever have to use bags, we will go at the slower rates/lower volumes. As for going at higher rates/more volume using the Pureflow, this will all hinge on the results of my husband's aluminum level. I cringe at the thought, I do not want my husband being poisoned. However, hanging 6-8 bags each treatment might also not be doable for us, either. I would not mind having to make a new batch/SAK every nite and going a little longer to do more volume but regularly hanging that many bags would hurt me and I am already living with pain 24/7 without meds. But I do not want my husband experiencing the ill-toxic effects of aluminum poisoning! Dang! Just when you think something wonderful, really wonderful has been invented, it all comes crashing down! It is so worrysome and scary. But I think everything about kidney disease and doing dialysis is worrisome and scary. Hard to stay focused without letting it scare the bee-jeezuz out of ya!
Meanwhile, if anyone else is getting high venous pressures and YC53 alarms on the new S, I'd be curious to know.
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Trauma and drama...
Ok, we've been using the new S cycler for the past 3 nites now and...pretty much runs the same as the System One cycler did. Has a few new settings to enter upon setup but the manual walks you through them. By the way, anyone else on the new S receive a new Ultrafiltration Chart to help you decide how much/how little fluid to remove and what the setting should be set at accordingly?? I love the old chart our nurse gave us for the System One so I hope they will be giving us one for the new S when they tell us what my husbands new prescription will be. Some nites we take more off, some nites less. Having the chart helps, as I do not want to have to log onto the computer every nite to look it up. I'd rather keep a chart handy with our treatment sheets. My husband was prescribed the new SAK 402's but until those arrive, NxStage said we can continue using SAK 302 but...at the same lower speeds that we had used on the System One. Everything seems to be going okay except that I notice that about halfway thru a treatment, we get a "New" Yellow Caution 53 alarm telling us "Low Fluid Temp". No action required. What's interesting, is that our Pureflow heater is set at 13 (quite warm) and because of 100 degree weather, it's been 78 degrees inside our apartment, even with the air conditioner on! So why the new S cycler is telling us the fluid temp is too low when we are sweating indoors, I don't understand. But, we only get the YC53 once and it goes away and nothing else becomes of it. So far, everything seems to be running smoothly on it, with the exception that right from the get go tonite, he had very high venous pressure 290 and we were still only at a blood flow rate of 200! It didn't alarm but nonetheless, that is quite high for him. We suspect his fistula is acting up again. Was not an easy needle stick tonite. He had an angioplasty 3 weeks ago and we are feeling the same signs/symptoms as before, so off we go to the vascular surgeon tomorrow! We tried to run him as long as we could tonite, staying at a Blood Flow Rate of 200 but when the venous pressure got up to 322, I said "enough" and made the decision to do early rinseback and get him off the machine. I did not want to end up with cascading Red Alarms and risk losing the whole circuit of blood, the man has enough to worry about (and so do I!). So, won't be surprised if he needs another angioplasty tomorrow but then maybe we'll get to come home and get back to singing the praises of doing home hemo again by tomorrow nite. We shall see...
As for other things with the S cycler, altho trivial, I don't like the "Troubleshooting" section in the new manual. It lists all the different kinds of alarms (red or yellow) and possible triggers and remedies but not as easy to understand or (in my opinion) as thorough as the alarms section in the old manual for the System One, so be careful when you get alarms. Don't just rely on the old manual.
As for not using bags at the new higher flow rates/volume on the S cycler, my guess is that this is a safety issue (I think the manual discusses it) and that they want the dialysate to be allowed to pass thru a warmer and actually be warmed up to a certain temp to avoid dangerous effects to the tubing, the dialyzer and membrane and to avoid hypothermia and hemolysis to the blood. If the fluid is passing thru at a fast rate, it probably doesn't have a chance to be warmed up to a safe temp rushing thru a warmer bag or warmer, altho I wonder if a person could use bags that they know are already very warm from a source other than the warmer before hanging them. ??? Anyways, guess if we ever have to use bags, we will go at the slower rates/lower volumes. As for going at higher rates/more volume using the Pureflow, this will all hinge on the results of my husband's aluminum level. I cringe at the thought, I do not want my husband being poisoned. However, hanging 6-8 bags each treatment might also not be doable for us, either. I would not mind having to make a new batch/SAK every nite and going a little longer to do more volume but regularly hanging that many bags would hurt me and I am already living with pain 24/7 without meds. But I do not want my husband experiencing the ill-toxic effects of aluminum poisoning! Dang! Just when you think something wonderful, really wonderful has been invented, it all comes crashing down! It is so worrysome and scary. But I think everything about kidney disease and doing dialysis is worrisome and scary. Hard to stay focused without letting it scare the bee-jeezuz out of ya!
Meanwhile, if anyone else is getting high venous pressures and YC53 alarms on the new S, I'd be curious to know.
I havent bought into all the hysteria here about aluminum yet. We are still using the pureflow. I am not convinced there is a big issue anymore with aluminum. We will moniter my wife monthly for now. We are drinking filtered water now as our well is quite high in aluminum.
The hanging bags were not really designed for every day use at the high numbers we do now ( 6 to 8 per treatment) . When the system was designed they were doing much lower levels of dialysate , like 20 liters rather then the 30 to 40 or more we now do. So they came up with pureflow to increase the dialysate volume ability over the hanging bags. It is much more efficient with pureflow. The heating is better also. Now everone is in an uproar over the aluminum and trying to use the bags at high volumes and hanging 6 to 8 bags. To me thats NUTS. Doing it every day will wear out people . It also creates issues with storage and trash. I just dont like it and at this point wont do it. I think this is an over reaction .
Has anyone realy been harmed significantly by the aluminum? I still havent been convinced . I am not saying it wasnt an isue as it shouldnt have ever happened. I still want to moniter nxstage carefully , and moniter my wifes aluminum. But Icant imagine hanging 6 or more bags every day . no way.
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In regards to the new Yellow Caution 53 "Low Fluid Temp" Alarm: I haven't talked to NxStage about this yet but I think I've figured out this new mysterious Yellow Caution 53 "Low Fluid Temp" alarm. During a 3.50 treatment, it seems to occur almost exactly halfway thru treatment AND...when we are using the last 30 liters of a 60 liter SAK. I've noticed that we don't get the alarm during treatment when first using a new batch of a 60L SAK, so I am guessing that as we use up dialysate from the SAK, the new S cycler senses a change in temp. By the way, our Pureflow Heater setting is at 13 and our thermostat indoors is about 75% F, so it's fairly warm indoors. The other day when we got the YC53, we were also down to our last 30L of a SAK and the indoor temp was 78% F. And yet, when we started using a new batch at a full 60 liters, our indoor temp in the living room and the Pureflow Heater setting were the same as before (setting 13, thermostat 75-78% F) but no YC53 occurred.
Just an fyi: We are still using SAK 302's on the new S cycler and per NxStage, that is okay so long as we stay at the lower flow/volume rates we were using when we had the System One. We have the new SAK 402's to be used at higher volume/flow rates but waiting on the Neph to give my husband his new prescription (time, volume, rates, etc). Also still waiting for his aluminum level to be tested, which they assured us would be performed at his next appt.
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In regards to the new Yellow Caution 53 "Low Fluid Temp" Alarm: I haven't talked to NxStage about this yet but I think I've figured out this new mysterious Yellow Caution 53 "Low Fluid Temp" alarm. During a 3.50 treatment, it seems to occur almost exactly halfway thru treatment AND...when we are using the last 30 liters of a 60 liter SAK. I've noticed that we don't get the alarm during treatment when first using a new batch of a 60L SAK, so I am guessing that as we use up dialysate from the SAK, the new S cycler senses a change in temp. By the way, our Pureflow Heater setting is at 13 and our thermostat indoors is about 75% F, so it's fairly warm indoors. The other day when we got the YC53, we were also down to our last 30L of a SAK and the indoor temp was 78% F. And yet, when we started using a new batch at a full 60 liters, our indoor temp in the living room and the Pureflow Heater setting were the same as before (setting 13, thermostat 75-78% F) but no YC53 occurred.
Just an fyi: We are still using SAK 302's on the new S cycler and per NxStage, that is okay so long as we stay at the lower flow/volume rates we were using when we had the System One. We have the new SAK 402's to be used at higher volume/flow rates but waiting on the Neph to give my husband his new prescription (time, volume, rates, etc). Also still waiting for his aluminum level to be tested, which they assured us would be performed at his next appt.
The air temp in the room may be warm at 75 but remeber the body core and blood temp is about 99 , so there is quite a bit of warming to the fluid.
AS the volume drops there is more effect of heat loss then in a larger volume . We run our setting at 18 and never have a problem.
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In regards to the new Yellow Caution 53 "Low Fluid Temp" Alarm: I haven't talked to NxStage about this yet but I think I've figured out this new mysterious Yellow Caution 53 "Low Fluid Temp" alarm. During a 3.50 treatment, it seems to occur almost exactly halfway thru treatment AND...when we are using the last 30 liters of a 60 liter SAK. I've noticed that we don't get the alarm during treatment when first using a new batch of a 60L SAK, so I am guessing that as we use up dialysate from the SAK, the new S cycler senses a change in temp. By the way, our Pureflow Heater setting is at 13 and our thermostat indoors is about 75% F, so it's fairly warm indoors. The other day when we got the YC53, we were also down to our last 30L of a SAK and the indoor temp was 78% F. And yet, when we started using a new batch at a full 60 liters, our indoor temp in the living room and the Pureflow Heater setting were the same as before (setting 13, thermostat 75-78% F) but no YC53 occurred.
Just an fyi: We are still using SAK 302's on the new S cycler and per NxStage, that is okay so long as we stay at the lower flow/volume rates we were using when we had the System One. We have the new SAK 402's to be used at higher volume/flow rates but waiting on the Neph to give my husband his new prescription (time, volume, rates, etc). Also still waiting for his aluminum level to be tested, which they assured us would be performed at his next appt.
The air temp in the room may be warm at 75 but remeber the body core and blood temp is about 99 , so there is quite a bit of warming to the fluid.
AS the volume drops there is more effect of heat loss then in a larger volume . We run our setting at 18 and never have a problem.
Ahh! Makes perfect sense now! Thanks for the info, obsidianom! I was thinking the drop in volume during treatment had something to do with it but didn't consider how NxStage might have figured in average body temp as well. Needless to say, we bumped up the heater temp on the Pureflow now.
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A couple of updates: You were definitely right about temp, obsidianom. We bumped up our Pureflow Heater setting just one notch from a 13 to a 14 and...no more YC53 alarms! Meanwhile, we are still waiting for my husband's "new prescription" from the Neph for the new S cycler. At his appt yesterday, he was told that as soon as we use up the rest of the SAK 302's that we have and are ready to start using the 402's (that they already had NxStage deliver to us), they will let us know what his new "volume/time/rates" will be. In other words, I don't think they know.
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Are there any differences in the functionality so far? How fast do you run the dialysate? Do you FEEL any differences at higher speed dialysate? Anything at all you can tell us about your experiences would be interesting.
I finally had enough experience to answer these questions.
There is no real difference in functionality except for the obvious dialysate flow rate. Of course there are a few different programming parameters. One interesting but somewhat insignificant difference is that the default programmed value for the volume screen timeout is 60 seconds, the other machines I have had defaulted to 10 seconds.
We've been running the dialysate at 14.5 or so. I was using a 40 liter SAC running for a treatment time of around 3 1/2 hours 5 days a week. I am now using a 50 liter SAC running for a treatment time of 3 hours 4 days a week. The goal is to eventually go nocturnal four days a week or maybe EOD.
I don't feel anything different during dialysis and I feel physically the same on my shorter treatments as I did on my longer 5 day treatments.
I know it sounds crazy but going from 5 to 4 days a week I feel like I have doubled my free time. I look forward to doing nocturnal.
Just wondering how you were getting along with the new S Cycler. Hope it's continuing to go well for you and that you're getting good labs and feeling well. My husband will be starting on 402 SAK's pretty soon, at which time his Neph will be giving him his new prescription (rate, volume, etc).
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Anyone else using the new System One "S" cycler? Just wondering how people are liking it and their thoughts or experiences on it. We are using it but not necessarily at the higher rates/higher volumes. We are still going at a low flow fraction (42-44) for 30 liter treatments just a tad bit faster (3:15 hour treatments versus 3:50 hour treatments) at a blood flow rate of 350-380. We think going slower and longer was/is better.
Even tho we aren't going much faster, my husband's blood pressure started becoming a little unpredictable. Sometimes high during treatment to suddenly very low and needing to get off the machine. As the carepartner, I've learned how to make necessary adjustments during treatment to deal with high/low blood pressure and pulse rates but seems ever since we started on the S cycler, his BP has been all over the map. Of course, there could be other factors that are affecting his BP so we aren't ruling those out, either.
Anyways, we were given a chart with the old cycler to calculate and estimate UF rates/treatment time based on dry weight and amount of fluid needing to be removed but no chart for the S cycler. I know I can call NxStage about it but I think if they do have a new chart, it will probably be for the higher rates/higher volumes, which is not what we want. So, I've been keeping a journal and kind of creating my own chart as we learn what rates work for my husband and which rates don't, meaning that I keep track of what rates we were using when his BP acted strangely, as well as tracking what rates were in effect when the dialysate "zeroed out" and finished versus when the UF goal was met. I try to get both the dialysate and UF goal to zero out/finish at the same time, if not very close or within a few minutes of each other. As for the new SAK's (we use SAK 402, which is the equivalent of the 302's except that the 402's can be used at higher rates), the added dialysate line and tubing is a bit clunkier/fatter/stiffer and not as easy for me to handle in my hands but like anything new, I am getting use to it. Overall, we like the new S cycler but would have been just as happy to have kept the old cycler. I'm not complaining in fact, we are grateful to be able to be doing home-hemo. I think like with anything else, we were starting to get comfortable with the old cycler when suddenly we were given the new S cycler and it kind of threw us off a bit. But overall, my husband is still doing/feeling good and his labs still look good, altho at longer treatment times, the amount of blood liters processed (BLP) was closer to 80-81 and now at 71-75. Not much difference but after reading up on what Australia's Dr. Agar says, time and frequency DO matter.
Thanks for letting me post such a long one. I hope anyone else using the S cycler will post about their own experience on it.