An interesting treatment session last night...

[HubbysPartner]

Last night it seemed like nothing was going right for treatment.  My hubby got the machine all primed and ready, I helped him to get on the machine and as soon as we started, we got all kinds of alarms.  There was so much air in the line that you could see it every foot or so.  It was a good thing we hadn't gone too far, because I couldn't rinse him back with all the air in the line.     At least there wasn't much blood in there yet so he didn't lose much.  So.....we started all over again with a new cartridge and waited for it to prime again.  I spent a lot of time making sure the dialyzer and lines were bubble free and we got started again.  At least he was already cannulated so he didn't have to go through that again.  Then about 2 1/2 hours into treatment, one of my biggest fears happened....but it wasn't bad at all.  My husband has a very sensitive gastro system and has numerous bouts of times where he is in and out of the bathroom.  So far we haven't had to do a temporary disconnect, but last night was the first.  I have been dreading it, but it turned out not to be so bad.  Anyway, it seemed like it took forever, but we finally finished treatment around 9:30.  I gained a lot of experience last night.  I think I will be collecting those little connectors in case he has a bad night and needs to disconnect more than once.   

[petey]

I have learned so much more through first-hand experience with NxStage than if I had just read it in that book!  Sorry you had to go through it, but it's not all bad -- at least you know how easy it is to do next time!

[Malibu]

Thank you very much for posting this.  I have been fearing the same thing you have:  the emergency bathroom trip.  So you just put the recirculator on and waited for him?  How long was the recirculator on?  We were told no more than 2 minutes but thought if you injected some saline in just before disconnecting then you might could go a bit longer. 

[rocker]

Yeah....we've never had to do a temporary disconnect and frankly, the thought of it terrifies me.  I've done a recirc once (and I can't remember why...), I think it was a very short time and I connected the lines directly together.  The nurse told me later that there was a way to recirculate through the saline bag to thin the blood down.  She said "It makes the saline bag look horrible and bloody as hell, but you're going to put it back anyway."

If I needed a temporary disconnect, I would be on the phone to the nurse on call in a very very very big hurry.

  - rocker

[HubbysPartner]

Malibu, Rocker, I could feel the dread in the pit of my stomach, but I called my trainer and he told me to stop the pump, then take the little connector that is hooked to the saline line (the one you put on the large syringe you use to flush the waste line, but obviously, a new sterile one) and connect the two blood lines to it.  You will need to unclip the two white saline lines and then start the pump.  That will keep the blood circulating so it doesn't clot.  I think he told me you can run that for up to 20 minutes.  Luckily it didn't take that long.  Also, make sure you rinse back the access lines with saline before you head to the bathroom so you don't clot them.  It worked fine.  I did reduce the pump speed, though, while the two lines were hooked together. Also, make sure you reclip the white saline lines before you start the pump again after reconnecting yourself or you partner.  It was a much easier process than what is described in the book.  So I will be collecting those little connectors and keeping them in a nice clean plastic bag so I have plenty when I need them!

[willowtreewren]

Our clinic gave me a supply of plastic wrapped connectors to use in an emergency. You may want to ask about those. While the "Mr. Peanut" should be sterile, I would prefer the plastic wrapped ones.

You'll have more adventures. I managed to pray the wall with blood just last week after connecting the arterial line to the saline bag for rinse back. I always snap the line to make any little bubbles go up into the saline bag before doing the rinseback. Argh! I hadn't tightened the luer lock well enough. Fortunately I was holing the arterial line with one hand so it was not contaminated when it came loose!

The important thing is to just keep learning! 

Every time we make a big boo boo, we learn not to do THAT again!

It mostly only happens now when we are really, really tired after a week of 10-hour work days. 

Aleta

[Malibu]

The nurse did give me 5 or 6 of the recirculators to take home.  You leave the saline open the whole time the lines are connected to the recirculator?  That would work keeping them unclotted.  When we were in training our nurse did the hook the lines up to the bag thing like rocker said.  I did not like that and the recirulator method I think would be much better.  MM says he does not think any saline will go into the lines like this because there is no more room for any more liquid in the lines like when there is when they are connected to your body.  What do you guys think about this?  Hubbyspartner, did you see how much saline was used?  Thank you Thank you for this post!

[HubbysPartner]

To tell you the truth, I didn't notice any saline being used, but we weren't on the recirculator long.  Yes, you keep the saline line open the whole time you are recirculating.  I think that just a tiny bit of saline would be used, because the machine wants to still take off fluid if you're not done doing that, so the saline would replace any fluid taken off so the blood doesn't thicken and clot.