Yellow 21 Alarm

[vcarmody]

Merry Christmas everyone.  I am doing my husband treatment and we are getting a yellow 21 alarm periodically.  I have done the manual bolus, no clots, no problems with needles position, I can not figure out why it is going off.  It goes off and then clears itself without intervention.  I called Nxstage and they basically said the same thing the book says but sense I can not seem to find a problem they said we should be fine.  Has anyone else every had this problem?  It is only a yellow alarm, it alarms once then clears, only once did it ding more then one time.  Any insight on why this is happening would be great, thanks!!

[looneytunes]

VC, we also have had this yellow 21 with a single ding for no apparent reason.  In talking with a couple of folks who have a lot of experience on NxStage, it sounds like all machines have their own personalities and quirks and this may be just one of yours.  If it is a yellow alarm, it should clear itself.  If it continues to trouble you, you might call NxStage and request they change out your machine.  We are on our 2nd cycler and I can attest to the differing personality theory.  This one is much quieter than our first and we get a lot of red 11 alarms that clear out on their own with no apparent reason. 

[tyefly]

Some days I get those too.....    yellow # 21.....    it comes on and off and on and off...flashing.....   there is nothing going on....  So What works for me is that I turn the pump off    ( hit the stop button ) and start it again......  usually only have to do this once and the 21 doesnt come back on.......   

[Bill Peckham]

What's happening is that the V pressure is outside of the range that the machine sets when you first settled in.

Let's say your V pressure is 200 and you settle in so the machine brackets 200 with a range - this is a machine setting so it can vary - normally something like +/-30 and then because you relax, put your feet up  and lean back you V goes below the bottom of the range. It alarms, you sit up and it goes away because you're back in range.

If it happens again, don't sit up, stay relaxed and decrease the blood pump speed 10 and then increase it 10. This will cause the machine to reestablish the brackets (same as turning it off). With the new brackets around your more relaxed V it could go out of the top of the bracket if you sit up but again just reestablish a new range.

If it recurs a couple times you start looking at needle position and do the bolus.

[vcarmody]

Thank you all for your help. We never had this alarm and have not gotten it again sense that treatment.  My husband and I love his Nxstage machine and will do our best to keep it as long as possible. We used another machine at the center and that one was so temperament it alarmed constantly. The couple that machine belong to gave up doing Nxstage and it was probably partly to do with that machine.  Our machine hardly ever alarms.... knocking on wood.

[tyefly]

  thx  Bill ... I didnt know that.... I was wondering now that I have slowed my speed....  I fall into the lower range all the time....hate the alarms.... nice to have a fix....  so that I can sleep all night.....   

[lillinny]

Yes!!!!  About the last month it happens continually!  It will clear itself and reappear in another few minutes.  If I stop the machine and restart, it tends to go away and not come back.  Glad to know we aren't the only ones.

[greg10]

Thanks for the useful info as usual, Bill.

Newbie here.  We have not gotten this alarm but I am wondering if you can fix this by changing the cycler system setting:
#41  TMP and VP High Alarm Delay: Time delay for high venous pressure (VP) or transmemebrane pressure (TMP) to alarm
Units sec
Resolution 0.1
Range 0.1 to 3.0

Is it possible that transient spikes in VP due to the structure of the individual's fistula can cause this alarm and by slightly relaxing the time to alarm, it may be possible to lessen the number of false alarms.

For information on how to change this startup system setting, go to your Appendix A in your NxStage System One User's Guide.

When vcarmody posted that some cyclers are more temperamental, I wonder if some of the system settings are not optimized for the patient and/or material and method of dialysis.