Air pockets...ugghh

[Mike_NC]

This may have been talked about before but I was wondering if anyone doing PD has had any issues with getting air pockets. For the last 5 days I have done my regular routine and then woke up only to have the aggravating and sometimes excruciating pain of an air pocket. It always migrates to my right shoulder after I sit up. I'm using the Liberty cycler ( which I still despise in comparison to the Baxter cycler). It was suggested by my nurse that I could have a bad box of cassettes so I opened a new case only to have the same problem. I called Fresenius tech support and told them of the problem and will be receiving a new cycler this afternoon. I believe this is the 6th Liberty cycler I've had since being switched from Baxter back in Feb 2011...I've actually lost count. In the 3+ years on Baxter I had only 2 machines and the first was only replaced due to a software upgrade, not any sort of problems. Anyway, back to the topic at hand ( Sorry, I tend to rant when it comes to the Baxter vs Liberty topic) ........So, anyone else ever dealt with this problem of air pockets? 

[Willis]

I use the Baxter cycler so it's hard to compare. But on my current prescription I wind up using almost exactly the amount of fluid in two 5L bags. My PD nurse set up the card to pull a total of 10,300 MLs...which ain't gonna work.

I think sometimes there is a variation in the amount in each bag since some mornings the bags have been sucked totally dry before reaching the desired last fill amount. If I'm awake, I will hold the bag up to get the last few MLs. I may have to go to the larger 6L bags but really don't want to since they are noticeably heavier!

So my point is...perhaps you should adjust the fill amounts so that you have some fluid leftover at the end to make sure the bags don't run out until the fill cycle is over. Sure beats the shoulder pain!

 

[Mike_NC]

Lucky you to be fortunate enough to be on a Baxter...they rule!! As far as the amount of fluid goes, I get where you're coming from but my prescription calls for 4 cycles of 2000 each for a total 8000 per night so there has always been a small amount of fluid left in the heater bag. That's been the same since I've been on the Liberty. The Liberty works a little differently from the Baxter, in that it fills the heater bag on a different schedule. When I was on the Baxter cycler, the supply bag was the one that was emptied at the and of my treatment....with the Liberty, it's the opposite....the heater bag is the one that is emptied (not completely dry though) at the end of treatment. Thanks for the input though, Willis. You make a very logical point but I can pretty much eliminate that from being the issue. I really think it's something within the cycler that's causing the problem.

[highway61]

Hey Mike, I am on a Liberty cycler and have had a few episodes of shoulder pain. My main complaint is that for an 8 hour program it sometimes run an extra 30-45 minutes. Makes for some hectic mornings getting ready for work. :-) I haven't been on PD very long and only have used this cycler.

[Mike_NC]

highway61, I can see how that could be a problem. I can't say I've had that particular trouble myself. I don't know how your machine is programmed but mine is set to be "cycle based" vs "treatment based" (I believe that's right...I confuse myself thinking about it lol) I'm not at home right now so I can't check my cycler to verify. Depending on my fill/drain times, the dwell time either has a few additional minutes tacked on or taken off of the standard 1hr 32 min dwell. Basically, I have some longer dwells on certain cycles and shorter dwells on others but they equal out to be the 8 hrs I'm prescribed unless of course I have any sort of alarms or other issues which thankfully have become fewer with the software upgrades. I'm on 2.8.2 software currently and was told yesterday that they are currently working on the next version (2.9) that "should" be out within 6 months or so.

As for the shoulder pain, I could deal with it if it wasn't a regular thing but I had it for 5 days consecutively and that leads me to believe there is a problem with my cycler. Also my cycler has progressively gone from silently running to being rather obnoxious with rattling noises and other random sounds. I spoke with someone at Fresenius today and was told that when I send my cycler back that it would be vigorously tested and broken down to try to confirm what the problem is. She is actually a tester of the cyclers and is in charge of trial programs when new software is introduced. She has been helpful to me and pays very close attention to the feedback I have given her and helps to get that information passed to the technicians involved. She told me she just hoped that this was nit a "tip of the iceberg" type of situation and hopefully my air pocket/ machine malfunction is/was an isolated incident.

[JLM]

Mike, are you clamping the patient line before hooking up your extension line?  I think this holds the fluid in there as not to get air in the line.  That would be my first thought.  I have not had any air as of yet, I started on the Liberty cycler last month.  I don't know how to find the software version though.

[Mike_NC]

JLM, I'm certain that this is not a 'user error' problem. After causing an air pocket during a manual exchange a few years ago, I found out the hard way to pay very close attention to the lines. I am always careful to clamp off the patient line after priming, and also the clamping the unused lines as prompted by the cycler during setup. I used the new machine last night and had no issues at all. My UF was also slightly better than it has been in recent months. The total UF increased ever so slightly but the amount drained per cycle was better. I'm convinced this is a cycler issue and I'm hoping I will be informed of the findings after the techs have a chance to evaluate the cycler for themselves.

BTW, your current software is listed on the top of your cycler, by the phone number for tech support. For example, mine is listed as "SW 2.8.2  024". My guess is that you are on at the very least, 2.8 version software, but more likely the 2.8.2 version since you have only been using the Liberty for a month.

[highway61]

My cycler has version 2.8.2 027.

[Mike_NC]

My cycler has version 2.8.2 027.

Yep, that's the most up to date software that's out, as far as I know. 2.9 is "on the horizon" as I was told, but again, it will be roughly 6 months until the release.

I've been begging for a manual drain to be added because of my catheter position. I have to be sitting upright in order to drain completely...if I'm not awake during the final drain, I have to disconnect from the cycler and then connect to a manual drain bag to finish. I was told it would be on the last two software updates but it wasn't. Again, I'm being told that it will be on the 2.9 machine but after my past experiences, I'll believe it when I see it. I was also told there will be several new features on the 2.9. We shall see....

[jeannea]

I use the Baxter cycler. I occasionally get air pockets during my first fill. I mostly cry and move around til it gets better.

Highway61, with it going longer. Your nurse set up the program to run 8 1/2 hours or whatever. But that timing doesn't start until after your initial drain and any warming time. So I always figure 9 hours if I have to go somewhere.

[Joe]

I'm using the Baxter system, and give it 9.5 hours from when I hook up to when I want to disconnect. It's never a problem if I finish early and I have some buffer time if there are any alarms during the night. They don't happen often, but I occasionally roll over and pinch my line causing me to have to untangle everything at 2 in the morning!

[JLM]

I, too, have the 2.8.2 027 Serial #

[highway61]

Yea, Joe, I do the same thing with my cycler too. It's a real bummer to have to get up and reset it. Mine requires a manual reset, you have to press stop and then ok buttons to get it to continue.

Too bad our cyclers weren't as well designed as our Macs. 

[Joe]

Mine is usually not a hard reset, unless it happens more than once.

Too bad our cyclers weren't as well designed as our Macs. 

That's a fact highway! 

[Annig83]

Highway, I am Liberty as well.  I have NEVER had the air pockets from the cycler.  My nurses told me to make sure you are pressing "BACK" when the cycler is "Priming". You should have two options before you use Aeseptic Technique and hook up. Before you get to that screen, press back and watch the fluid flow into the end of the tubing that hooks into your cath. So you should be priming the tubing at least 2 times.  It gets all the air out.  If you do this already and still have an issue, I suggest seeing if your doctor will swtich you to treatment based rather than cycle based??  Good luck.

[highway61]

Highway, I am Liberty as well.  I have NEVER had the air pockets from the cycler.  My nurses told me to make sure you are pressing "BACK" when the cycler is "Priming". You should have two options before you use Aeseptic Technique and hook up. Before you get to that screen, press back and watch the fluid flow into the end of the tubing that hooks into your cath. So you should be priming the tubing at least 2 times.  It gets all the air out.  If you do this already and still have an issue, I suggest seeing if your doctor will swtich you to treatment based rather than cycle based??  Good luck.

My wife usually sets the machine up for me. I get home between 6-6:30 and finish dinner 7-7:30 and hook up at 8 to be able to get up at 4:30am for work. I will mention this to her. Thanks.

[drgirlfriend]

Mike NC - my boyfriend started the Liberty cycler in December. He occasionally has problems with air/shoulder pain. He has to sit up during the initial fill and final drain for a chance for everything to be complete. He sits up during the first fill so if an air bubble gets in, it will go up to the shoulder where it's more bearable. He sits for the final drain so everything will come out. It has left a few hundred mL in him on occasion but he just keeps it in until the evening. He told me that in his searching for answers online, both problems are software related and we just have to wait for the fix.

I did suggest multiple priming to him and he said it made no difference.

[Mike_NC]

drgirlfriend - Until this recent episode I've never had any issues with air pockets, whether during the first fill or at any time through my treatment. The only time I've ever had an air pocket was caused by me, doing a manual exchange when I first started dialysis in 2007....I didn't properly flush the lines before doing the fill....Lesson learned!! I used the Baxter cycler for over 3 years with no issues and the Liberty has been one headache after another. Maybe they'll get the kinks worked out one day. I just received yet another replacement cycler after only having the last one for just over a week because it wouldn't read the IQ drive. This is the 8th Liberty I've had since being forced to switch from Baxter in Feb 2011.

Annig83 - I watch my line fill EVERY night. I use the short lines so technically I am not required to do the second priming although since having the problem with air pockets I have done the second priming a few times but it almost immediately goes back to the screen acknowledging that it is primed. So far, since having the cycler replaced I haven't had any air pockets. We'll see how long this one lasts.

[Annig83]

Glad it's better!   

[drgirlfriend]

Hey Mike NC - any news? Did the new machine make a difference? The boyfriend has had 3 bad incidences with air in the last couple weeks. It's terrible for him and no fun to watch either. I'm wondering if the difference in height between our new bed and the machine has anything to do with it.

[Mike_NC]

drgirlfriend - Thus far, no troubles with air pockets with the latest cycler *knock on wood*. As for the height of your bed, I seem to remember during my training with the Baxter cycler years ago, that the height of the machine in relation to the bed did or could have an effect on some part of the treatment. Not necessarily air pockets but there was something mentioned. My cycler (the bottom) has always been just above or even with the top of my mattress. All I can suggest is to ask nurse at your clinic if that could be causing your boyfriend's air pockets. Best of luck getting the answers he needs. If they don't have the answers, my suggestion would be that you ask for a way to contact a Liberty rep that can answer your questions. You might even want to call the support number on the top of the cycler as a starting point (if you haven't already) Good luck!