What am I doing wrong?

[alewis328]

Hello all. I have posted on this forum before but it has been quite awhile. We have been doing NxStage at home for a little over 2 weeks now. Things have been so crazy hectic between work and rushing home to get him on the machine, etc.
I have noticed that after the last few treatments, we have had some clotting issues. Mostly in the port on the dialyzer but after the last couple, there have been a few clots in the access pod and the lines are not running all the way clear.
We are using a CVC currently until the fistula is usable. I ALWAYS check for clots pre treatment and usually never have any. But last night, after checking for clots, when I went to administer the 2000 u of heparin (pre-treatment), I pulled back on the syringe to pull out a couple of tiny air bubbles.  When I did that, a pretty sizeable clot appeared. I removed it, but where did it even come from? After tonight's treatment and the most clotting we have had so far, I called the nurse. We are going to up the heparin to 3000 u tomorrow night.  But I am still confused, because we have had no alarms. If there was a clotting issue, wouldn't it trigger an alarm?
Also, after a few treatments, especially since the clotting issue has popped up, the saline in the bag has been red?  The nurse had no idea about that one, except maybe I forgot to unclamp the venous line after re - attaching it to the saline spike.  I doubled checked after she asked me that. I had not yet broken everything down.  All the clamps that were supposed to be clamped - were.
I am very frustrated. As far as I am aware, I am doing everything exactly the way it is supposed to be done, yet these little issues keep coming up in the last few days. And I would like to find a solution before it becomes a massive issue that causes a new alarm and another mini heart attack on my part....Thanks in advance for your replies. You may be saving my sanity 

[willowtreewren]

This is one of those times that I would call tech support. EVery once in a while we found that just before rinseback, before I hit the fluid button, the blood would work it's way up the saline line almost to the bag.... Could that be happening to you?

Also, see if the increased heparin solves the problem. 2000 seems like a pretty measly amount. My husband was 59-60 kilos and we used 3000.

You are going to get alarms... just work through the book to clear them.

 

Aleta

[cdwbrooklyn]

I've had the same problem.  You can get your partner to take baby aspirins once a day to thin the blood. It worked for me and after a while I've stopped having large clots.   

When you rinse back, be sure to connect the arteria (red line) first.  Be sure that the machine is on 273 by pressing the stop button when you are completely done with your treatment.  Connect the red line first then press the fliud button.  There will be times when the venous line will have a little red in it when rinse back clears but don't worry its because you were clotting.  It should clam down after taking baby aspirins every morning.  Just take one only. 

Hope this helps
  

[boswife]

im kind of done for the night but see your post and wanted to see if you wanted to join some of us over at nxstageusers.com, The board itself is of great help but the listserve is priceless.  You will find some VERY experienced people to help you and the answers come quick. You just have to go to here  http://www.nxstageusers.com/forum/forum.php  for the site but here http://www.nxstageusers.com/  you'll find on the left of the page in the black section, where it sais about "listserve"...  YOu need to apply for it but i tell ya, they're wonderful people and kept me sane during my just home from training stage, and now home for a year stage..lol   some of us from here are there too you'll be very welcomed...  Hope you get your answers.. 

[M3Riddler]

Hello all. I have posted on this forum before but it has been quite awhile. We have been doing NxStage at home for a little over 2 weeks now. Things have been so crazy hectic between work and rushing home to get him on the machine, etc.
I have noticed that after the last few treatments, we have had some clotting issues. Mostly in the port on the dialyzer but after the last couple, there have been a few clots in the access pod and the lines are not running all the way clear.
We are using a CVC currently until the fistula is usable. I ALWAYS check for clots pre treatment and usually never have any. But last night, after checking for clots, when I went to administer the 2000 u of heparin (pre-treatment), I pulled back on the syringe to pull out a couple of tiny air bubbles.  When I did that, a pretty sizeable clot appeared. I removed it, but where did it even come from? After tonight's treatment and the most clotting we have had so far, I called the nurse. We are going to up the heparin to 3000 u tomorrow night.  But I am still confused, because we have had no alarms. If there was a clotting issue, wouldn't it trigger an alarm?
Also, after a few treatments, especially since the clotting issue has popped up, the saline in the bag has been red?  The nurse had no idea about that one, except maybe I forgot to unclamp the venous line after re - attaching it to the saline spike.  I doubled checked after she asked me that. I had not yet broken everything down.  All the clamps that were supposed to be clamped - were.
I am very frustrated. As far as I am aware, I am doing everything exactly the way it is supposed to be done, yet these little issues keep coming up in the last few days. And I would like to find a solution before it becomes a massive issue that causes a new alarm and another mini heart attack on my part....Thanks in advance for your replies. You may be saving my sanity 

Alewis,

How are the treatments going ?  Any problems with pulling clots at the beginning of the tratment ?

[amanda100wilson]

If you are getting clots in the lines before connecting, I suggest doing wet sticks.  Your nurse should be able to tell you how.  With a wt stick, you put 5or 6 ml of saline from saline bag  using syringe and needle (use saline swab to clearn port on saline bag first).  Then you simply unscrew the end of the needle line, remove needle from syring and fill line and needle with saline.   The good thing about this is that just before you cannulate, squeeze the tube slightly which will put a drop of saline on end of needle the mo net before you cannulate.  This acts as a lubricant to help needle insertion..  Once needle is in and you have taped, unclamp.  Leave syringe in place until you connect up .

With regard to the other clotting issue, just sounds like you need to go up on heparin.  More like.y to happen when Hgb is higher, but there doesn't not always seem to be rhyme or reason, probably just fluctuations in blood viscosity and p,ate let count.