strange new peoblem with pressures

[fuzzyL]

after over 5 yrs home treatment we are having an unusual situation---before you say its my fistula or access, I had it checked out at a vascular clinic this summer and all was fine--when we start treatment all pressure numbers are very good-however after some time--usually an hour or so the artery or vein,, usually the vein pressure start climbing high alarm to be near alarm and in some cases have sent off the alarm-at the same time the effluent numbers change,often climbing as well--and my care giver has to watch me and she tries different ways to place the needle which help but doesn't solve the problem--here's the thing, once all the water is taken off whether 2L or 3L all numbers  drop back to normal and the rest of the session goes well-so what is happening--if it is my fistula or access then why are numbers real good at first-and why after all water is pulled do all numbers go back to normal??--

[PrimeTimer]

If you are using the Pureflow machine and have the big black drain line, try flushing it out with some bleach and water using a fat syringe the home nurse should provide you with. Instructions on flushing your drain line should be in the manual or call NxStage and have a tech walk you thru it. NxStage use to send us a cleaning kit with washing soda. It was a lot like powdered washing detergent. I stopped using it because it would clump up in the drain line and I think that caused the venous and effluent pressures to go up. I just used bleach and warm water about every 2 weeks. And altho you had your fistula checked out over the summer, wouldn't hurt to have the nurse or vascular surgeon do a follow-up on it. My husband use to have to get an angioplasty every few months. Take care. 

[Simon Dog]

I was told to use the bleach flush weekly, and the sodium carbonate flush every 3 months when NxStage includes the cleaning kit in my order.

[caregivertech1]

Definitely call tech support. You mentioned you're taking off 2 to 3 liters of fluid. What blood pump (Qb) speed are you running and for how long and at what UF removal rate? I've never seen in our 6 years a VP drop when the UF is completed. We run 3 1/2 hrs at Qb of 320. We never exceed 600ml per hour of fluid being removed. NxStage recommends no faster removal than 10ml per Kg of weight so my wife weighs 60kg which translates into the 600ml per hour. I assume you're getting a caution 30 alarm. Just a wild guess maybe you're taking fluid off too fast.

[fuzzyL]

thanks to all for good advice--to "prime" and "simon"  for the drain problem, one issue we have is the drain runs at least 25 feet to the tub-hard to do it any other way so we are concerned that it doesn't always drain right and we do run bleach thought it--I thought of adding a sump pump to pump it better to drain but not sure how pump would do --to "care giver tech"  we do 60L of cleaning usually 2.5 or 3l water removed at speed 480--we set water removal rate per hour at .75--we found that if we lower the removal rate the cleaning gets done before all the water is removed --but if she lowers a little during treatment it will lower the pressure problem, adds a little time to the session but at least we make it thru

[caregivertech1]

We were trained at a blood pump speed of 500, FF at 35%, and only 20L. We had multiple pressure alarms and multiple fistulagrams for those 2 years. We now run at 320 Qb, 48% FF, and 30L per treatment. Pressures have dropped in half , no fistulagrams 3 1/2 yrs running, and we never get high pressure alarms. NxStage has a dosing calculator that is awesome. It can be found on their website. I guess I'm saying you're way too high at 480. Lower that and increase your FF and your high VP will go away. If you're using 60L you have lots of room to lower your speeds. There's a lot of research on this. Go to the website, create an account and plug in the "what ifs". Your home nurse should be able to help you. Good Luck!!

[PrimeTimer]

We were trained at a blood pump speed of 500, FF at 35%, and only 20L. We had multiple pressure alarms and multiple fistulagrams for those 2 years. We now run at 320 Qb, 48% FF, and 30L per treatment. Pressures have dropped in half , no fistulagrams 3 1/2 yrs running, and we never get high pressure alarms. NxStage has a dosing calculator that is awesome. It can be found on their website. I guess I'm saying you're way too high at 480. Lower that and increase your FF and your high VP will go away. If you're using 60L you have lots of room to lower your speeds. There's a lot of research on this. Go to the website, create an account and plug in the "what ifs". Your home nurse should be able to help you. Good Luck!!

I agree with you, caregivertech1. From what I remember when we were given the new "S" cycler the neph had us change the speeds and Flow Fraction. We changed it back because of too many alarms. We also slowed down the UF. As for blood pump speed, I don't think my husband ever went over 380. We've read that higher speeds can lead to fistula damage over time. I think one of our past members on here (obsidian) posted an article about it titled "Don't Flog The Fistula".