Saline Bag problem

[micknjudy]

   We have been doing home hemo dialysis for 5 years now and this is the first problem I have had with the tip in the saline bag.  After treatment I can barely remove the tip from the bag (I usually drain the remaining saline).  In the past I have had to give Michael saline boluses so I am concerned that if it occurs again I wouldn't be able to change bags.  I have no idea why suddenly I have to actually cut the saline bag open and the connection is still attached to the spike.  Any ideas?

[caregivertech1]

We use saline bags supplied by Fresenius and have never experienced that problem (yet).

[PrimeTimer]

We've had that very thing happen (tip of spike break off inside saline bag) when I was trying to change saline bags during treatment. Immediately called NxStage Tech Support and a tech walked us thru a procedure involving the spike from a new cartridge and new saline bag...cannot remember all the details but thankfully we were able to do rinseback and end treatment without losing any blood. The saline bags we use are from Fresenius and the spike from the NxStage Cartridge is long and a real bugger to insert and remove. Several months back, I think during the saline shortage, they gave us a different brand of saline bags and they were much, much easier to spike. Anyways, we were grateful to NxStage Tech Support!

*I corrected my post to include that the spike is from the NxStage Cartridge, not the saline bag itself. Sorry for any confusion I may have caused.

[micknjudy]

Thanks for the replies.  We also use Fresenius supplies and tried new lot #'s just to see if that was the problem only in that particular batch but still could not remove the spike after treatment.  So that idea didn't work.  Just want to solve the problem before it becomes necessary mid-treatment.  It's good to know NxStage had a  solution to a broken spike.  Although I haven't needed it YET I have given plenty of boluses in the past and would like to be prepared to change bags if needed in a hurry.

[amanda100wilson]

Fresenius bags are typically ease to spike and re-spike than Baxter bags

[Simon Dog]

It's good to know NxStage had a  solution to a broken spike.  Although I haven't

I suspect it's just replacing the line with the spike up to the point where attaches on the fitting on the arterial line.

I hate the NxStage long spike - the shorter more conventional spike on the tubing set used by the BabyK is much easier to deal with.,

[PrimeTimer]

It's good to know NxStage had a  solution to a broken spike.  Although I haven't

I suspect it's just replacing the line with the spike up to the point where attaches on the fitting on the arterial line.

I hate the NxStage long spike - the shorter more conventional spike on the tubing set used by the BabyK is much easier to deal with.,

Yes, I vaguely remember it involving the red arterial line and spike of a new cartridge. I also remember something about closing clamps on the new cartridge and hanging it (I think) upsidedown above (higher) than the saline bag. I'd like to practice that little maneuver but then that would mean wasting cartridges and saline bags. Don't know why their spikes have to be so dang long. I'm glad I keep NxStage's phone number taped to the front of the cycler..

[obsidianom]

The reason its so long is that they have  2  holes in the spike for the various lines to empty into and that takes up the length. There are 4 lines emptying into the spike. One hole is at the tip and the second hole is way back about 2/3 down. This keeps the holes from effecting each other in the priming sequence.
The red (arterial)line and the saline clear line go to the closer to the base hole and the blue (venous) line and drain line go to the hole near the tip. .They have to be seperated widely so a long tip is required. 

[Simon Dog]

The reason its so long is that they have  2  holes in the spike for the various lines to empty into and that takes up the length. There are 4 lines emptying into the spike. One hole is at the tip and the second hole is way back about 2/3 down. This keeps the holes from effecting each other in the priming sequence.
The red (arterial)line and the saline clear line go to the closer to the base hole and the blue (venous) line and drain line go to the hole near the tip. .They have to be seperated widely so a long tip is required.

Excellent info - thanks.

[PrimeTimer]

Thanks, obsidianom. I didn't have my thinking cap on but I was figuring/hoping that NxStage had a good reason in their design and turns out, they do. Now I need to figure out how to remove the spike without breaking it. Fortunately, I have not had to change saline bags during treatment very often and I've had a spike break only once but am wondering if perhaps it was something I didn't do right that caused it to break.   

[PrimeTimer]

It's good to know NxStage had a  solution to a broken spike.  Although I haven't

I suspect it's just replacing the line with the spike up to the point where attaches on the fitting on the arterial line.

I hate the NxStage long spike - the shorter more conventional spike on the tubing set used by the BabyK is much easier to deal with.,

Yes, I vaguely remember it involving the red arterial line and spike of a new cartridge. I also remember something about closing clamps on the new cartridge and hanging it (I think) upsidedown above (higher) than the saline bag. I'd like to practice that little maneuver but then that would mean wasting cartridges and saline bags. Don't know why their spikes have to be so dang long. I'm glad I keep NxStage's phone number taped to the front of the cycler..

The little "off label" maneuver mentioned above was performed while there was power and the cycler was on. Never had it happen yet but, what does one do during a power outage if you can't spike a new saline bag to perform a manual rinseback?  Anyone perform a manual rinseback just using the saline bag you started treatment with, despite it not being a "full bag"? If it's at least half full, did that provide enough pressure in addition to squeezing the bag to force the saline and blood to rinse back?  Were you able to rinse back all blood or just some of it? Thanks in advance to anyone who shares their experience with this.

[cassandra]

I could rinse most of the blood back with about half a saline bag.

[PrimeTimer]

I could rinse most of the blood back with about half a saline bag.

Thanks, cassandra for responding! On bad weather days I keep a close eye on the weather reports so we can avoid doing treatment during a storm (we try for before or after) and if the lights at all flicker, we end treatment early. So far I have not had to do a manual rinseback and altho I am sure I could handle it, the issue of the saline bag and spike worries me.

[*kana*]

We have this issue too.  We prime, flush the entire line and then hang another bag.  So we normally go through 3 bags of saline a treatment.  We have found as long as we don't push the spike all the way in we can remove it without a huge struggle. 

[Simon Dog]

what does one do during a power outage if you can't spike a new saline bag to perform a manual rinseback? 

I always plan ahead.   As soon as I use enough saline to prevent me from having enough to do the rinseback, I change the bag immediately - that way, I do not get caught short if there is a power failure before I complete treatment.   It limits the power fail risk on this issue to a very short period of time.

[PrimeTimer]

what does one do during a power outage if you can't spike a new saline bag to perform a manual rinseback? 

I always plan ahead.   As soon as I use enough saline to prevent me from having enough to do the rinseback, I change the bag immediately - that way, I do not get caught short if there is a power failure before I complete treatment.   It limits the power fail risk on this issue to a very short period of time.

I'm not sure I follow...you are using 2 bags of saline each treatment? What do you do if you cannot get the spike out of a used bag to spike a new bag during a power outage, or any time for that matter? The NxStage spikes don't seem to want to come out of the Fresenius saline bags once they've been spiked. So, I was wondering if rather than wrestling with it or risk breaking the spike, has there been much success doing a manual rinseback using a saline bag that has already been spiked but is only half full of saline? Sorry if my question doesn't make sense, it's late here so I know I'm getting sleepy and sloppy...sorry..I'll check back tomorrow.

[Hemodoc]

I have had that problem several times until I began punching the spike, then partially pulling it out to allow a little saline to leak and provide lubrication. If you insert without getting a few drops of saline on the spike, it will stick more often than not. That is the only solution Imhave found with the NxStage spike. Soup lie drops of saline on the spike is enough to resolve the issue. However, you MUST take extraordinary care to avoid contamination such as gloves and mask when doing this.

[Simon Dog]

I'm not sure I follow...you are using 2 bags of saline each treatment?

I usually use one bag of saline per treatment.    I use a second bag if I infuse more than 100ml of saline during a treatment.

I have found that it works best if I push the spike in until it is almost, but not totally, seated.   A 1/8" gap from fully seated does not seem to compromise the integrity of the connection, but makes it easier to disconnect.  I always disconnect the saline bag to drain the residual at the end of treatment and have not yet failed to disconnect without breaking anything.

[PrimeTimer]

I'm not sure I follow...you are using 2 bags of saline each treatment?

I usually use one bag of saline per treatment.    I use a second bag if I infuse more than 100ml of saline during a treatment.

I have found that it works best if I push the spike in until it is almost, but not totally, seated.   A 1/8" gap from fully seated does not seem to compromise the integrity of the connection, but makes it easier to disconnect.  I always disconnect the saline bag to drain the residual at the end of treatment and have not yet failed to disconnect without breaking anything.

Thanks, Simon Dog! Will practice your technique and add to my cheat sheet. Thanks, too Hemodoc! And I agree about the gloves and mask.

Forgot to practice...

[PrimeTimer]

I'm not sure I follow...you are using 2 bags of saline each treatment?

I usually use one bag of saline per treatment.    I use a second bag if I infuse more than 100ml of saline during a treatment.

I have found that it works best if I push the spike in until it is almost, but not totally, seated.   A 1/8" gap from fully seated does not seem to compromise the integrity of the connection, but makes it easier to disconnect.  I always disconnect the saline bag to drain the residual at the end of treatment and have not yet failed to disconnect without breaking anything.

Thanks, Simon Dog! Will practice your technique and add to my cheat sheet. Thanks, too Hemodoc! And I agree about the gloves and mask.

Forgot to practice...

Okay...I tried it. Had to do it a couple times before I got the hang of it (no alarms) but it worked. Thank you very much for the tip!

[cbatsea]

Agree...do NOT push the spike all the way to the "hilt"!  As long as the tip of the spike is visible in the saline bag, you'll be ok!  I, too, leave about 1/4 to 1/8 inch of the spike visible on the outside of the saline bag.....had one time when I pushed it too far in....couldn't get it out!