NxStage Tips & Tricks

[Sluff]

This is for anyone who is currently using Nxstage, and would like to share Tips and Tricks on saving time or making things go smooth.

[silverhead]

I'm sure I will think of more, but the one I always use is to not hook uip the vacuum sensor line from the "Pod" until just before I hit the treatment button, very rarely have to reset the pod if it is done this way......
Tom

[Meinuk]

I've summarized some of the tips that Black, JBeaney, Silverhead and Bill Peckham posted on the NxStage Training starts thread

leave the machine running in the 23 recirc for as long as possible - it makes snapping and tapping a breeze.

the filter port cap comes loose in shipping - check it every time. 

the connection between the two blue clamps on the pureflow bags does the same.  Always loosen and retighten it before starting a batch.

things I do that they don't teach in training - once it's in 23 recirc, shake all the air out of the saline T first thing - this also helps hurry up the snapping and tapping, as it keeps air from bubbling back up from the T every time you move the line during snapping and tapping. 

the fastest way to clear the air out of the access pod is to turn it upside down and tap if firmly against the door handle on the NxStage. 

When you connect the saline line to the saline T - unclamp the white clamp, snap the air that got into the connection up the line to the saline bag, and reclamp.  You don't get so many alarms when you have to do a bolus if that little bit of air is gone.

If you have a leak of clear fluid, the smell can help you determine what's leaking - Saline is salty and smells it, but clean dialysate is sticky sweet.  Used dialysate reeks horribly.  Knowing the difference can help you determine where your leak is coming from.

centrifuge: it runs quieter with a test tube opposite the one with the blood sample (if it is the type with a four tube capacity). I keep a tube with saline as a counterweight.

RE: pulling your needles

There isn't much information out there about taking the needles out (some good information about putting them in). A few months ago I found a simple step to decrease the bleeding. I pull the needle out a quarter to half the way and then proceed with one handed needle removal. I found that starting the needle out makes it easier to get the gauze right on target.

and

Sharon has real good luck by pulling the needles out half way, placing a sure-seal band-aid over the needle entry sight, then she pulls the needle, presses on the sight, then places a gauze pad and a clamp on it for 10 minutes, then an x of paper tape for a while just to be sure......

and

We use the SureSeals also and we LOVE them, but in the reverse order.  We use the gauze pads for 5 to 7 minutes.   (Since Mike is no longer anemic he clots very quickly even though he uses 6,000 units of Heparin.) Then we use the SureSeals.  We started using them after he used his fistula arm to exert pressure as he got out of the chair and blood spewed out from under the regular band-aid.  The only thing we found that cleans up blood easily is peroxide.  I never knew before that it was so sticky!

[Adam_W]

One thing I've started doing is using a 3cc syringe to pull saline up into the recirc piece (peanut) before I connect the two patient lines together. It lessens the chance of air bubbles getting into either of the lines before I connect them to my access.

Adam

[Black]

If you're using bags, one of the best ways to cut the time is to spike the saline bag and start the prime first.  Then while it's priming, get your supplies together.

I lay out my supplies in the exact same pattern every time, so if anything is missing it's immediately noticeable.

When you connect the lines to the cannulation sets, pinch the cannulation line line to bring the blood all the way to the end of the line so there is no air bubble when you connect them.

At the end of the session if there is a lot of dialysate left in the bags, clamp and disconnect the connection to the warmer and use a peanut to attach to the drain line so they can drain while you do everything else (don't forget to unclamp).

[goofynina]

This was a great idea Meinuk  , i am sure if/when i get on NxStage, this is going to be one of my favorite threads for sure      Love ya 

[jbeany]

If taping the tubes to your arm to loop them out of the way is making your skin raw, use the white tabs that protect the lines from disconnecting during shipping and a hemostat clamp to clamp the tubes to your sleeve.  I find the clamps work much better than any amount of tape, and the tabs are easily gripped by the clamp without risking squeezing the tubes.

[Meinuk]

In a case of necessity breeds ingenuity our own road warrior Bill "MacGyver" Peckham came up with this fix when he found himself in a DC hotel room ready to dialyze with no drain line:  (Maybe for his birthday this year, I'll make him a NxStage travel packing list!)

The best thing to do is remember the friggin drain lines but this work well http://www.billpeckham.com/from_the_sharp_end_of_the/2008/03/the-continuin-1.html

And continuing with the helpful hints, cev told us how he drains dialysate bags when he has a set up and can't initiate the run (it sure beats unhooking them and carrying them to the sink!):

love that solution - would not have thought about it. Even tho if  for some reason we can not do a run and are already set up, I hook the heater line to the drain line and let the bags all drain.

Thanks Guys!