Cycler Issue ????

[Vt Big Rig]

Last week, each day we did a treatment we did not get a full run time in when the machine would either give a 14 caution or a 39 alarm and go to "000". But then it would go to "9" and we can't do anything but wait till the "9" clears. Then we would would hit stop and often stop and hold to get to rinse back. The run time got increasing shorter and the amount of dialysate reported used got increasingly less.

So NxStge asked us to use bags to rule out the Pure Flow. We did so and it was worse than ever. Stopped with 12 minutes left and went to 39 alarm. But at rinseback it told us we used 37.6 liters. Prescription is 40 liters. Another call to NxStage and they ship overnight a "new" cycler. Take everything off, put everything back on ....... use the Pureflow ...... stops at 6 minutes, same issue but at least this time is says 39.6 liters. Bags or SAKs have always been very empty.

Never had this before ... I have had times when it did not say we used 40 liters. And we have had times when it has said 40 liters but there is "stuff" left in the SAK. Thing was running like a champ and now this   

[micron]

I get frequent yellow 14's but always at the start of treatment.  The pureflow and 60L saks don't get along.  Always have to re-position them at the start of treatment.

As for the Red 39 and running out of dialysate, that can happen on our 2nd night of using the sak sometimes (60L sak / 30L per treatment).  Just seems like it doesn't always make the perfect amount of fluid, running short by 1-2L.   I always keep an eye on it towards the end to avoid the dreaded yellow 9.  If it's happening so often, could be a sensor issue?

Do you get off the machine at all during treatment?  If you don't set the dialysate flow rate to 0.1  it'll keep running through fluid while you are off.  Or, possibly, are letting it run for a while during rinse back, so it could still be pumping fluid through until the pureflow is stopped. 

[Vt Big Rig]

I get frequent yellow 14's but always at the start of treatment.  The pureflow and 60L saks don't get along.  Always have to re-position them at the start of treatment.

As for the Red 39 and running out of dialysate, that can happen on our 2nd night of using the sak sometimes (60L sak / 30L per treatment).  Just seems like it doesn't always make the perfect amount of fluid, running short by 1-2L.   I always keep an eye on it towards the end to avoid the dreaded yellow 9.  If it's happening so often, could be a sensor issue?

Do you get off the machine at all during treatment?  If you don't set the dialysate flow rate to 0.1  it'll keep running through fluid while you are off.  Or, possibly, are letting it run for a while during rinse back, so it could still be pumping fluid through until the pureflow is stopped.

We also often get the 14 at the beginning. We are using 40 liter SAKs.  No, I have never gotten off the machine during a treatment. I think your last sentence does not apply since we use up a complete SAK with each treatment.

[PrimeTimer]

Are you using the regular NxStage Cycler or their "S" Cycler? Did your Neph change your Flow Fraction? I remember we had these problems when the Neph changed my husband's FF to 44. When we went back to FF40, the YC14 alarms stopped. Check all your system settings on the cycler to make sure they are set according to which cycler and software version you have, make sure the dialysate rate and UF rates are correct.

As for kinked dialysate lines, there are lot of places where lines may be kinked...whenever I make a SAK, I gently rock and "swish" the dialysate in the SAK back and forth, side to side and turn it over and do it again before placing it in the tub. Once in the tub, with the palm of my hands open, I run my fingertips along the sides of the SAK to feel for any wrinkles and gently smooth them out. I also make sure that none of the dialysate tubing inside the SAK is too close to the sides...the swishing I mentioned helps move the tubing away from the sides so that no blockage will occur. Also, the dialysate line that comes out the very top of the control unit sometimes bends and leans to the left, creating a kinked line. I use tape or a straw to keep it upright. See my post from March 13, 2014 "Redneck Remedy to Kinked Dialysate Line". Sometimes the dialysate line at the cartridge is bent/kinked (the part of the line that you can still see after you shut the cycler door). In other words, sometimes lines are a little bent or flimsy and simply need to be straightened but...if you notice any lines are too kinked before making the SAK, ditch it and use another SAK.

If you still have problems, I would definitely call Nxstage back and have them walk you thru it all again. Sorry you are going thru so much with this!

[Vt Big Rig]

We have the "S" cycler. The flow fraction has not changed. Before they took the old cycler away I went through each setting and wrote it down in the book. I then went through the new cycler and verified (or changed) so they are all the same. Also checked the software version.

I admit I do not go through the steps you do on the dialysate. I do make sure the lines coming out are not kinked, but other than smoothing and positioning the SAK it has always run great.

Last night .... same thing .... 6 minutes early a 9 comes up. But when we started just as we tried to ramp up speed we got a 9 alarm then, and an immediate "2". So we could not ramp up for a time. That could have contributed to the problem. But at least it says we used 39.9 liters of fluid.

NxStage is starting to frustrate me.  :stressed;They keep telling me ..... "well that is within spec"

[Hootie]

One thing to check is the level of the pure flow system. We moved to 50 L saks with 25 L treatments. We were running out of dialysate at end of second treatment causing alarms. We leveled the machine up and have had no alarms and now have a little left in bag at end. NxStage told me on phone that there is 1-2L extra in a bag. For what its worth.

[Vt Big Rig]

After five treatments .... each one having some problem with stopping early, running out of dialisate but saying I used 38 or so instead of 40 .... and the last issue of taking off only 1.3 kg when I had it set at 2.5 (yeah it was a long weekend)  NxStage shipped me ANOTHER new cycler. Last night with the new one was a perfect run  .... let's hope it stays that way.

[PrimeTimer]

Bet that's a relief! I'm sure that wasn't helping your blood pressure...

[Vt Big Rig]

Bet that's a relief! I'm sure that wasn't helping your blood pressure...

Oh, you should see my post about BP cuff. That took care of raising my BP.

[Vt Big Rig]

After five treatments .... each one having some problem with stopping early, running out of dialisate but saying I used 38 or so instead of 40 .... and the last issue of taking off only 1.3 kg when I had it set at 2.5 (yeah it was a long weekend)  NxStage shipped me ANOTHER new cycler. Last night with the new one was a perfect run  .... let's hope it stays that way.

I spoke WAY too soon. After five treatments with the new cycler the weight fluid removal has been off by more than 20 % three times. And last night it was off by 75%. Set at 0.8 and it removed 0.2. Can't they send me one that works?

[PrimeTimer]

THIS is unacceptable! Certainly they will give you a working cycler and ASAP!! If needed, have them walk you through every setting to make sure it's not somehow defaulting to some weird rate. I know your problem is different but when we got the new "S" cycler, it was using up all the dialysate before we met the UF goal. I posted about it last December. We lowered our Flow Fraction from 44 back to 40 and went back to using slower UF and dialysate rates for 30 liter treatments. Problem stopped. BUT...I also think it uses up dialysate faster whenever my husband only needs less than 1 liter kilogram of fluid removed...if I recall correctly, the S cycler doesn't like anything under 1 liter kilo. Every once in awhile my husband doesn't need a full liter kilo removed so on those nites, I cross my fingers and hope it doesn't blow through all the dialysate before meeting goal. I'll say a prayer for you guys...you've had it rough! 

[Simon Dog]

Be sure you step on and off your scale at least 3 times when getting your pre and post weight.   I've found it sometimes gives readings that are inconsistent, and it takes a few tries for it to "settle in" and give consistent readings.

[Vt Big Rig]

I do weight three times.

Get this NxStage wants to tell me this is in spec. He compared what I took off (0.3 when set at 0.8 ) to the 40 liters of dialysate.  Huh??
Their brilliant solution is to send me a thumb drive to download the jewel box.
So, for now I guess we run with no idea how much he fluid it will take off.