hey guys.. got a nxstage question

[Neo]

I might be starting it soon. Now im doing 6 hours 3 nights a week, im actually on right now at my unit. i come off at about 1am. I was told by the nurse at my unit who is going to do the training that  i would have to get my EPO, zemplar, subcutaneously. Isn't there any ports on the lines to inject that stuff? There is no port in the line to inject meds?? if not why not? I get EPO just about every treatment not to mention zemplar, benadryl iv as well..

[willowtreewren]

There is a port on the cartridge. Once during training, when I forgot my husband's Heparin, they shot it in the port.

I did ask once about the Epogen and they said that it would have to be given subQ.

I am not sure why. But NxStage gives you lots of freedom. I'm sitting in my den with my husband while he is having his treatment right now. And we are taking it to Massachusetts next week to visit our daughter. We even take it camping.

Aleta

[Bill Peckham]

I might be starting it soon. Now im doing 6 hours 3 nights a week, im actually on right now at my unit. i come off at about 1am. I was told by the nurse at my unit who is going to do the training that  i would have to get my EPO, zemplar, subcutaneously. Isn't there any ports on the lines to inject that stuff? There is no port in the line to inject meds?? if not why not? I get EPO just about every treatment not to mention zemplar, benadryl iv as well..

Between now and 2011 there is an issue with reimbursement that makes it unlikely you could continue to get Zemplar or Benadryl IV at home, one good thing about expanding the payment bundle is that units will have the option of providing IV meds other than EPO once the expanded Medicare payment goes into effect - due to be 2011

As far as getting it into the lines - before you hook up you could inject into the needle lines and there is a port on the artificial kidney to bleed air that some use to inject IV meds. The nocturnal blood tubing set has a heparin line which could be used for any med.

Generally if you switch to IV Arnesp for your EPO you would need it less often - once every two weeks vs. 3x/week; I've never heard of anyone getting IV meds each treatment when doing 5 or 6x/week

But the issues are all around unit policies and reimbursement not the device. You may find that with more frequent dialysis you wouldn't need all the meds or you might need less meds. Overall you'd probably feel better but there are tradeoffs.

[funnygarcia]

My husband also had multiple doses per week of EPO in center.
After using NXStage at home (short daily), his EPO needs have dropped tremendously.
At first it was once a week sub-Q, now it's one or two doses every couple of months.
His neph added IV push iron to be given at monthly clinic vists, that too may help keep EPO needs to a minimum.   

[jbeany]

I did hectorol thru the filter port, twice a week.  I did my epo sub-cu, usually once a week, but I didn't always need it.  Iron was the only problem - the insurance I had would not pay for it if I did it at home.  I had to go to the transfusion center for the hours long IV when I needed it, but that was rare.  It was more of a billing issue than an ability one.  I know the clinic sort of skated around the billing issue for the hectorol.  I kept a monthly log sheet of med doses and the times I took them, and faxed it to the clinic each month.

[Wallyz]

I do aranesp twice  a month.  My hemoglobin production went up after I switched to nxstage.  Its not bad.  You can use the blue port at the top of the filter for in line medication it you need it.

[Neo]

Thanks for the info guys... The reason I want to know about the I.V meds is because if I do the home diaysis i plan on keeping almost the same dialysis schedule but 4 nights a week, because im doing well now my dialysis adequacy is 87% and the only times i can do it is late at night because of my schedule and my partners schedule. But that extra treatment will be priceless because I want to stay as healthy as possible til I get a kidney. If any of you stumble on any more info about it or if the have equipment that allows it let me know. Thanks again for the info Its greatly appreciated. Stay healthy everyone!!

[M3Riddler]

You do not have to give Epo, Aranesp subq. It can be given through the port on the cartridge filter.
I was always told that subq is the prefered method because it gets absorbed better and can last a little longer, but who knows.
I use Aranesp and usually get it once a week at home depending on my hemoglobin level.
Iron is a different story. There is a better chance you will have a reaction, especially if you have not had it for a while. This is one drug that is not approved for to be given at home. They started me off on a low dose and then switched to a higher dose next time i received  it since i had not used it in over 4 years. They inject it over a 10-15 minutes period  using a butterfly needle when i get labs.

There is also a discussion about iron on the nxstageusers.com website forum. the link to the thread is  http://www.nxstageusers.com/forum/forumdisplay.php?f=4

Hope this helps.

[monrein]

My understanding is that Aranesp is OK in the lines (longer half life) but that Epo should be given sub q since it is better absorbed and less will be required.  In the US giving it in the lines is one way to make more money but I'd consider that wasteful, myself.