Liberty Cycler injecting air bubbles during treatment

[tmcgough]

Hi, I just started my automated night treatment with a Liberty cycler.   However, I am very woried that each night I get on it, it is injecting about an inch worth of air into me at the beginning of each fill.   It happend during training and is at home as well.  Is this normal, I thought air in the cavity would cause problems and other issues.  I told my nurse about it and she dosen't seem to be concerned.    In fact when she was training me she put the bags on wrong and filled me with even more air.

I am also concerned that the machine does not stop when it is pumping air into me.  Has anyone else seen this issue?   Is my machine broken or my nurse crazy?   Anyone else that is using the Liberty Machine, please let me know if during the first fill if it is sending air bubbles into you as well.

Thanks,
Tim.

[KICKSTART]

I dont use the sort of cycler you have, im on a Baxter. The cycler Primes itself before use , does yours?  If you watch it while its priming you see air bubbles going through the tubes, but seeing that you always start on your cycler with a drain out , i doubt that anything would be going wrong with it ?

[prospector]

I am on my second Liberty cycler. The first one injected me with air, among other issues, a couple of days prior to  changing the machine out. The pain was with me all day long. There were several issues with that cycler but this one is much better. I still get some alarms that I don't under understand what sets the alarm off. The Liberty far exceeds the Newton cycler in my opinion. I will be going on vacation for 2 weeks in a fifth wheel next week so am looking forward to getting back on the road again. Hopefully we get everthing necessary packed.

[tmcgough]

Yes everything is fine on the drain out, it is when it starts to fill that it does some sort of check on each line and when it does that, the lines that are clamped and don't have liquid in them get some liquid ejected, but a lot of air bubbles. So when the system goes to fill, the air that is in the unused clamped lines seems to get sucked into the stream of liquid that is going into fill me.
 
I called Liberty support and they said that there should not be any air going into me and sent me a new machine over night.  Sadly, this new machine does exactly the same as the one I had replaced.  That is why I am thinking this is happening to everyone but nobody is paying attention.  It is only at the beginning of the fill process. So if you are just watching the drain and then don't pay attention to the beginning of the fill, you wont see the bubbles.   I am pretty sure I am not the only one this is happening to.   After reading how just a little air in your peritoneal can cause pain and problems, I am worried that so much being pumped in every night is going to build and cause a much greater damage.   Also air in the peritoneal can lead to Peritonitis

[bmevans]

tmcgough,

Can you move your clamps up the line?  If you get air in your abdomen, you will know it!  It usually hurts bad in your shoulder areas.  I started on the gravity fed fresenius cycler which sometimes caused unwanted air into my system.  I hated it!  I changed to the Baxter cycler with a pump.  I have loved it.
I believe the purging system on the cycler is suppose to remove any air bubbles in the line.  I've never heard of a Liberty Cycler so I just am not sure how yours works.  Keep trying to solve the problem! 

[Restorer]

I'm on the Newton, and the way I prime the patient line, if I have no initial drain (which is usual, because I'm dry during the day), I get a small air bubble during the first fill. It hasn't ever caused me any problems, but it's just a small amount - maybe a half inch of air in the tube, and only once at the first fill.

I'm switching to the Liberty cycler very soon - I'll keep an eye out for air in the lines.

[tmcgough]

Thanks for your inputs.  I tried yesterday to put the clamps for the  non used lines as close to the cartridge as possible but that didn't seem to help.  Today I have put the unused lines in a u shape so that the air bubbles in the unused lines would float up and away from the cart. instead of back to it.   I still got the inch or so air on the first fill, however the unused lines at the U joint seem to be full of liquid now and no air, so I am hoping the rest of the fills for the night will be without air.   
 
Thanks for your suggestions.   I'll update you if I ever get to a successful 0 air fill.  From what I have been reading, any air is not good.  So I am shooting for 0%.  At least when doing capd you had full control over how much air was in the line so I had no air when doing it manually.  Seems that the designers could over come this if the either plugged the lines at the initial configuration since they aren't going to be used, or maby supply a 500ml bag for each unused line so that the air could be purged. 

[tmcgough]

Here are some pics, showing how I have purged the lines but still get air in the lines.  Can't seem to get tech support to offer any advice other than saying it is not suppose to happen.  This is the second machine they sent me.  Surely all PD patience on this Liberty machine are not going through this every night???  I purge the lines as much as 3 times but no difference.

[KICKSTART]

Sorry we cant be of more help only to say ..can you not possibly change the make of cycler you use? It seems like the majority of us use the Baxter one.

[Savemeimdtba]

Interesting... I've never noticed this problem (I also havent really looked).. and dont really have any pain.  The only problem I'm having at the moment is it not stopping when the drain is finished.. (just had to get cycler replaced so I'm trying to adjust to this new one) It just keeps pulling until I have to physically get up and bypass it.  The previous machine learned to stop doing this but this one hasn't yet.. it's very annoying. 

[tmcgough]

I would love to change cyclers as I really think this is a bad design.  Called customer support again tonight, they say they have never heard of this problem and will send me another unit (#2).   They also say the system has air detectors and would have given me an error if there was air in the lines.  So far, it scares me because it has never detected air even when the solution bag was set up wrong and air was directly sucked off of the solution bag top and went through the system and into me.  So now I don't sleep when I do the cycle because I am afraid that something will go wrong like the solution bag going dry and pumping pure air into me without any warnings.   Seems that Fesenius only has this Liberty cycler and does not use baxter.  My insurance company bcbs works with Fesenius but not with many others.
 
Savemeimdtba - to make sure I am not going crazy, next time you do the fill, please look at the line and see if you get a bunch of air bubbles at the beginning.  I find it hard to believe I am the only one that is having this problem, especially since this is my second cycler.
 
PS: The tech is suppose to call me again tomorrow night before I go on the system to "make sure" I am doing everything correctly.   CCPD sounds great, but so far, I don't see how anyone can stand it......
 
 

[Restorer]

I'm training on the Liberty today in about an hour at my clinic. I'll watch the lines to see if the machine I'm training on does this - though it has had other problems, so I might not be able to say that it's "normal". I'll be getting my own Liberty on Monday, and the casettes on Wednesday, so that's when I'll play around more.

[tmcgough]

Restorer that sounds great. I am eager to hear what you see and find.   Thanks, Tim.

[Restorer]

I didn't see any significant air bubbles in the patient line today when it filled the bag that stood in for a patient. I should note that in this case, there was a good bit of fluid already in the bag, the initial drain was bypassed after draining only 500 ml, and there were air bubbles in the catheter when the initial drain started. But I didn't notice what you've been talking about. I get my machine and supplies for it on Tuesday, so I'll check that one out more thoroughly then.

[tmcgough]

Thanks for the update.  I just got off the line with the main sales person and they are trying to tell me that these are "microbubbles" and that I should not have to worry about them.  But since when is an inch long bubble or a foot long stream of foam considered microbubbles.    Also, I keep trying to show them my video and pictures but they dont' seem interested.  They just keep telling me that 1300 people can't be wrong and that I am just over reacting.  But how many needles in the eye are too many needles.  When is a microbubble not a microbubble.     
 
Oh well, if nothing else, I am getting things stired up around here ;-)
 
Let me know how it goes next Wed. when you do it yourself.  The air bubbles come in at the very beginning of the fill.  If you don't look for them at the beginning they will already be in you before you can find them.
 
Thanks again for the update.
 
Tim.

[Restorer]

I did my first full and active setup on my Liberty today with the clinic staff (boy, not only did the PD nurse and other nurse (I don't know here real title) show up, but the Fresenius area manager was visiting the clinic today and decided to come along), and I just connected for the night 45 minutes ago. I wasn't able to watch the lines when I set it up 6 hours ago, but when I did my first fill tonight, I didn't see excessive air. I did get the "microbubbles," but not enough to call foam, or for it to form together into measurable bubbles. I'll note that I had no initial drain - it registered as 1 ml and alarmed because it was expecting 50, and I had to bypass. I don't know if that's a factor.

My cycler's not in the best spot right now. Tomorrow I'll be moving it to a better space, and I'll have to freedom to really watch it through the setup, flushing, priming, and first drain and fill. I'll let you know if I see anything then.

Oh, I also have the extra-long tubing sets - 20-foot drain line and 20-foot patient line with only one connection, and I have to prime it twice to fill it all.

Edit: it just occurred to me... if air's getting in the clamped lines, maybe the problem is with the cassettes. Can you check your supplies and see if you have a different batch of cassettes to try?

[tmcgough]

Thanks for the update.  That information is very helpful.  I didn't know they had 20ft patient line.  I might look into that 20ft patient line.  I hate it that I can't get up to go to the bathroom during the night because I only have a 10ft or less patient line.    Maybe I am just over reacting and have a very high expectation level of this thing.  It seems that they should be able to create the system so that no or very low air is delivered.  I'll check out a different batch of cassets and see if the same thing happens there as well.    Thanks again for your input.

[kaycee71858]

i used the liberty cycler for 4 or 5 months and i hated it. the alarms drove me crazy and my husband out of the bedroom. i never got air bubbles in me. i would get air in the cassett alarm and one bout the drain alarm. i went back to manual. now i am on hemo, and i might stay on it, i believe i feel better.

[tmcgough]

Thanks for everyones input.  I just got off the phone with the marketing people and they say that the system will allow up to 3ml of air without any issues.  And that this is ok and would not hurt anyone.  So I guess I will close this chapter as air seems to be an ok thing even though I was tought to not ever get air into me.  Thanks again for your input.  Maybe someone somewhere is seeing the same thing I am but it seems from this thread that I am the only one seeing it so I am assuming it is just me.    Have a great week.