NxStage Alarm #14

[HemoHelper]

My partner have been on Nxstage for about two months.  She gets to sleep while I attend to the alarms. She is on nocturnal (7 hours) treatments.  The machine has introduced sleepless nights for me.  It keeps alarming yellow #14.  Yes, There is air in the dialysate line.  it is located at the cartridge in the line between the heater and the cartridge  (green clamps).  There is a chain of bubbles that goes in and out like it is breathing.  These bubbles are present after the prime.... so it is there before I do the tubing switching before connection the patient.   I am very careful when hooking up the cartridge (green clamp) to the heater (green clamp) I let it drip dialysate into the connection before tightening to make sure there is no air bubble enter the system.  Guess there is some bubbles coming from the heater later when the treatment is running.... Don't know as I try to get some sleep and not up until ALARM #14 wakes me up.  Is anyone else on Nocturnal having this problem?

NxStage suggest that I increase the dialysate rate to 3.5 to try to pull the bubbles thru the system.. When I try to increase the flow to 3.5 from 2.8 it only allows me to increase to 3.2 (clinic set FF max 30) The only way to get it to 3.5 is change the UF rate to a lower rate.  Then the treatment time is longer because of the rate change.  This is unacceptable as I would like to get the UF and Hemodialysis to end about the same time...Which I now have about 7 hours.  I've tried to extract the bubbles from the line by using a syringe with some dialysate attached to the line coming out of the cartridge.  Would you believe I actually get about .2 cc of air.  Some nights this works and other nights I still get the 14 alarm.  but it is better.  By the way the alarm 14 happens any time after 2 hours into the treatment. usually happens before the #2 alarm.  Usually after the 14 alarm is reset within 5 minutes the #2 alarm (Normal Check) comes on....

[goofynina]

This sounds like a job for "EPOMAN"    

[leafsunbear]

I have had something simular.  The first time I had problems with #14 it was the cartridges and we had to change to a upgraded version of my cartridge.  I use nocturnal cartridges.   The #14's were non recoverable from though.  When you prime the green circuit do you prime the extras by the bags first, then the one on the front of the heater( the one you hook to the cartridge), and then the one at the top of the heater.  My nurse told me that this is the best order to prime the lines in.  SHe said this helped prevent getting #14's all night.  Are you using the 162b cartridges?
LSB

[Treasure]

Hiyas!  I'm returning to NxStage after a little transplant break...I was on 6 dailies before...this time I want to try nocturnal. Can someone give me a heads up what nocturnal is like?  I used 4 bags of dialysate on daily...how many do you have to hang for night runs?  What about sleep positions? Hmmm. I don't even know what else to ask at this point... what else should I consider before we get started on nocturnal?

Michelle  ~  Treasure

[Rerun]

Just a "hint"....go up to search and type in Nocturnal and see what it brings up.  I know it has been discussed several times on this site. 

Thanks - Rerun - Moderator

[HemoHelper]

I have had something simular.  The first time I had problems with #14 it was the cartridges and we had to change to a upgraded version of my cartridge.  I use nocturnal cartridges.   The #14's were non recoverable from though.  When you prime the green circuit do you prime the extras by the bags first, then the one on the front of the heater( the one you hook to the cartridge), and then the one at the top of the heater.  My nurse told me that this is the best order to prime the lines in.  SHe said this helped prevent getting #14's all night.  Are you using the 162b cartridges?
LSB

Thanks for your suggestion
Yes, I am primiing the dialysate lines as you have suggested.  What is the NOCTURNAL Cartridge?  The cartridge that We are using is CAR-161-B..... The bubbles in the line are present after I prime the system by inserting the priming spike into the salline bag and press the priming button.  after the lines get primed and the machine is in state #23 there are bubbles in the green/white clamp line. It is like alive and breathing it goes in and out of the cartridge.  I have been successful extracting the bubbles with a syringe before I hook the patient up.  It works and am now able to run 7 hours without the #14 alarm.  (Three days of sleep)....  There must be a better way.  Also had the opportunity to look into the cartridge after a treatment with the 14 alarm and noticed that there were bubbles trapped in the line.  Guess the line that is in the cartridge is reduced just before it comes out.  Cutting it open there is a step or bump there and the bubbles are stuck there.....  Thanks again 

[HemoHelper]

Hiyas!  I'm returning to NxStage after a little transplant break...I was on 6 dailies before...this time I want to try nocturnal. Can someone give me a heads up what nocturnal is like?  I used 4 bags of dialysate on daily...how many do you have to hang for night runs?  What about sleep positions? Hmmm. I don't even know what else to ask at this point... what else should I consider before we get started on nocturnal?

Michelle  ~  Treasure

Hi there;

Nocturnal works best for my partner.  We are using 4 bags(20 ltrs) per treatment.  My partner has been on Nocturnal for about 5 years.... Most is it was on the Fresenius machine.  This past two months she has been using the Nxstage.... sleeping position has been mostly on her back or on her side facing the machine.  Yes, the tubing do get pinched and the machine will alarm.  If you partner is there to let you know that you must change your position before the alarm will go away after the machine is reset.  Also since you will be doing it 6 days a week, usually the first treatment after your break you will be carrying the most liquid that needs to be removed.... Just remember that you have 5 more days to remove it.  So don't try to take it off all at once.... Cramps will cause you unnecessary pain.... And after a while you will find what your max is.  Just stay below it and you will not have those painful cramps.  Also I do not how you will be attaching yourself to the machine.... My partner has been using a cathater so we don't have to worry about the needles leaking or disconnecting.  Heard some where that there are blood leak detectors of some sort that people are using... Don't know anything about it.... We have noticed that during the long treatments she has been getting rather COLD.... Three blankets and she still feels a bit chilly in the morning.  Have the dialsyate heater at MAX... she still feels cold....
Our adivice would be go for it  Nocturnal is doing wonderful for my partner.  It is scary at the start but the rewards are will worth the trouble of doing at home on your own time....

[leafsunbear]

The nocturnal cartridge has the heparin pump line and no arterial pressure pod.  I am using the 161-B cartridge also.  When you chase the air do you also chase the air in the dialysate lines?  When you have the cartridge in your hand turn it over so the lines are coming out towards you and turn it so all the air in the dialysate lines leaves the arterial side or red side of the cartridge.  Then just like you do with the rest of the lines pop and snap the dialysate lines to get the air bubbles out.  Do you inspect your cartridge for loose connections before you put it in the machine?  If not you should start doing that too.  I hope this helps some.
LSB

[HemoHelper]

Thanks for the information.  We are using the 161-b cartridge also.  Yes, I do get all the air out of the lines when I do the snap and tap.... even out of the dializer... Can't get the bubbles out of the line that comes down the priming spike the one with the white and green clamp that goes to the cartridge.  This is where my problem with the 14 alarm is.... What's strange is  sometime even after I extract the bubbles out of the line that is coming out of the cartridge (Green Clamp) before I connect it to the Heater line... I still get the 14 alarm.
I mean I really do extract air out of that line and somehow it returns.  Maybe some if it comes from the heater but I make sure that when I connect the heater there is no air introduced then.  The heater air trap has only the two air bubbles in the corners and I sometime still get the alarm.... Sometimes you can see the bubbles go in and out of the cartridge when it is running but the darn thing does not alarm.... Why?? anyway I check the cartridge after the treatment  by peeling off the paper that covers the tubing.  Yes; you guest it; there is air  trapped in the tubing behind the joint that reduces the tubing size....before it exits the cartridge...
Mel posted  on forums.homedialysis.org on what Nxstage suggested to fix this problem that is the 14 alarm.
I need the run the dialysate rate higher up to 3.5 (Was suggested to me also by Scott at NxStage).  When I tried this checking the line with the bubbles it did nothing the chain of bubbles still was present and stayed that was for about 1/2 hour before I decided to change it back to the way that we normally run.  Any way by increasing the dialysate rate it causes the Hemodialysis to finish before the Ultrafiltration.  Yes, you can run that way but now what keeps the blood that circulating through the machine WARM.... No dialysate is going from the heater to the dialyzer.  My partner is already cold.... Never had the problem of getting cold when she was on the Fresenius machine but with nxstage even with three blankets she is still cold at times.... Will call Scott at NxStage Monday and see if they have come up with other suggestions....
Thanks Again