Snap and Tap????

[kimberlyn50]

Ok, so it seems like it takes me forever to get through snap n tap.......am I being too picky?  It sometimes takes me 20-30 minutes or more to get these lines clear.  I've heard that it ok to leave some small air bubbles...but can someone define small???  It seems like no matter what, small bubbles  re-appear...I think the lines are clear....then I check one more time and there's more!  I'm doing everything right......just these darn bubbles make me crazy!! I was told by my training nurse the longer you let it sit at 23 the less air..but found that not to be true.   I welcome anyone's experiences or advice...

[willowtreewren]

We are most concerned about the large bubbles that run up the lines when banging on the cartridge. I think you might be seeing what we call micro-bubbles that stick to the sides of the lines. Those are less of a worry than the big jobs!

Our snap and tap takes about 5 minutes. We sometimes do a third time through, but usually, only do the circuit twice.

Aleta

[kimberlyn50]

Wow! 5 minutes!  Oh what I would do for that!!  I'm definitely going to reconsider what I'm doing then.......i
Thanks Aleta!

[cdwbrooklyn]

Hi Kimberlyn50,

First and foremost, I'm glad you decided to give it another chance.  I've read your post when you were having problems.   It will get easier as you guys move forward.  That said, what works for me when it comes snap and tap, I would snap the red line first as hard as I can starting from the top (close to saline bag) to the bottom (close to cycler).  Then I would go to the dialyzer and bang the bubble out, then I'd go to the blue lines and snap from the bottom (close to the cycler) to the top (close to the saline bag).  I would do this routine twice and check for mirco-bubbles.  It usually work but sometimes I may have to do the routine again. It take me about 5-10 minutes. 

Before starting to snap and tap, I'll let the machine sit at "23" for about an hour and half when I come from work.  I work from 9-6.  It gives me time to have dinner and do minor things around the house before I start my treatment.  I get on about 9 or 10 o'clock.  I'm usually off by 12 or 1am.   However, this routine work well for me.   

Hope this helps!   

[M3Riddler]

Ok, so it seems like it takes me forever to get through snap n tap.......am I being too picky?  It sometimes takes me 20-30 minutes or more to get these lines clear.  I've heard that it ok to leave some small air bubbles...but can someone define small???  It seems like no matter what, small bubbles  re-appear...I think the lines are clear....then I check one more time and there's more!  I'm doing everything right......just these darn bubbles make me crazy!! I was told by my training nurse the longer you let it sit at 23 the less air..but found that not to be true.   I welcome anyone's experiences or advice...

Kimberly,

The snap n tap is one of the most important steps setting up.  There is no law that says it must be done in 5 minutes, nor 20 minutes.  I take anywhere from 3-15 minutes.
I also believe the bubbles you are seeing are "micro bubbles"  Thing of pouring a glass of champagne.... if the bubbles look like that, I would not worry. 
The most important things is to get the bubbles out of the fillter.  If you see any streaking in the filter, these are air pockets in which you should try to bump out. Also check the pressure pod for air.  If  I see anything larger than a pin head, then I go another round of snap n tap. 
It sounds as if you are doing everything correctly as long as you are not receiving any air alarms during treatment...   

I have never heard of letting it sit at 23 to get air out.. I would not go by this... Just go by your gut feelings.

My motto is that you can never snap n tap too much!!!!

///M3R

[tyefly]

   I too only snap and tap for three or four full rounds....that it..... I dont worry about the small bubbles and I never have any problems with air.....   I think your working too hard....LOL

[kimberlyn50]

Thanks for your advice...I have lightened up on my snappin and a tappin , and cut my time in half..no alarms so no worries so far....lol.......

[greg10]

I have never heard of letting it sit at 23 to get air out.. I would not go by this... Just go by your gut feelings.

///M3R

I would disagree with this statement.  You can do this experiment.  Finish your snap and tap, check the amount of air in the airport in the cartridge.  Continue on '23' for an additional one hour, check the air again.  You will be surprise how much air has accumulated.  cdwbrooklyn is more correct with regards to '23' priming to remove air.

[Hemodoc]

Ok, so it seems like it takes me forever to get through snap n tap.......am I being too picky?  It sometimes takes me 20-30 minutes or more to get these lines clear.  I've heard that it ok to leave some small air bubbles...but can someone define small???  It seems like no matter what, small bubbles  re-appear...I think the lines are clear....then I check one more time and there's more!  I'm doing everything right......just these darn bubbles make me crazy!! I was told by my training nurse the longer you let it sit at 23 the less air..but found that not to be true.   I welcome anyone's experiences or advice...

Any one that has a fish tank will understand what happens with the NxStage prime producing oxygenated saline.  Look at how agitated the water gets inside the saline bag.  The microbubbles that form are simply from that rapid priming process.  I let my machine "cook" for a while before I snap and tap.  I set it up, do my errands often including my exercise which is mainly walking about 1.2-1.8 miles, then I take my shower, my vitals and finish the set up.

Then after all of that I do all of my snap and taps which take only a few minutes to complete.  Snap and tap, do my vitals, snap and tap, pick my scab, snap and tap and then set up the lines and cannulate.  I have not found any thing but time as the way to get rid of the microbubbles. 

Using this method, by the time I set up, very few bubbles remain.

Micro bubbles may have long term impact especially on the lungs, so I take those little bubbles seriously.

[boswife]

another question on the snap and tap...............  So, i have never heard of anyone snap and tapping the little lines (saline and dialystate) but i see plently of bubbles in there.   Anyone do that and it was just something i missed in class   

[tyefly]

I would think you could snap and tap that too....   I dont because it is connected to the saline bag and with movement it should take care of it self....but then I never have had to use that line...never have added saline to my line....  never have had BP or cramps....using Nxstage......

  If you think it needs to be done.....Do it...... it  makes for a peacefully mind........   

       

[Hemodoc]

another question on the snap and tap...............  So, i have never heard of anyone snap and tapping the little lines (saline and dialystate) but i see plently of bubbles in there.   Anyone do that and it was just something i missed in class   

Micro-bubbles that end up in the blood system should be eliminated to the best that you can.  Quite simply, you cannot get rid of them all.  The drain line is a non issue since that is the waste line, but the saline line is not.

I snap and tap all of my lines together, not separately after letting them "cook" for a while as the small bubbles come together into larger bubbles. Some studies have shown you can get rid of about 70% of the bubbles or more with close attention.  That is 70% less bubbles impacting your lungs causing small micro clots at the level of the lung. I start with the three saline/blood lines closest to the saline bag and then work over to the other end. I don't worry about the yellow line.  I tap the pressure pod which collects air and then I go to the artificial kidney and tap it into the palm of my hand, I don't tap it against an object to avoid any cracks in the material.  I repeat this before I pick my scabs and after I pick my scabs before hitting the stop button on the 23 prime.

The Saline line is another issue.  After I have hooked yellow to yellow, green to green and white to white, I do tap from the bottom to the top of the line all the bubbles I can see. You simply cannot hook up any of these lines and not get some small amount of air in the line, especially with the blood lines. It takes about one minute with the saline line simply leading the bubbles all the way up the line and tapping at the spike to get them all the way out.  I have lost a couple "doses" of my blood by an 11 Alarm when I start my rinse back because of air in the saline line.  Paying close attention at the start of dialysis to the saline line avoids this complication and helps me keep my precious little blood at the highest possible level.

I should note that I don't use the standard disconnect of the arterial blood line for my rinse back, but instead, use the saline line to clean the venous end and then the arterial end.  I place a hemostat below the saline infusion point so that it stops bringing in arterial blood, any small clots in the saline line and any small bubbles goes into the kidney as you start to rinse the venous line and the upper part of the arterial line.  I then stop the rinse back and place the hemostat above the saline infusion port and let gravity clear the lower arterial line.  I then place the hemostat below the saline infusion port and use the machine to clean the rest of the upper arterial line going by the pressure pod, the kidney and the venous line.  I avoid breaking the lines to do the rinse back because that is another point of possible blood contamination.  I can completely clean my lines with them still closed and then once they are clean, I open and disconnect them without any further rinsing once again to avoid possible blood line contamination. 

One of the biggest risks of dialysis is blood borne infections.  In my opinion, this helps reduce that risk significantly. The number of bacteria that reside on the size of a pin head would astound you.  It doesn't take a large contamination to cause an adverse outcome.  I don't believe that is taught as a rinse back method to most folks, but some may remember this as the standard in-center rinse back for a lot of folks.  It may take  more saline to accomplish than the other method, but for my own use, that is not an issue since I don't have fluid restrictions at this time.  As with all issues, it may not apply to your situation so discuss any information placed here with your own medical team first.  In my opinion, it just helps reduce the daily risk of blood borne infections which can be deadly.  Be careful out there folks, it is a daily battle.

[Bill Peckham]

Peter you snap and tap the dialysate lines?

[Hemodoc]

Peter you snap and tap the dialysate lines?

Sorry, meant the blood lines.

Take care,

Peter

[lmunchkin]

Seriously, guys, I dont mind doing it 3 sometimes 4 time thru the circuit, but when Iam having dreams about it.  Listen to this, the other day my husband and I were napping in bed, we have to get our "beauty sleep you know". I was dreaming that I was snap/tapping and setting up his machine. I think, in my mind, I was beating it on the cycler, desparately trying to get those little buggers out of their.  I was slamming it harder and harder against the machine, to the point of exhaustion. I remember sweating profusely, when suddenly, BAM, BAM, BAM.....I woke up to a very close neighbor beaten on our bedroom window to come open the door.  I got up and I was shaking from all that snap/tap opened the door and neighbor ask "are you guys ok?" I thought WTH, of course we are ok, Like cant you see Im trying set up for dialysis. I said sure we are okay, she replied, I kept knocking and neither of you were responding. Yea we are ok.  She left, and I thought what the heck is wrong with her. She is a wonderful neighbor, but the nerve of her peering through our window & watching me dialysis my husband.
Got back to the room and husband was still asleep and looked at the machine and nothing was on or set in it, and then it dawned on me, I was setting it up in my dream and snap/tap was what woke me up!  Didnt know this thread was here, but when I saw it I had to tell this. It was like I was setting everything up in my sleep. 
Looking back on that day, I bet me and hubby laying together in bed and her knocking, she probably thot we both were dead cause I know she almost broke our windows trying to wake us. Hubby cant hear very well so it didnt bother him, but it sure woke my up in a sweat. All that "SNAP/TAP" going on. I still crack up when I think of how real it seemed!

[boswife]

Thats so funny lmunchkin    And *almost* familiar..lol   I have gone through 'snap and tap' a few times in my sleep as well   It's amazing how that 'step' is worn into us to THAT point..lol    It's so funny to hear of anothers dreams of it..  Yours much funnier than mine, but still...................a dream of such a BOARING part of our existance...  lol

[lmunchkin]

Boswife, IT WAS SOOO REAL!  I really thought she had the nerve to peer through our windows (which she does to honestly check on us) and to think I came close to telling her when I opened the door.  Heeee Heee it so funny just how real it was!

[ihernandez]

i dont think it takes that long but i may be wrong

[M3Riddler]

Ok, so it seems like it takes me forever to get through snap n tap.......am I being too picky?  It sometimes takes me 20-30 minutes or more to get these lines clear.  I've heard that it ok to leave some small air bubbles...but can someone define small???  It seems like no matter what, small bubbles  re-appear...I think the lines are clear....then I check one more time and there's more!  I'm doing everything right......just these darn bubbles make me crazy!! I was told by my training nurse the longer you let it sit at 23 the less air..but found that not to be true.   I welcome anyone's experiences or advice...

My theory is that you can never Snap n Tap too much.  You will never get all of the micro bubbles out. I consider micro bubbles like you would see if you were to pour a can of pop into a glass. These will always form on the sides the longer you let it sit. You want to try to get rid of anything larger than this and what is in the pressure pod if you have one.  I believe the Snap n Tap is one of the most critical steps in setting up.

[CebuShan]

I have tried letting the machine set for a while in 23 ad I find that it really helps.  It was taking me 45 minutes to an hour to snap and tap! I also tap the saline bag to get rid of most of the bubbles in there. It may or may not help but it helps my peace of mind!   

[big777bill]

 I set up for the next day as soon as I'm done treatment. I let the machine run at 23 for 10 minutes. The next day after starting the machine it runs for 2 minutes before the 23 comes up. Snap and tap is 5 minutes or less. We  never have any problems with air alarms.

[CebuShan]

I set up for the next day as soon as I'm done treatment. I let the machine run at 23 for 10 minutes. The next day after starting the machine it runs for 2 minutes before the 23 comes up. Snap and tap is 5 minutes or less. We  never have any problems with air alarms.

I was told that it could not be set up more than 4 hours in advance of the next treatment?!

[amanda100wilson]

I checked with tech support at NxStage and they said 72 hours,although they were a bit circumspect, in that they said that the dialysis center recommendations trumps theirs.

[big777bill]

 I set it up 24 hours in advance. When you get all 8's and then the descending #'s you shut the machine down using the switch on the back. When starting up the next day turn the switch on the back to the on position and it will run for 2 min. before the 23 comes up. Then snap and tap and you're ready to go. I've found that we have less problems with air this way.

[CebuShan]

I set it up 24 hours in advance. When you get all 8's and then the descending #'s you shut the machine down using the switch on the back. When starting up the next day turn the switch on the back to the on position and it will run for 2 min. before the 23 comes up. Then snap and tap and you're ready to go. I've found that we have less problems with air this way.

I'll have to ask about that!