Forced to switch from Baxter home Choice to Fresenius Liberty Cycler

[cath-hater]

thanks for the reply Wish. yes, that did make sense.  so basically, everything goes through the heater bag before it goes into you. yeah, i decided to stay on the Fresenius system for now. our clinic is still half and half, so they leave it up to the patient. they do tell me that every NEW patient they get, is automatically put on Baxter.  they prefer Baxter because, apparently, most of the hospitals in the area use Baxter and drives the nurses "crazy" when they get a Fresenius patient. all they have to do it connect an adapter. i don't see the fuss. when i was in UCLA recovering, they too use Baxter. so they gave me an adapter and it went fine.

[HouseOfDialysis]

Reading this thread actually is making me feel better about doing my Baxter CCPD training tomorrow. I'm hesitant about doing it just because of the time involved. I'm set for nine hours and 6 exchanges, versus my 4 exchanges a day now... We'll see how it goes when I get the unit home on Wednesday night.

[WishIKnew]

I sure miss my Baxter HomeChoice cycler!  Good luck to you!

[Mike_NC]

Just me complaining again but, I really hate the Liberty.   

I've missed more dialysis treatments in the few short weeks I've been on the Liberty than I had in the three and a half years I did the Baxter machine.  Last night the cart moved and the machine came unplugged.  Of course with the Liberty that means a whole new 20 minute  set up....while my poor husband was trying to sleep.  Oh, forget it!!!!!  Very frustrated with the Liberty!!!!!     Still doing antibiotics for the peritonitis I got right after I switched....    RANT RANT RANT!!!!!!!!!!   

WHY DON'T I, THE PATIENT, HAVE A CHOICE?

I too have faced just about everything you have spoken about, in regards to the Liberty cycler. It doesn't even compare to the quality of the Baxter cycler. I have been doing PD for almost 4 years now and in the 4 months that I have been on the Liberty cycler, I have not had one single good night's rest. I was furious with my clinic and the way the handled the change. I went in for labs in Jan and was told then that I would need to come in for 3 days of training to switch to the new cycler. I get 3 days notice when the clinic had been training new patients on the Liberty for a year or more. Not a single word spoken to me about a possible change. The Baxter cycler is hands down the best cycler of the two. I am presently on my 3rd cycler since Feb and was told today that I now have a new machine waiting for me at the clinic, with supposedly updated software, to address the sensitivity of the cycler as well as adding a manual drain (which id a necessity for me due to catheter position) I currently have to make sure I am sitting up for the final drain or else I have to disconnect from the cycler and then reconnect to a manual drain bag because I get close to 2/3 of my total UF from my final drain. I will be part of a test group for this new software so I really don't know what to expect. I am supposed to get a call tomorrow to set up a time for training on the new machine as the new features apparently add a couple more screens to trudge through, as if there aren't enough already. Now as far as the situation regarding peritonitis...Today I happened to ask about peritonitis and if I was in a majority or minority, being that I have not ever had peritonitis. The conversation quickly turned to an area that made me very uncomfortable. She told me that she has seen more cases of peritonitis since the switch to the Liberty cycler, than she has seen in the 18 years she has been a PD nurse at the clinic. She and my Dr confirmed that the 'bug' causing it was in fact 'gram negative' which means something internal rather than some sort of outside contamination, or mishandling of the equipment. My regular prescription calls for 2 - 1.5% bags over an 8 hour period. If I notice fluid retention in my legs, then I was told to alternate either 2 - 2.5% bags or 1 of each for a night until fluid is removed. With Baxter, there were no issues at all. I could use 2 - 2.5% bags in a night and be fine. With the Liberty cycler/Fresenius solution I have used 1 of each when needed and have had the uncomfortable side effect of being constipated the following day. My Dr seemed interested in what I was saying because it seems that the stronger 2.5% solution may well be drawing water/fluid from my bowels. The 'bug' I referred to earlier in the patients that have peritonitis is common as something originating in the bowels. In my opinion, Fresenius has a long way to go before their cycler/supplies are up to par. I would give anything to go back to a Baxter cycler and I am considering changing to another clinic that uses Baxter cyclers, but the financial strain of having to travel out of town to another clinic is going to make such a transition next to impossible at this time. Being on a limited disability income, it's all I can do to survive month to month as it is. I feel as though I'm being backed into a corner and left with no options. Please forgive the ranting here but I need to get it out. Bottom line Baxter is far superior to Fresenius/Liberty.

[WishIKnew]

Mike - FASCINATING!

Since my last rant I have gotten perontintis AGAIN - gram negative, from a micro perferation of the bowel.  Sound familiar?  I had been infection free for over two years when I was forced to switch from Baxter Home Choice to Fresenius Liberty Clcler in March.  I have had THREE bouts of peritonitus and TWO hospital stays since switching.  I have been told that the next infection I get I will have to switch to hemo!!!!!!

It seems to me that the Liberty is not only a pain  (time consuming, too many screens, too many alarms, etc) but DANGEROUS!  What do we do?

My solution for now is to refuse to use the Liberty Cycler.  I am doing manual exchanges only now, which I don't like but I feel like every time I'd hooked up to the liberty I was playing Russian Rullette!  They picked up my cycler and cycler solutions and delivered all manual solution for next month. 

How do we get statictics about the frequency of peritonitis on the Liberty versus the Home Choice?  I've never filed a law suit in y life, but this is criminal if people are being forced to switch to a dangerous machine all because of the all-mighty dollar!!!!!

[cath-hater]

To Mike and Wish -

It concerns me reading your rants and how you both have gotten peritonitis after using the Liberty cycler.  I personally have not used that particular machine, but am with Fresenius. I use the Fresenius Newton IQ, the one that comes with it's own stand. As I've said before, I've been doinig DX for 9 years and never had any case of peritonitis with it. I've alwasy been with Fresenius and using the same machine throughout.  Since your clinics are switching over to Fresenius, will they be willing to train you guys on the Newton IQ machine? IMHO, it's a far better machine than the Liberty cycler (from what I've read).  Since it sounds like you 2 are stuck with Fresenius, try asking for a better machine. I don't think asking for replacement with the same type of machine will change anything if it's THE MACHINE MODEL that is defective.

Let me tell you about my experience with my machine so you can compare it with your current one.

One major difference I can tell you between Baxter and MY Fresenius machines is the pump.  I don't know if the Liberty cycler has a pump or not.  Newton IQ has no pump to extract the fluid from you or to put the fluid in you, so it works mainly on gravity.  This means that bed HEIGHT LEVEL is crucial.  The height of the stand is about 5 feet, higher than your standard bed. Your bed height should be anywhere between the height of the machine and the floor.  If I stand during drains, it comes out faster. If I lie down (as apposed to sitting), it goes in faster. I can't be standing while filling or it won't fill and the alarm will go off.

Most nights my machine will alarm because I rolled over my line, but rarely will it be a machine mal-function.  My machine does work on a scale system, so you shouldn't touch it while filling or draining. It also has a slot for a programmable card for your prescriptions, burt I don't use that feature.

It is fairly easy to setup. You have your basic tubing that you must setup everyday.  You can have drain bags or a drain line. The programming of the machine is very simple. You can change your prescription "on the fly" also. Meaning that in the middle of your session, if you changed your mind about the dwell time, number of fills, etc.. you can just change it on the machine. You can also disconnect as many times as needed using their multiple transfer sets (MTS sets).

Fresenius claims the Newton IQ is their most advanced machine offered for APD.

Inquire about this machine at your clinic and find out if they can switch you over. Since you both feel like you were shoved into a corner with no options, try this exit.

[Willis]

I would give anything to go back to a Baxter cycler and I am considering changing to another clinic that uses Baxter cyclers...

Mike, if you don't mind saying, where are you? I'm in Huntersville and the PD clinic I'm going to uses Baxter.
 

[CHeatherS]

Ok, so I am new to all of this, only a month on PD, and I started on the Liberty cycler, which the center had must moved to from Baxter.  So, I don't know the difference personally.  The workers at the center (of course) say this is best, yadda yadda....  but I sure don't know.  I am on my third cycler machine, but I think that it's because I was trained wrong, to put both bags on the scale while connecting them and breaking the cones..... well, a support person said you NEVER put more than one on the scale.  So..... that's fine...  So now I am only having an occasional "patient line blocked" alarm, and that's often my own fault. 

So, I would really like to know more, and of course I am not going to hear anything from my center.  The other center I could go to, I don't know that I could keep my nephrologist (who I really don't want to lose).  But I do want the best....   

[wildcat]

Hello all,
I am on Liberty and used to hate my machine.  I would have system alarms every night.  Usually it was because the cassette and door sensors were not working well.  The machine even stopped reading an IQ card which has my prescription on it.  After calling tech support 3 or 4 nights in the same week, they offered me a new machine.  I have heard bad stories about their equipment so I was not expecting to much, I could always do manuals if all else failed.  The tech support said that they were developing new software that was not as sensitive to alarms and to the patient.  My new machine showed up and it had a more recent software version.  I am starting to like liberty again, (they should of never replaced newton machine that worked well).  The only alarms that I get are patient flow blocked alarms which is because I tend to be a restless sleeper and often end up laying on the line.

If you are getting malfunctions and alarms with the machine, (that are more than patient alarms for being on the line), call tech support right away.....even at 2am to let them know.  Also keep a hand written log of each alarm, day and time of occurrence to report Fresenius tech support.  SQUEEKY WHEEL GETS THE GREESE.

[Mike_NC]

@WishIKnew.... Just to clarify, I haven't contracted peritonitis...yet. I too will probably move to the manual bags but I am not certain that is a solution to the problem. Personally, based on my experience there seems to be a difference in the solutions. The 2.5% of the Fresenius solution seems stronger than the 2.5% Baxter solution. I will be doing a lot of my own investigating into this mess, regarding getting the statistics of infection rates since the switch. I have considered retaining a lawyer to help, but financially I can't at this point. I have one nurse at my clinic that is more forthright with information, when the others try to paint a better picture, so to speak. You mention the idea of a lawsuit and I can see that as a distinct possibility if Fresenius doesn't get their act together...and fast. Of the 5 most recent peritonitis cases in my clinic 3 were in the hospital and 2 had lost their catheter. I'm not fond of the head nurse at my clinic as she is often condescending in her tone and will surely cover up any potential problems. As you said, this is about the all mighty dollar. The contract with Baxter was terminated either in March or April and both sides are being childish and cannot work together. At my clinic, it's either go Liberty or go somewhere else.

@Cath-Hater... I'm not familiar with Newton IQ, but I will inquire about it. I'm not sure the gravity system would work for me, but willing to look at all alternatives that could be available. You asked about a pump on the Liberty and yes the Liberty works on a pump system like the Baxter cycler did. Never had an issue with the Baxter cycler though. Rarely ever got an alarm and the ease/speed of set up and break down was much nicer than the Fresenius set up/break down.

@Willis... I'm in Greenville. The closest clinic to me that still uses Baxter is about an hour drive for me. I wouldn't be able to keep the same nephrologist (who I do like) but it would be an associate within the same practice as my present nephrologist. The financial strain is what is keeping me tied down to my local clinic right now. With the cost of gas and the fact it will probably increase more, I am stuck where I am. It's all I can do right now, getting by a a small disability income.

@CHeatherS... The Baxter cycler is a dream in comparison to the Liberty cycler. Generally my clinic is the same way as far as promoting the Liberty but all the nurses do admit, although sometimes hesitantly, that the Liberty cycler does get a lot of complaints from the vast majority of patients. As far as your training, I too was trained to put both bags on the cycler tray during set up and breaking of the cones, but ONLY after the prompt on the screen to connect bags and drain line. If I do it to begin with the machine instantly sets off an alarm. Not sure why you were told differently by a support person, but I know the protocol that my clinic goes by is to place both bags on the tray during set up.

@wildcT... The new machine I will be getting (I train June 9 on a conference call with the person performing the trials on this newest version) supposedly addresses the sensitivity issue that liberty cyclers are notorious for. I hold little faith in the Liberty cycler and my one call so far to tech support (my cycler basically just froze up entirely) was a waste of time. The person I got at 3:00 am really had no info or support for me other than to tell me that I could either disconnect and stop treatment or get 2 more bags and start the entire cycle over again. The main alarms I get are also due to flow, whether it be drain or fill and yes usually it's because of my position or because the line is kinked. That's another thing I don't care for on the Liberty cycler. The tubing is so flimsy that it's very easy to pinch it or kink it,causing alarms. The cassettes that came with the Baxter cycler had much more firm/ stiff tubing that was more difficult to kink by rolling over. I used to be a restless sleeper myself, but since being on dialysis, I sleep only on my right side, which is completely opposite of how I was pre dialysis.

To everyone... I wish everyone good luck with your individual cases and as wildcat said ...squeaky wheel gets the grease. Well my Dr and nurses at the clinic are well aware that I squeak A LOT...so far to no avail though. I am very outspoken with my care and don't take whatever the nurses, or even what my Dr says as the gospel. Over the last several months they have begun to trea me based on an algorithmic scale that is based on all patients rather than me as an individual. When I speak up about it, they are usually receptive but I have to stay on my toes and pay close attention to each and everything they do, or want to do. They have wanted to medicate me based on their algorithm even if I didn't need it. Be very proactive with your care as you know yourself better than anyone else does. I will check back soon to see what everyone is dealing with and if any solutions or new info have been found. Take care everyone.

[CHeatherS]

Thanks Mike......  I am feeling squeeky.  It's 1 am, another System Error on my third machine, in less than a month.  This is NOT good.  I see my doctor tomorrow, and am going to see what he says.  Crap!

[Mike_NC]

Thanks Mike......  I am feeling squeeky.  It's 1 am, another System Error on my third machine, in less than a month.  This is NOT good.  I see my doctor tomorrow, and am going to see what he says.  Crap!

I hope all went well with your appointment. Really curious if you get any "grease" for your "squeaking". I'll check back soon to see if you have any news.

[CHeatherS]

Well, there was so much going on for this doctor appointment:  the news that my donor was accepted (after over a year!!!!!!!!), and my heart was skipping beats, needed an EKG.   This doctor said he knew there was a lot of politics involved, but he hadn't heard complaints about the Liberty machine.  So, I put a lot of questions in his head, and he is very good at listening and checking into things.  I see him again in two weeks so it will be interesting.

Last night I had a lot of alarms in the beginning, patient and drain lines, even though I could clearly see there was NO blockages.  A head nurse from Fresenius had told me that it could be inside at the catheter.  But I kind of doubt that.  But at least I went through the whole night once it got going, with no alarms.  Who knows, maybe it will be alright. 

Another thing I took issue with, which the doctor was surprised to hear, is that once you mask and wash up, then there is the process of connecting the lines (including the drain line, which would be a TOILET).  I told him that it just seems to me that it should be separate.  That means (and it doesn't instruct you) that you have to wash AGAIN so as not to come back and have contamination on your hands for connecting yourself.  He was surprised, thought that you just used bags to drain.  Nope, that's not the case.  So, I think he will be asking questions.  He is from Poland, so isn't of the same stripe as some of our FDA and Drug company doctors in this country. 

[Mike_NC]

So Congrats are in order for donor being approved...  for you!! Stay vocal with your Dr though. Sometimes they will take a neutral approach so as not to rock the boat. Sounds like he at least listens and will take your thoughts into consideration. So stay squeaky lol.

As far as your alarms, well, the Liberty can be so darn sensitive, who knows. Have you ever had an issue with fibrin? I have had some fibrin but can't necessarily associate it with alarms, although I can't discount it either.

The contamination issue you brought up is a very serious one indeed. My clinic trained me to use the long drain lines and take them to the toilet, or to use drain bags, which are a pain. I only use them (drain bags) now when I have an adequacy test done. I was trained also, to restart the process of washing hands, new gloves, etc. after taking the drain line to the toilet. After a few nights of doing that I decided to go back to the way I did with the Baxter cycler. I just put the drain line in the 5 gallon jug that I used from the very beginning. It eliminates some extra trash ( the 2 extra drain lines and wrappers they come in) and once I'm in my bedroom and setting up I don't have to break routine and re-wash my hands and get new gloves and such. It already takes 2-3 times longer to set up the Liberty as opposed to the Baxter cycler so using the drain jug just works better for me.

[tito]

I don't have much experience with the Liberty machine, as I have used the Baxter system for almost two years.

However, I just had a hip replaced at New England Baptist, and they use the Liberty. I had a PD nurse twice a day to set up and to disconnect. I watched the process, and it seems fairly equivalent to Baxter. I had no alarms, no problems at all. I actually like the Liberty machine, as the screen has much more information and is very easy to use.

Baxter recently did away with their little contraption to spike bags under plastic. Now you do it manually. More chance for infection. Plus, their new bags in the US have frangibles that you have to break. I have had several defective bags where the frangible doesn't have a proper opening for the fluid to pass through. You don't find out until you're ready to start - and since I have to be up at 5:30 am, I didn't bother throwing the whole mess away when I got a defect. Just skipped for that night.

[Mike_NC]

@tito...after 3+ (successful) years on the Baxter machine, I am still wishing I could go back to it. Yes, the display on the Liberty is 'informative' although I feel the Baxter cycler is superior to the Liberty. I am on my 4th Liberty cycler since I started using the Liberty in Feb. I'm currently working on a trial machine with new software. While there have a been some improvements, there is still much room for improvement. This software version has a 'stat drain' option that can be used if overfill is suspected or if for some reason you need to stop fill and drain out. Also instead of being set at 85% for drain volume, it has been lowered to 70% in an effort to stop drain alarms. The one function I was promised would be on this software version is a manual drain, which I need due to catheter position. Rougly 2/3 of my total UF drains in the final drain and I have to be sitting up for me to drain properly. Unfortunately, that was not the case. With the Baxter cycler I was able to sleep past the treatment time, and the when I would wake up I could simply hit 'manual drain' and complete my treatment. If I sleep past my treatment time on the Liberty, I have to disconnect from the machine and then reconnect to a manual drain bag, thus opening my catheter twice and, to me , that means a slightly higher risk of contamination. I mean why open the cath twice when I should only have to open it once? Personally I believe the Liberty was pushed into production, and onto the patients before it was truly 'ready'....for financial reasons.

Not sure what you mean by the change Baxter made to their setup with the spike bags, and the higher risk of infection. Before I was switched to the Liberty they (Baxter)  had changed the bag connections to a twist on style connector, which is similar to the connections that the Liberty uses. The Liberty solution bags have 'cones' rather than frangibles and can be troublesome if not broken and moved from the neck of the bag. Also need to be watchful of the patient line on the Liberty. I recently went though setup and was ready to connect but happened to notice that the patient line had no solution in it. My fault because the line had been caught under a wheel on my cart, but there was no alarm to show that the line was blocked. If you've ever had an air pocket, you know how painful that could have been. Also had a night recently when the Liberty would flush the lines but would not prime the line. Maybe a fluke but still first time it has ever happened. My confidence in the Liberty is quite low even with the 'improvements'. I still stand by my statement the Baxter is superior to Liberty.

BTW, hope all went well with the hip replacement. My sister had that done several years ago and has done great ever since.

[WishIKnew]

My life has been one steep downhill tumble since my forced switched from Baxter Home Choice to the Liberty......  Can't help but think there's some cause and effect going on....  I'm glad that others of you have found peace with whichever cycler you use!!!!!

Mike - so glad you're fighting the fight to make the Liberty better!

[pkav1]

Air in the peritoneal is so painfull, my shoulders one night nearly made me faint until i thought about it, pain defferal from under the diaphragm gives you shoulder pain so i put my legs up in air against wall and a pillow under my lower back so any air under my diaphragm would move to my lower abdomen.....relief.