not enough dialysate in pureflow

[happyonhemo]

   I was just in the hospital for about 2 weeks for some g.i. trouble and, as always,they filled me up with so much fluid that I came home at LEAST 10 kilos over! I'm so overloaded-everything is a struggle.I'm constantly short of breath so obviously I need to take off as much fluid as possible each treatment until I get back to normal.I asked my nurse how much I could take off each time and she said I couldn't take off more than 3 kilos each treatment and the best thing to do was to change the setting of how much dialysate to use from 20 litres up to 25.That way I could run a full 3 hrs without running out before I got all 3 kilos off.Well,that was fine for the first 2 uses of this batch but now its the third day and I realize I only should have 10 litres left.20 short for this run.I don't have time to make another batch an I hate running bags cuz I always end up SO cold that I'm shivering uncontrollably-even with the warmer turned up.I was wondering if anyone knew of a way to use a mixture of bags and the pureflow to give me enough for this last treatment.Thanx for any help!

[yliebert]

You should call nxstage for the answer.

[jbeany]

It's been a while, but I don't think it's that complicated to switch - you just have to get the bags up and running and then pause the machine to switch sources when one runs out.  I now I did it once, but it's been a couple of years since I was on NxStage.

I'm with bert, give tech support a call and have them walk you through it.

[greg10]

  I was just in the hospital for about 2 weeks for some g.i. trouble and, as always,they filled me up with so much fluid that I came home at LEAST 10 kilos over! I'm so overloaded-everything is a struggle.I'm constantly short of breath so obviously I need to take off as much fluid as possible each treatment until I get back to normal.I asked my nurse how much I could take off each time and she said I couldn't take off more than 3 kilos each treatment and the best thing to do was to change the setting of how much dialysate to use from 20 litres up to 25.That way I could run a full 3 hrs without running out before I got all 3 kilos off.Well,that was fine for the first 2 uses of this batch but now its the third day and I realize I only should have 10 litres left.20 short for this run.I don't have time to make another batch an I hate running bags cuz I always end up SO cold that I'm shivering uncontrollably-even with the warmer turned up.I was wondering if anyone knew of a way to use a mixture of bags and the pureflow to give me enough for this last treatment.Thanx for any help!

Hi happy, welcome the forum.
Although I won't go directly against your nurse's advice, I think it is possible to reduce your flow fraction by dropping the dialysate flow rate (green) so that you use about 20L, but run longer in order to pull more in total UF (Ultrafiltration).  You will likely get slightly less effective dialysis, but not overly so.  You would be doing this only for a few sessions until your excess fluid is removed.  One thing NOT to do is to increase the UF RATE too high.  The general rule limiting the RATE of 10 ml per hour per kg dry weight should be respected.  For example if your dry weight is 75 kg, then 0.01 L/hr x 75 = 0.75L per hour is the upper limit.  If you are an older person, that number should come down even more.  So in a three hour treatment, the total UF is expected as 3x0.75L or 2.25L.  In practice, the NxStage cycler does not normally do UF in the first hour, so you end up with 2x0.75L = 1.5L total UF in a 3 hour tx.
Please see this thread for calculation: http://ihatedialysis.com/forum/index.php?topic=21177.0

The other way is to do what you have been doing and then run into switching dialysate in the middle of a treatment.  The Nxstage system one cycler is a dumb machine when it comes to dialysate.  As long as you don't get too much air in the lines and get an alarm, you could stop the cycler and Pureflow and switch away with the dialysate.