HELP - the new Baxter cycler does not work for me

[purgatory]

Has anyone else has problems with Baxter's HomeChoice Pro software upgrade??  Not only do I hook up to the machine dry, I also do a last daily fill of 300ml in the morning to alleviate the nightly drain pain I still have even on 80% tidal.

The new machine does not allow you to bypass initial drain.  Unfortunately, in my case, this makes no sense, because I need to start my prescribed therapy on a fill.  I tried the new machine for one night (with initial drain set at 0), and it was a very painful experience.  You're supposed to get a "low drain alarm" after which you are supposed to be able to bypass the initial drain.  I never got to that point.  The machine tried to drain my fairly empty abdomen and did not stop - it was excruciatingly painful.  It did drain mercilessly for about 10 minutes (!) and then finally went to the first fill.  The rest of that night's treatment was also very painful, since the machine had drained out most of my 300ml buffer which generally helps me greatly with against drain pain.  FYI, I am very sensitive to pain, but there is nothing wrong with my catheter since it works perfectly with my old machine.

They also seem to have changed the flow rate, at least on the machine they sent me.  It drains twice as fast as my current cycler.  Not only does it feel like the machine tries to pull my intestines out during the drains, it also gave me "Check Patient Line" alarms during the night, which I never ever had with my old cycler.

I got less than 2 hours of sleep and was still in pain for part of the next day.  Not an experience I would like to repeat, especially since the old cycler works great for me.  For the time being, I have held on to my old cycler.

I really need to keep my old cycler since the new machine will never work for me.  So far, suggestions I have gotten from my providers are all geared towards adjusting my body to the machine, not the other way around.

I am pretty desperate since I will not be able to use Baxter's new cycler in its current configuration.  I do like the Baxter cycler and have heard some mixed comments about the Liberty cycler.  Does anybody know how the Liberty cycler operates and it if allows for an initial drain???

Thanks for your help

[Joe]

Purgatory, just a suggestion to get around that initial drain; clamp your line until it alarms, then go to bypass. Just a thought. I have the same problem if I can't get my afternoon manual in and I hit the cycler dry. I usually can start the cycle and let it alarm out, but sometimes it's really uncomfortable (I know how you feel). Hope things get easier for you.

[JLM]

I have the Liberty and one morning the power went out before I got the 500 ml fill in the morning.  That night the machine insisted on draining the fluid I didn't have in me.  At my nurse's suggestion I ran some solution into me with a manual bag and then reconnected to the machine and that fooled the machine into working as it should.  I could not bypass the initial drain until I did the partial manual fill.

[Atooraya]

Baxter called to get their old machine, I told them to go pound sand..... they have stopped bugging me for now!

[Willis]

I have the new Baxter cycler and because once in a great while I go "dry" or expect a small drain I first set the initial drain alarm to zero right after I got it. Mistake! Try setting it to 10 or something other than zero. I think at zero it just keeps sucking trying to get a prime or something. With some minimal setting it will alarm fairly quickly--and as already mentioned, just close your transfer set until it alarms, then hit Stop and Enter then Down-Arrow until you get the Bypass option. If I remember correctly, you will get a loud Beep and then you will have to repeat the Bypass steps to make it take effect.

 

[purgatory]

Thank you all for your input.

Willis, we did try to hit Stop-Enter- Down Arrow several times to get to Bypass after clamping the patient line, but never got to the Bypass stage.  Baxter tech support told me the new cycler goes through 5 tries of initial drain before it moves to First Fill.  We found this to be true.  PS: I always enjoy reading your comments on this board.

Joe, I also live in the Colorado Springs area.  Glad to meet a fellow PD user so close to home.  Have you called Baxter about your occasional issues with the new cycler  - they told me the more people complain the higher the likelihood that they will address the the initial drain issue.  Funny that my PD nurse told me the one thing I should not do during initial drain is clamp the line.

Atooraya, I'm with you.  Since it is a FDA mandated class I recall, I hope they won't go as far as forcibly remove the old cycler which work so perfect from us. 

JLM, thanks for sharing your experience with the Liberty.  The procedure you had to go through to start treatment sounds insane.

[Joe]

Suzanne, it is great to have someone so close to home on here. I work with Liberty over on Union. I don't have a problem with my cycler, sometimes I just have a problem with my schedule. I typically do a manual in the afternoon so I have 2L in when I connect. If I get jammed during the day, I may not get that fill in so I'm connecting empty. That's when I have to let the machine alarm out on the Initial Drain and then go to bypass. You can't get to bypass on the Initial Drain until it alarms, there's a software lockout that keeps you from getting to it. I do like the idea of setting the initial drain at something really low like 10 and see if that works.

[Willis]

Willis, we did try to hit Stop-Enter- Down Arrow several times to get to Bypass after clamping the patient line, but never got to the Bypass stage.  Baxter tech support told me the new cycler goes through 5 tries of initial drain before it moves to First Fill.  We found this to be true.

I carry a fill during the day so my circumstances are different, but I was curious and tested this myself when my initial drain got close to the end. You are definitely correct! I pulled out the manual (no, gosh!) and it says very plainly that you CANNOT bypass an initial drain until there is a LOW VOLUME alarm. So the trick would be I suppose to make it generate the alarm as soon as possible.

After priming, my initial drains always move quickly to about 40-50ml (I think that's probably what's in the line to start with). Then the machine just cranks away for a minute or two before it actually starts the initial drain. When I first got the new cycler I had tried setting the alarm limit to zero but this caused a feedback loop where it kept trying and failing to start the drain. So I bumped the limit up to 150ml but I think anything over that initial start amount would work. That way it actually will start the initial drain process (because it's still under the "limit"), but after getting nothing to drain it should alarm fairly quickly...THEN, according to the manual, a bypass should be possible. Next time I hook up dry I'll have to test this!

 

[purgatory]

Willis - thanks for being so helpful and using yourself as a guinea pig.  And for making me smile (oh, gosh)    Looking forward to hear how it goes on your next dry hook-up.

[Joe]

The times I've hooked up dry it has taken a couple of minutes for the system to generate the 'Low Volume' alarm. During that time it is certainly trying to pull fluid out, and that can be kind of uncomfortable. That is why I suggested clamping the line to let the system suck against the clamp instead of your peritoneum. I do know for a fact that you have to get the 'Low Volume' alarm before you can get to the bypass selection on the screen, believe me, I've looked.
HTH

[austinsoul2011]

My dad's on the Liberty cycler, and he's also noticed the hard pulls/suctions that come with each of the drains.  I'm not certain that if, by switching from Baxter to Fresenius, you'll not face the same problem.  Those drains are painful!  My dad especially feels it during DRAIN 0, when the cycler insists on pulling 50 mL even after we've input a midday exchange of ZERO!   And that DRAIN 0 persists for 10-15 mins relentlessly, so I can't hit that "bypass" option fast enough.

The one advantage might be that each cycler we've used (we've gone through 2 liberty cyclers) has ALWAYS obeyed a bypass command during DRAIN 0.  Maybe that might help you out here.

Incidentally, I have heard good things about the older Baxter cyclers, and I'm shocked by news that the new Baxter cyclers might be more inflexible and irritable...

Hope you're able to resolve this very painful issue!

[purgatory]

austinsoul - thanks, I'm going to check out the Liberty cycler on Friday. I'm not hopeful.  I've been following your post re: your dad's PD ordeal, and I'm so sorry you have had such a hard time.  The old Baxter cycler (which I still use) truly is a fabulous cycler.  They will take it away from me in July.  Thhis will leave me with the option to do manuals or nothing.

I am so frustrated and scared that I can't stop crying - even though I will not be able to use the new Baxter cycler for my PD, I have not received any support whatsoever from those who are supposed to be my "team."  Not even a compassionate word. All I've gotten is advice to get my catheter surgically evaluated (it works fine) and questions what is wrong with me because I have drain pain.  One extremely dense nurse suggested a transplant to solve my problem (I'd like to see that accomplished in 2 months). 

[Willis]

The old Baxter cycler (which I still use) truly is a fabulous cycler.  They will take it away from me in July.  Thhis will leave me with the option to do manuals or nothing.

Are you saying that your clinic will not be giving you ANY kind of cycler? Or is it just the new Baxter cycler that you are apprehensive about?

If so, let me re-assure you. I was the first in my clinic to get the new Baxter cycler--not even the PD nurses had seen it yet! (I got it first because I filled out the "refresher training" booklet and my PD nurse mailed it in.) REALLY...it's the same cycler with some upgraded software. It LOOKS exactly the same from the outside. They did make a few minor tweaks in the programming but the only significant issue I've found is a bit of difficulty bypassing an initial drain when necessary. They actually made some nice improvements...the screen is a lot easier to read now and there are more options to manage your own prescription that before the nurse needed some kind of code to do. Of course, if you don't know what you are doing, then that could be bad! But I like more control, rather than less. I was glad to get this new cycler because my old one sounded like a drilling rig. This one is nice and quiet!

 

[purgatory]

Willis, they will gladly give me the new cycler.  But as I said in my first post, I Lalready tried it and I can't use it because it does not allow me to run the therapy I require and caused me a lot of pain.  I feel it gives me less control than the old cycler, especially since I do need the Bypass Initial Drain feature.  ARGH

[jeannea]

Can't they set the initial drain low? Mine was set at 50 mL so I hardly ever had to bypass. Maybe they could set yours really low like 10 mL. Worth a shot.

[Joe]

Purgatory, look at page 9-11 of your Baxter Pro Choice Book. I think that will help. it's the instructions on setting the I-Drain value. Good luck!

[KathyT1311]

I am supposed to be getting the new machine with my delivery tomorrow (I believe that is when I will be getting it). From everything read here I don't know if I want it!!!!!! Why the change?

[jeannea]

I don't understand this discussion. I had gotten my new machine a few months ago and didn't have this problem. Just set the limit for the initial drain really low and you won't have to bypass. Plus I did bypass the first night I had my new machine. The initial drain I mean. I think there must be a misunderstanding. Has anyone called Baxter and discussed this? The number is on the website.

[Joe]

I am supposed to be getting the new machine with my delivery tomorrow (I believe that is when I will be getting it). From everything read here I don't know if I want it!!!!!! Why the change?

Don't they change them out periodically? Take them back for refurb or something?

[purgatory]

As I said before, on the new cycler with the software upgrade there is NO way to bypass the initial drain.  If you hook up dry (or worse, as in my case, need to retain some fluid buffer because you have drain pain even on tidal) this will be a painful problem.  I have repeatedly spoken to the tech support supervisor (let's refer to him as D.) at Baxter about this and he has told me the following:

It will make no difference at all if you set the initial drain value low (30-50 ml) - the machine will still try to drain you for 10 minutes at a minimum flow rate until it reaches Low Drain Volume which is the only point where it will allow you to bypass.  If it detects any fluid at all (even 3-5 ml every 20-30 seconds), it will proceed to drain. He confirmed that you CANNOT bypass initial drain on the new cycler.

If you clamp the line during the initial drain, it will take even longer to reach the first fill.  Every time you clamp, the machine goes back to the start of the initial drain program.  D. suggested pushing stop.  He also said this is not a fix and for anyone hooking up dry it will be a difficult process to reach first fill.  The program goes through 5 cycles before it accepts first fill.

Quite a few people have called Baxter tech support with this issue.  D. was very friendly but currently has no solution to offer.

I talked to my PD nurse and to my nephrologist about the upgraded Baxter cycler and it program limitations, and they both said that Baxter's new cycler will present problems for PD patients on tidal.

Jeanna, if you can bypass initial drain right away, I'm willing to bet you still have the old Baxter.  I still have the old one with Initial Drain set to 0 and bypass with ease.  Joe, believe me, I have thoroughly studied the manual.

Baxter is replacing the old cyclers with the upgraded ones using both new machines and refurbished ones.

BTW, Fresenius has just released notification that they will change the software on their cyclers in a similar fashion.   Kathy, Baxter had a lawsuit because some people overfilled by bypassing drains, and someone died, hence the change.  IMO, they have gone way overboard trying to eliminate overfill.

[jeannea]

I didn't bypass right away. I got my new machine and I didn't know how to set up everything and mu nurse had gone home so my initial drain was set on 1500 mL. I drained about 300 mL then waited for it to beep with the error low drain volume. Then I bypassed it. It worked just fine.

[JLM]

I got a letter from F warning about the possibility of overfilling if the drain is not complete.  Had to sign and return a paper stating I read and understood the problem.  How will _I_ know if I don't drain completely, I do it at night and am usually sleeping.

[kporter85db]

I got a letter from F warning about the possibility of overfilling if the drain is not complete.  Had to sign and return a paper stating I read and understood the problem.  How will _I_ know if I don't drain completely, I do it at night and am usually sleeping.

Yea, I refused to sign and return that paper. It was just a notice "you could overfill and die, now sign here so we can cover our a**." When they tell me what they are gonna do about it to keep me from dieing then maybe I'll sign that paper. Until then, not a chance.

[austinsoul2011]

It's a slippery slope, trying to avoid overfill while also ensuring that enough diasylate is there to ensure good, pain-free exchanges.  Every night I'm battling with my dad's Liberty cycler, trying to pull off just enough fluid (often with stat drains) to ensure the next fill won't be an overfill, yet retain at least "some" fluid in-between so that he isn't too dry and is hit with drain pain.  I use the TIDAL setting to approximate how much of a tidal drain would be "just enough" to remove most fluid but keep some leftover so that his catheter stays afloat, but it's so difficult sometimes.  The configured tidal drain volume might be too optimistic for early exchanges (where it'll keep painfully draining him while he's dry), and also it could be woefully inadequate in later exchanges when he's built up excess fluid that should be pulled out).

For example, lately I've set my dad's TIDAL treatment (time-restricted) program with a first tidal fill of 1800mL , a standard tidal fill of 1600 and a tidal drain of 1750mL.  So for the first exchange, he fills with 1800mL and dwells.  The cycler then drains 1750mL and leaves conceivably 50+ mL in him.  Second fill of 1600mL happens, it dwells, and it then drains 1750mL.  The next exchanges follow the same pattern as the second exchange.

The problem is that as my dad progresses into the later exchanges, he accumulates a LOT of leftover fluid.  And I do mean a LOT.  Once, on the sixth drain, I decided to do a STAT drain to completely drain him out to see how much excess I could pull out.  I was able to stat drain about 2700mL out of him, for a UF of 1100mL.  A tidal drain would only remove 150mL and then move on to the next fill.  And that leftover fluid would just increase and increase with every exchange...  Gosh.  So yeah, you really need to be on-the-ball with some of these exchanges, ESPECIALLY if using the tidal option.

I know the F warning had more to do with older software miscalculating fills, but I just wanted to point out to potential overfill complications in addition to the older releases.

[JLM]

My letter was for the 2.8.2.027 version.  My machine now is 2.8.2.029  Mayhaps I should call tech support and ask why I don't have 500 or less ml as my first drain (that's my final fill).  I can have a 1000 or more at times.  Go figger, eh?