Pureflow Pak don't fit

[Maggie and Jeff]

The last 8 pureflow Paks we have been shipped are to wide to easily fit in the pureflow chassis.  NxStage has been wanting them back. 

[EDIT] NxStage does not want them back anymore.

Here is a work around.

First here you can see the foam that makes the pak to wide.



Here is the pak



I peeled the tape back 6 black pieces and the top handle.





Opening the back flap





Flipped the pack over to peel back the rest of the tape.









When opening I found it helpful to press on the front near the label so it would stay open.







I found it easiest to grab the foam with both hands thumbs pointing away from each other and lift toward the top of the pak. 

Watch the water lines you don't want to pull everything out. 

Lift the foam and move it a few inches until the water lines are good and taught.







In the following pictures I moved the tube labeled MB first I found moving the tubes starting with tube AC is better because the water tubes have more room so the tubes move easier.







At this point I grabbed the foam and pulled it out sort of like pulling the table cloth off the table leaving the dishes behind only a lot slower and it was easier if I tilted the pak 45 deg.





Check the water lines to be sure they are not pinched.



Reattach the tape.



I put the pak back in the box.



I did all 10 I have on hand.

[Speedy1wrc]

Where did your Pureflow come from. Directly from NxStage or from DaVita? My chassis came from DaVita and had been dropped and never has been straight. When I first got it I also had to loosen the screws that hold the controller in and let it be loose. I then was able to slide a PAK in and then I tightened down the controller. It's still crooked, but most of the time I can get things to work.

[Maggie and Jeff]

The pureflow chassis and supplies come from NxStage as we have been going through FMC (Fresenius Medical Care) for the last 4 years.  Our chassis is in good shape.  The Paks are just wider due to some change in assembly.  They started using a different dividing system for the filters and didn't test them before they shipped them out.  When I told the NxStage tech support guy the replacement pak has the same issue he said "Oh boy".  I expect there will be many more of them before the issue is fixed.  I opened one, removed the packing, and put it back together so we have a working pack the slides easily into the pureflow chassis. 

It's just one of many issues over the last 8 years we've been using NxStage.  NxStage always does there best to fix these things in a timely manner. We have very hard water so we go through paks.

Davita is not my favorite clinic and I'll leave it at that.

[Speedy1wrc]

Seems like love hate with this whole business. I just received 2 new pak's. I am not due to change one out for at least another month or so, but will keep this in mind.

[Maggie and Jeff]

If you open the box there are 2 things to look for:
1) new lot# label wraps the pak to the right (instead of just on the front)
2) If you look on the left side (away from the tub when installed) there are slots in the plastic cardboard stuff.  Look into the slots at a 45 deg angle a good pak has more black plastic.  The new ones that don't fit have gray stuff (thin gray plastic covering foam)

These Paks are not bad/unsafe they just don't fit.  I forced one in and called NxStage about it and found out all the ones I had were the same.  I had to remove the pak after it was primed because the new control unit was bad.  So when I took out the primed pak I had to sit on the floor one foot on the tub and the other on the edge of the door and my hand slid inside the pak (tape broke).  I'm 34 year old male and I thought it was a bit difficult and my wife could not pull it out.  Most probably would not be able to install to begin with.

With the pureflow off leaving the blue line connected you can clamp and disconnect the white line and unplug the inside connection then pull the pak out and set it by the tub.  Just do not disconnect the blue line.  One could then verify if the new paks fit.  I would only do this with tech support on the line if I suspected the new paks would not fit.  I tend to be proactive on these issues so they don't cause us to miss a treatment.

Over the 8 years we have missed treatments 3x due to equipment and 0x due to lack of supplies.  Nearly 2,500 treatments to date with NxStage.

I've read you've had a hard time       hang in there it will get better.

When we were with Dah-vita they counted our gaze pads and wanted to know why we needed more than they thought we should.  With FMC supplies are no issue but there tech support is lacking no 24 hour nurse on call yada-yada-yada

[Maggie and Jeff]

Got 3 more delivered and picked up today.  All 3 were to big.

[Speedy1wrc]

I just looed at my PAK's. I have 1 old style and the one I got last week is the new style. I asked my HHD nurse is she had heard anything and she hadn't. We'll see.

Yes, the whole idea of HH is great and wonderful, but the implementation stinks. I can't count the number of failures I've had. Right now I have a bad cycler and I emailed the senior tech at NxStage 2 days ago and I can't get in touch with him. I ended up calling to try and reach him today, but couldn't reach him. The person I got wanted me to give him the last 3  months worth of troubleshooting we have been through and I decided not to go through that.

I am also trying to get supplies and Sterling is just plain useless. I've been calling and on hold for 2 weeks getting no where. My nurse called them today and was shocked that the person she reached couldn't give her a straight answer on anything. She (Sterling rep) did suggest I not call on Monday or Tuesday or before 5 because, well...they're busy. Really??

My center and nurse are the best in the world. I couldn't do it without them. After that though it's a crap shoot.

[Maggie and Jeff]

When you do need to change paks try the new style one first If/when it don't fit call tech support and tell them the pak will not fit.  They'll ship a new one and may want the new style one back.  I'm sure they'll issue a recall at some point.

I think the first 2-3 years of HH were the hardest. 

I remember when it was not uncommon to get cartridges with kinks in the lines due to the way they were packed we had to make splints for them with plastic and paper tape.   

The old cartridges 2006 & 2007 had a second hard plastic shell around the filter.  The first time I got one of these newer style ones I cracked the filter open getting the air out.

Our first system one lasted until it had to go back for maintenance.  Second one lasted a few days.

In the last 8+ years we've had about 12 cycler's and around 20 pureflow control units.  But those are only a guess cause I can't remember exactly.  I know we have shipped over 100 CAR, PAK, SAK back due to quality control issues.

We've had leaks - got a hole in the waste line on the pureflow soaked the floor and trashed the carpet.
                      - forgot to move the yellow line the saline bag held 7 liters before it exploded and killed the phone the pureflow the walke talkes and the fax machine.  Salt water and electronics don't mix.

I hooked the venous and arterial lines up backward and it took over 30 min to figure out why we kept getting alarms.

We make pottery and go to craft shows.  Maggie dialyzed in the middle of the street behind our booth at one of the shows. We got asked "Are ya'll doing permanent tattoos" 

Wife accidentally pulled her venous needle - That was a bloody mess.

But I am really happy with NxStage all things considered.  Most of tech support folks are very helpful. (you got to remember most of them live up north so they are a bit odd) I'm always kind to them (think: sugar/flies) I got a new cycler one time cause I thought the one we had was to loud.
 
Wife is able to live and have a somewhat normal life. And that is the whole point.

What is wrong with your cycler?

 

[Speedy1wrc]

Interesting.... Every time I call tech support (which I only do when I really hit a dead end) and explain a problem, they always say they've never heard of it. We know what each other is doing around me so I know when other patients are having the same problems. So I usually have to push and only then will I get an admission that maybe they've seen a problem or two. If I push a tad harder then I will get an admission that they do know about it, but they don't think it's a real problem.

I'd have to look at my other posts, but I think this will be my 6th cycler in just over 1 year. The current one has been getting noisier and noisier and now is shaking. I can tell it's a failing stepper motor. After working out settings for prime to minimize air, it's starting to creep back in. On a very noisy day there is a ton of air in the system.

I haven't sent nearly that many cartridges back, but again they have told me point blank that they never get cartridges sent back at all. Huh...? They've told me they haven't seen a cycler come back in some time, yet I know that I was the third locally to send one back in just one week. Plausible deniability.

We've all made bonehead mistakes. I just have to earn I can't try and hold a conversation while getting on of off. Been there done that.

[Maggie and Jeff]

Next time you dialize call tech support with you phone on speaker phone set it on top of the system one.  If they can't hear you you may have to move it until they can that way they can hear how loud the machine is.  If the phone falls due to the shaking tell them the nxstage shook the phone off (It should not)

Use the 866NxStage # 1 wait wait 1  and be so sweet sugar wont melt in your mouth.  explain your current issue.  stay on topic.  let them chose the best way to resolve the issue.  and stay on the phone until the issue is resolved if possible.  Every call is documented in your file.  If at first you don't succeeded well call again later you'll get someone else stay on topic and with the current issue other wise you'll confuse them.

Every time I call it starts like this:

"NxStage tech support this is ------"

"Hi this is Jeff.  How are you doing today"

3 to 5 seconds of silence



You see up north they don't do small talk and they've had so many patents go off on them.

I had a 601 on the system one today while I was on the phone about the paks.  saline down. cartridge out machine off/on reload 601 He was going to send a new system one.  I said "hold on let me try a new cartridge"  This one worked.  He stayed on the phone until we were sure it would go.

Give it a try "kill them with kindness" If your enemy is hungry, give him food! If he is thirsty, give him something to drink! This will make him feel ashamed of himself, and God will reward you.

Just to be clear I don't think being mean or yelling at them.  I'm not even saying your telling them how to do there job.  I just think your not realizing the sheer volume of calls they get from people who keep getting a red 21 because of needle placement and blame it on the machine.  Or even a red 35 because the yellow clamp is clamped. 

I never try to talk to anyone in particular but on the rare occasion the issue is not resolved I just call back later and start over.

Be kind
Stay on topic
leave the past in the past deal with the current issue

let me Know how it goes
If you want you can PM me and I'll give you my # and you can call me.  I can't order you anything But I bet I've had almost every problem that can be had.
God Speed my friend.   

[obsidianom]

I am quite happy with Nxstage in general. I havent had an alarm in months. Our cycler is only our second in 2 years and we still have the original pureflow system. Dialysis runs like clockwork for us. I hardly notice the system is running for the 3 plus hours of dialysis. I go on my treadmill while my wife works on her com puter while being dialyzed. WE get an occasional bad sak or cartidge , but thats it.

[obsidianom]

I do want to add that anyone who hasnt looked at their prescription for NxStage, particularly the volume of dialysate, should check on it.
I have an old calculator sheet from Nxstage from 2 years ago when my wife started and the numbers for dialysate volume are ridiculously low. On the sheet the maximum they recommended , even for a 140 kg male was 30 liters . Most of the recommendations were for 20 t0 25 liters which is very low. They started my wife on only 17 liters which is quite low and not very good for her. I have her up to 30 and she is only 53 kg.
Since Nxstage is totally volume based for the most part , it is important to get enough volume to get proper clearance. More is better, period.
Anyone using less than 30 liters now should rethink and talk to your team. The on line calculator shows much higher volume than the old sheet I have which is obsolete. So do some checking. Raise your volume as much as possible.

[Speedy1wrc]

Next time you dialize call tech support with you phone on speaker phone set it on top of the system one.  If they can't hear you you may have to move it until they can that way they can hear how loud the machine is.  If the phone falls due to the shaking tell them the nxstage shook the phone off (It should not)

Use the 866NxStage # 1 wait wait 1  and be so sweet sugar wont melt in your mouth.  explain your current issue.  stay on topic.  let them chose the best way to resolve the issue.  and stay on the phone until the issue is resolved if possible.  Every call is documented in your file.  If at first you don't succeeded well call again later you'll get someone else stay on topic and with the current issue other wise you'll confuse them.

Every time I call it starts like this:

"NxStage tech support this is ------"

"Hi this is Jeff.  How are you doing today"

3 to 5 seconds of silence



You see up north they don't do small talk and they've had so many patents go off on them.

I had a 601 on the system one today while I was on the phone about the paks.  saline down. cartridge out machine off/on reload 601 He was going to send a new system one.  I said "hold on let me try a new cartridge"  This one worked.  He stayed on the phone until we were sure it would go.

Give it a try "kill them with kindness" If your enemy is hungry, give him food! If he is thirsty, give him something to drink! This will make him feel ashamed of himself, and God will reward you.

Just to be clear I don't think being mean or yelling at them.  I'm not even saying your telling them how to do there job.  I just think your not realizing the sheer volume of calls they get from people who keep getting a red 21 because of needle placement and blame it on the machine.  Or even a red 35 because the yellow clamp is clamped. 

I never try to talk to anyone in particular but on the rare occasion the issue is not resolved I just call back later and start over.

Be kind
Stay on topic
leave the past in the past deal with the current issue

let me Know how it goes
If you want you can PM me and I'll give you my # and you can call me.  I can't order you anything But I bet I've had almost every problem that can be had.
God Speed my friend.   

There is a difference between being rude or unkind and being direct. I have never been or will be rude, mean or disrespectful. However I do take exception when they tell me they have ever had a cartridge returned when I know myself how many I have sent in. When I "push", I mean I urge them to reconsider their answer. I was in customer service for over 20 years, I know how it is from both sides of the fence. I have a direct line to one of their senior tech's. I generally don't work with the tier one people unless it's something minor.

[Maggie and Jeff]

Had another over sized Pak today.  I even tried to slide it in the pureflow but it was to wide. 

It still holds true.

The new ones that don't fit have gray stuff (thin gray plastic covering foam)

 

[/color]

[obsidianom]

I just checked on mine and one pak is the old and one is the new wider one . I called nxstage and they want the wide one back and will replace it.
This is weird and very poor . This kind of issue SHOULD NEVER HAPPEN with medical materials. I asked the tech support guy about ity and he knew nothing about what occurred or wouldnt admit he did. They did admit to taking quite a few back so far.
Everyone should check on theirs. Measure them.  Measure the width of one in the machine that fits, it should be about 8.9 cm. . The wider one measures about 9.3 cm. wide so the extra 4 mm. is enough to not fit the tight metal chasis.
If you have a wide one , dont try to play with it to fit, CALL NXSTAGE and have them replace it.  Dont take chances.

[Maggie and Jeff]

If you have a wide one , dont try to play with it to fit, CALL NXSTAGE and have them replace it.  Dont take chances.

+1

[Speedy1wrc]

This illustrates my concerns with NxStage. Lack of communication or plausible deniability. I've been working with one of their senior tech's since January on an on going problem,. When I called last week there was nothing in my record to indicate this. That's why the tech that day wanted me to give the entire history. My objection was that I shouldn't have to go through that...again. It seems pretty certain there is a flaw with the PAK's There should be or have been a notification sent out. I checked with my nurse and she hasn't heard anything from them about this.

[obsidianom]

Yes the company is not perfect. But at least they make a product that works well and is a lot better than anything else we have currently in the US. for home dialysis. I look at the final results and they give what they claim. so all we can do is keep pushing them to continue to do their best to fix any problems. I have been known to email execs. there and voice my displeasure at times with issues that have arisen. They have listened and always tried to correct the problem.

[Speedy1wrc]

I contacted their head of customer relations a year ago.

[Speedy1wrc]

Soooo...the new cycler arrived today. It smelled a little odd, but OK. I plugged it in and reprogrammed it and let it go. The door was really rough to pull out and the handle latch was really tight. I turned it off and left it plugged in for about an hour. When I went back in the room the fan was very loud so I pulled the plug. Immediately it started to alarm and wouldn't stop. I called NxStage and couldn't get them to understand it was alarming while unplugged . I don't know how many times they told me to shut it off and unplug it. Finally it clicked and the only explanation I got was...that shouldn't happen. While standing over the machine I could smell burned electrical components, so I passed that along too. I am waiting for confirmation that will be sending yet another machine out.

[Speedy1wrc]

The tech from NxStage was supposed to call me back to confirm they had a cycler to send me. That way I knew whether I needed to make alternate plans for treatment. I also wanted to make sure to request a new jewel box since this one was questionable. I ended up getting a call late from National Logistics saying they wanted to schedule a delivery tomorrow. Bitter sweet. So I called NxStage to ask about the computer box and the tech I had been working with went home for the day. Good thing I wasn't holding my breath waiting for that call.

Supposedly a cylcer is coming from a center in LA. No computer box.

I am not holding my breath.
 

[Maggie and Jeff]

Had another wide pak yesterday. 

[Speedy1wrc]

So it sounds like that while they know about it, nothing is being done? Are they coming from a warehouse or from NxStage? I know some supplies are warehoused in remote areas accessible to National Logistics.

[Maggie and Jeff]

So it sounds like that while they know about it, nothing is being done? Are they coming from a warehouse or from NxStage? I know some supplies are warehoused in remote areas accessible to National Logistics.

yep, National Logistics.

Got got another one today but I forgot to call it in I'll call tomorrow.  UPS has been coming every weekday for 2 weeks.  I really don't mind this is not much of an issue to me.  They are the ones wasting money shipping those paks to me then shipping them back to themselves.

[Speedy1wrc]

I don't know about your schedule, but I don't have time to spend all my time on and off the machine with this stuff. I started this morning at 6:15, didn't get on till 10:30 due to a bad cartridge, didn't get done and off till 2. I felt like poop so the rest of the day was done. I didn't get any work done yet again today. Been trying to call Sterling for a week to get supplies and have to follow up with an email to NxStage about how the new (to me) machine is or isn't working. Then another call to find out why I didn't get the new computer box today. And then one more call to NxStage to report the bad cartridge.