NXStage System One S

[kporter85db]

I started using the System One S yesterday. It looks exactly the same as the System One except for the logo i n the upper left of the screen.

The really interesting thing is the new Pureflow SAC. My 50L SAC #406 has larger tubes, two inline filters arranged parallel to each other and an new return line from the chicken foot to the SAC.

[obsidianom]

Are there any differences in the functionality so far?  How fast do you run the dialysate? Do you FEEL any differences at higher speed dialysate? Anything at all you can tell us about your experiences would be interesting.

[Speedy1wrc]

From what I have heard from NxStage, there is no difference in the hardware. I was asking them in reference to changes to the pumps that might help the air issue.

I am interested in how Nx2Me works. they are rolling it out slowly.  I think it will be a significant difference in setting up and monitoring the machine and treatment. Anyone using it yet?

[Simon Dog]

I am interested in how Nx2Me works. they are rolling it out slowly.  I think it will be a significant difference in setting up and monitoring the machine and treatment. Anyone using it yet?

Nx2Me sounds like a more polished version of a systgem I wrote for my own use.

I started NxStage about 6 weeks ago, and the clinic I use is still working with paper logs.  I wrote a web application to enter and store the data from the machine as well as my vitals, and the RN at my clinic grabs my logs from my web site - much easier than paper logs and the home support nurses get the data more quickly. 

[Speedy1wrc]

There are two parts to Nx2me. One is automatic logging. The other is machine control. You can graph your pressures and make changes from your tablet. Not sure if there is a remote control component, not being supported, I can't get much information from NxStage.

[kporter85db]

Are there any differences in the functionality so far?  How fast do you run the dialysate? Do you FEEL any differences at higher speed dialysate? Anything at all you can tell us about your experiences would be interesting.

I finally had enough experience to answer these questions.

There is no real difference in functionality except for the obvious dialysate flow rate. Of course there are a few different programming parameters. One interesting but somewhat insignificant difference is that the default programmed value for the volume screen timeout is 60 seconds, the other machines I have had defaulted to 10 seconds.

We've been running the dialysate at 14.5 or so. I was using a 40 liter SAC running for a treatment time of around 3 1/2 hours 5 days a week. I am now using a 50 liter SAC running for a treatment time of 3 hours 4 days a week. The goal is to eventually go nocturnal four days a week or maybe EOD.

I don't feel anything different during dialysis and I feel physically the same on my shorter treatments as I did on my longer 5 day treatments.

I know it sounds crazy but going from 5 to 4 days a week I feel like I have doubled my free time. I look forward to doing nocturnal.

[PrimeTimer]

Question: Can you run at low blood flow rates (example: 350 or 380) on the new S cycler? Or do you have to run at a higher BFR since you are doing more volume?? The reason I ask, is that we do home hemo using the System One cycler and we've just been told by our center that we might be getting the new S cycler and I don't know yet if we have to accept it or can tell the Neph that we just want to stay on the System One cycler...we don't want to have to use higher blood flow rates.

[Hemodoc]

Question: Can you run at low blood flow rates (example: 350 or 380) on the new S cycler? Or do you have to run at a higher BFR since you are doing more volume?? The reason I ask, is that we do home hemo using the System One cycler and we've just been told by our center that we might be getting the new S cycler and I don't know yet if we have to accept it or can tell the Neph that we just want to stay on the System One cycler...we don't want to have to use higher blood flow rates.

I would really love to be able to run 60 liters in a 4.5 hour session. However, at present, the 140 mmol saline levels are too high from me to increase the volume since that gives me a noticible salt load.

Baxter is promoting their new machine in Europe as "high dose." that is a direct reference to NxStage which has used their low volume system for years. I am not a fan of the NxStage low volume theory and from the beginning doubled my dose from 20-40 liters. The NxStage System One 1 shoudl be the standard option for all NxStage patients. We further need to abandon the standard of a weekly Kt/V of 2.0.  The Baxter machine is not High Dose when compared to the in-center home machines and the Baby K. Only when compared to NxStage. It is an Achiles heel for NxStage and developing the System S I believe is in direct response to the Baxter machine.

You can access the NxStage calculator and review treatment options on this ap.  The more the better is likely the best way to go.

[Speedy1wrc]

On a side note. With running a higher volume of dialysate, is your aluminum level high?

[Pod99966]

I'm running a System One S machine as well. I run my distillate flow at 18 Lph and Blood flow at 420. I've notice no difference between this and the non "S" unit I was using  I'm using the 405 SAK (40 liters), 6 days a week. I'm trying to switch to a bigger SAK so I can do it less days per week.

[obsidianom]

I'm running a System One S machine as well. I run my distillate flow at 18 Lph and Blood flow at 420. I've notice no difference between this and the non "S" unit I was using  I'm using the 405 SAK (40 liters), 6 days a week. I'm trying to switch to a bigger SAK so I can do it less days per week.

Why are you running your blood flow so fast? 420 really stuns the heart and can damage the fistula. Also at 18 LPH at 40 liters you are only dialyzing about  2 hours and  15 ,minutes?  If that is true then you are really going very short on your time. Just my opinion but it seems a bit off.

[Speedy1wrc]

It had been suggested to me to go to 6 day's. The theory was that it would allow me less hours per day. For a number of reasons I chose not to go that route. I have however lowered my blood flow rate from 500 to 450. It added roughly 20 min to my treatment time. Given the opportunity I will drop it down to 400.

[Dannyboy]

Anybody have a Model S machine through a Davita At Home Clinic?

[Pod99966]

Why are you running your blood flow so fast? 420 really stuns the heart and can damage the fistula. Also at 18 LPH at 40 liters you are only dialyzing about  2 hours and  15 ,minutes?  If that is true then you are really going very short on your time. Just my opinion but it seems a bit off.

When I first got the "S" unit, it was shipped to my clinic (1st one my clinic had seen). So I started using in in-center so that we could all learn how to use it. 420 was the number my nurse was using when I was in-center, so I just keep using it. I've done 2 sets of labs since I've been on it and everything seems good.

[obsidianom]

Why are you running your blood flow so fast? 420 really stuns the heart and can damage the fistula. Also at 18 LPH at 40 liters you are only dialyzing about  2 hours and  15 ,minutes?  If that is true then you are really going very short on your time. Just my opinion but it seems a bit off.

When I first got the "S" unit, it was shipped to my clinic (1st one my clinic had seen). So I started using in in-center so that we could all learn how to use it. 420 was the number my nurse was using when I was in-center, so I just keep using it. I've done 2 sets of labs since I've been on it and everything seems good.

The problem with high blood flows is a LONG TERM problem that shows up later as you continue to stun the heart and flog the fistula . Its a "wear and tear" issue that in time causes a lot of damage. In Australia where they go far slower they dont see the fistula damage we see in the US. . Even my nephro talked about it the other day as some American docs are seeing the light. He talked about stunning the heart and LVH .

[Pod99966]

The problem with high blood flows is a LONG TERM problem that shows up later as you continue to stun the heart and flog the fistula . Its a "wear and tear" issue that in time causes a lot of damage. In Australia where they go far slower they dont see the fistula damage we see in the US. . Even my nephro talked about it the other day as some American docs are seeing the light. He talked about stunning the heart and LVH .

I asked my nurse, and she said she wants me to run it a little higher than normal right now because my fistula is under developed. I had the fistula done in late Oct. then in Jan. my vascular surgeon moved the vein and brought it closer to the surface. But it's still a bit deep. We started canulation in April, and it is not easy to hit even by a nurse who has worked in dialysis for 30 years.

I played with the numbers today (on dialysis as I type) and the lowest I can run blood flow while at 18Lph is 400... and keeping the FF at 80 or lower.

PrimeTimer:

I checked at 350 - max 15.5 Lph, at 380 - max 17Lph... this is with FF80

[obsidianom]

The problem with high blood flows is a LONG TERM problem that shows up later as you continue to stun the heart and flog the fistula . Its a "wear and tear" issue that in time causes a lot of damage. In Australia where they go far slower they dont see the fistula damage we see in the US. . Even my nephro talked about it the other day as some American docs are seeing the light. He talked about stunning the heart and LVH .

I asked my nurse, and she said she wants me to run it a little higher than normal right now because my fistula is under developed. I had the fistula done in late Oct. then in Jan. my vascular surgeon moved the vein and brought it closer to the surface. But it's still a bit deep. We started canulation in April, and it is not easy to hit even by a nurse who has worked in dialysis for 30 years.

I played with the numbers today (on dialysis as I type) and the lowest I can run blood flow while at 18Lph is 400... and keeping the FF at 80 or lower.

PrimeTimer:

I checked at 350 - max 15.5 Lph, at 380 - max 17Lph... this is with FF80

In your circumstance you are doing what the nurse asked for a specific reason, so obviously that is more important for now. Hopefully in the future it will mature the fistula and you can back off.
In terms of the FF, IT IS IRRELEVANT.  It is a totally useless number created by Nxstage. Even the company is now backing off on it other than as a general guide. We just ignore it completely on ours. I set it to go up to 100 but run fron 40 to 70 at various times. All that matters on Nxstage is the volume of dialysate and the time on machine. We just go for 3.5 hours at 30 liters. It aveerages out to a dialysate speed of about 8.4 . I dont look at the FF.
I did a post on that earlier.



 Time to Dump the Flow Fraction
« on: April 23, 2014, 12:08:43 PM »   

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I was interviewed by some senior staff at Nxstage and they asked for any recommendations I had on their prescriptions. One recommendation I had was to dump the flow fraction forever . I told them it is a confusing concept and basically useless . I think they heard me and basically agreed.
What really matters on Nxstage is number one, the volume of dialysate . That is the most important part of the prescription and really determines how much dialysis you will obtain. The second most important part of the prescription in my opinion is the time on machine. The longer the better. I always try to run the dialysate speed slow enough to get at least 3.25 hours per treatment and some days go for 3.5 hours. This is in line with Dr. Agar's thinking of minimum of 17 hours per week or 10% of total time. (this is at 5 days per week). I dont care what the flow fraction is. I just set the dialysate speed to give me what ever time I decide on .  The only other aspect of the prescription that is important is the blood speed. I will never go over 340 . Again I follow Dr. Agar and what he preaches about slower speeds . He is against going over 350 due to clear evidence increasing speed above 350 causes damage long term to the fistula and heart. There is just no reason ,on Nxstage especially, to go faster. Its the volume of dialysate and time on machine that give the proper clearances , not speeding up the blood.
The flow fraction is irrelevant and we just rest the backround setting on the machine to 100% max. flow fraction (you can even go higher) , so it is no longer a factor at all. I dont even look at it. It is a meaningless number.
I beleive in the future they will probably do away with the whole concept.

[Pod99966]

I never knew anything about the FF on my original Nxstage machine, but when I got the new model I started getting all sorts of crazy error codes during treatment. When I called nxstage (during treatment) we adjusted my distillate and blood flow until the errors stopped. The Tech then told me that my FF was to high the way I was setting it up. /now I keep the FF under 80 and don't have any problems, if I make the FF closer to 90 I start getting errors again.

Not to argue or even disagree with you obsidianom, just sharing my experience. 

[amanda100wilson]

Obsidionom, are you saying that FF can be totally ignored?  In that case what would you recommend setting it at?  0?, 50, 80?  It has to be set to something, so what?

[Pod99966]

Obsidionom, are you saying that FF can be totally ignored?  In that case what would you recommend setting it at?  0?, 50, 80?  It has to be set to something, so what?

The FF is not really something you "set" it is a result of the setting of Blood Flow Rate and Distillate Flow Rate. So once you set those two the FF will be whatever it happens to be. So I believe Obsidionom is saying don't worry about the FF, worry more about the Blood and Distillate flows.

[PrimeTimer]

I guess I wouldn't mind going a little longer each nite to do more volume but certainly wouldn't want to increase the blood flow rate any higher than 350-380 and work my husband's heart (and precious fistula) even harder than it's already being pumped at. So now I wonder if in order to do 30-40 liters of dialysate on the new S cycler if a patient will be forced to increase their blood flow rate just to keep up with the added volume and be able to complete their treatment in a reasonable time. Would not be good to have to stay up all hours of the nite doing dialysis...I believe they call that "nocturnal" and that is a whole other ballgame!   

[Pod99966]

I'm 43 with a wife, a 12 year old daughter, and a 7 year old son (at home). I can't imagine doing any longer on my machine than necessary.
 
1hr setup + 3 .5 hr dialysis + .5 hr cleanup X 6 days a week
+ misc. time dealing with supplies/boxes/appointments/ect

I never knew how time consuming it would be, and with two kids at home, I have very little spare time as it is.

[Dannyboy]

Pod,
I hear ya.
For the common issues you mention, I'm inching my way to doing nocturnal.
Gotta get my dear wife on board however LOL.
-Dan

[obsidianom]

Obsidionom, are you saying that FF can be totally ignored?  In that case what would you recommend setting it at?  0?, 50, 80?  It has to be set to something, so what?

Yes, ignore it. We do. I just set it on the backround settings at 100 AND dont ever look at where it actually is during treatment. All that matters is volume od dialysate , time on machine and blood speed.

[obsidianom]

I guess I wouldn't mind going a little longer each nite to do more volume but certainly wouldn't want to increase the blood flow rate any higher than 350-380 and work my husband's heart (and precious fistula) even harder than it's already being pumped at. So now I wonder if in order to do 30-40 liters of dialysate on the new S cycler if a patient will be forced to increase their blood flow rate just to keep up with the added volume and be able to complete their treatment in a reasonable time. Would not be good to have to stay up all hours of the nite doing dialysis...I believe they call that "nocturnal" and that is a whole other ballgame!

The blood speed has nothing to do with time on machine . The time is based solely on the amount of dialysate and the speed of the dialysate. I still advise blood speed of no more than 350 as per Dr. Agar and his writing on not flogging the fistula. If you want more volume dialysate you simply speed up the dialysate. PERIOD.  we do 30 liters in 3.5 hours. That works out to about 8.5 liters per hour speed.  If you want to go to 40 liters you could increase the dialysate speed to 12 liters per hour for example and that would take 3 hours and 20 minutes. The blood speed can stay the same always. We run 340 blood speed.