NXStage System One S

[PrimeTimer]

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. 

Pod99966: Are the alarms on the new "S" cycler the same as the alarms on the System One? For example, does the "S" cycler have a "Red Alarm 11" and does it mean the same thing as getting a "Red Alarm 11" on the System One? Or is there a whole other set of alarms that come with the new manual that we will have to learn? Thanks in advance.

[Pod99966]

yes the alarms are the same... from what I've seen so far.

[Speedy1wrc]

In my discussion with NxStage about the differences between the two machines, the only difference is the dialysate flow and volume. Everything else is identical.

[PrimeTimer]

yes the alarms are the same... from what I've seen so far.

Thanks, Pod and Speedy. The nurse that will be coming to help set it up and train us here at home is new at this too, so I am preparing a list of items/questions to bring up with her before she heads over. For instance, don't forget the manual or any pieces/parts! Would be a real bummer...

[Simon Dog]

One bit of trivia - the higher flow rates on the 1S can only be used with the Pure Flow, not bags.  I don't know if this is because of flow rate or greater total volume. 

It means patients using the higher flow rates need a "bag friendly" Rx as well in case they have to fall back to bags due to Pure Flow problems.

[Pod99966]

I have used the 1S with bags at max flow. But shhhhhhh, it's a secret.

[PrimeTimer]

I have used the 1S with bags at max flow. But shhhhhhh, it's a secret.

 

[PrimeTimer]

One bit of trivia - the higher flow rates on the 1S can only be used with the Pure Flow, not bags.  I don't know if this is because of flow rate or greater total volume. 

It means patients using the higher flow rates need a "bag friendly" Rx as well in case they have to fall back to bags due to Pure Flow problems.

Thanks for the trivia. I think...

[Simon Dog]

I have used the 1S with bags at max flow. But shhhhhhh, it's a secret.

Thanks.  I got the info regarding "pure flow only" with high flow on the 1S from NxStage phone support.

[PrimeTimer]

Trauma and drama...
Ok, we've been using the new S cycler for the past 3 nites now and...pretty much runs the same as the System One cycler did. Has a few new settings to enter upon setup but the manual walks you through them. By the way, anyone else on the new S receive a new Ultrafiltration Chart to help you decide how much/how little fluid to remove and what the setting should be set at accordingly?? I love the old chart our nurse gave us for the System One so I hope they will be giving us one for the new S when they tell us what my husbands new prescription will be. Some nites we take more off, some nites less. Having the chart helps, as I do not want to have to log onto the computer every nite to look it up. I'd rather keep a chart handy with our treatment sheets. My husband was prescribed the new SAK 402's but until those arrive, NxStage said we can continue using SAK 302 but...at the same lower speeds that we had used on the System One. Everything seems to be going okay except that I notice that about halfway thru a treatment, we get a "New" Yellow Caution 53 alarm telling us "Low Fluid Temp". No action required. What's interesting, is that our Pureflow heater is set at 13 (quite warm) and because of 100 degree weather, it's been 78 degrees inside our apartment, even with the air conditioner on! So why the new S cycler is telling us the fluid temp is too low when we are sweating indoors, I don't understand. But, we only get the YC53 once and it goes away and nothing else becomes of it. So far, everything seems to be running smoothly on it, with the exception that right from the get go tonite, he had very high venous pressure 290 and we were still only at a blood flow rate of 200! It didn't alarm but nonetheless, that is quite high for him. We suspect his fistula is acting up again. Was not an easy needle stick tonite. He had an angioplasty 3 weeks ago and we are feeling the same signs/symptoms as before, so off we go to the vascular surgeon tomorrow! We tried to run him as long as we could tonite, staying at a Blood Flow Rate of 200 but when the venous pressure got up to 322, I said "enough" and made the decision to do early rinseback and get him off the machine. I did not want to end up with cascading Red Alarms and risk losing the whole circuit of blood, the man has enough to worry about (and so do I!).  So, won't be surprised if he needs another angioplasty tomorrow but then maybe we'll get to come home and get back to singing the praises of doing home hemo again by tomorrow nite. We shall see...

As for other things with the S cycler, altho trivial, I don't like the "Troubleshooting" section in the new manual. It lists all the different kinds of alarms (red or yellow) and possible triggers and remedies but not as easy to understand or (in my opinion) as thorough as the alarms section in the old manual for the System One, so be careful when you get alarms. Don't just rely on the old manual. 

As for not using bags at the new higher flow rates/volume on the S cycler, my guess is that this is a safety issue (I think the manual discusses it) and that they want the dialysate to be allowed to pass thru a warmer and actually be warmed up to a certain temp to avoid dangerous effects to the tubing, the dialyzer and membrane and to avoid hypothermia and hemolysis to the blood. If the fluid is passing thru at a fast rate, it probably doesn't have a chance to be warmed up to a safe temp rushing thru a warmer bag or warmer, altho I wonder if a person could use bags that they know are already very warm from a source other than the warmer before hanging them.   Anyways, guess if we ever have to use bags, we will go at the slower rates/lower volumes. As for going at higher rates/more volume using the Pureflow, this will all hinge on the results of my husband's aluminum level. I cringe at the thought, I do not want my husband being poisoned. However, hanging 6-8 bags each treatment might also not be doable for us, either. I would not mind having to make a new batch/SAK every nite and going a little longer to do more volume but regularly hanging that many bags would hurt me and I am already living with pain 24/7 without meds. But I do not want my husband experiencing the ill-toxic effects of aluminum poisoning! Dang! Just when you think something wonderful, really wonderful has been invented, it all comes crashing down! It is so worrysome and scary. But I think everything about kidney disease and doing dialysis is worrisome and scary. Hard to stay focused without letting it scare the bee-jeezuz out of ya! 

Meanwhile, if anyone else is getting high venous pressures and YC53 alarms on the new S, I'd be curious to know.

[obsidianom]

Trauma and drama...
Ok, we've been using the new S cycler for the past 3 nites now and...pretty much runs the same as the System One cycler did. Has a few new settings to enter upon setup but the manual walks you through them. By the way, anyone else on the new S receive a new Ultrafiltration Chart to help you decide how much/how little fluid to remove and what the setting should be set at accordingly?? I love the old chart our nurse gave us for the System One so I hope they will be giving us one for the new S when they tell us what my husbands new prescription will be. Some nites we take more off, some nites less. Having the chart helps, as I do not want to have to log onto the computer every nite to look it up. I'd rather keep a chart handy with our treatment sheets. My husband was prescribed the new SAK 402's but until those arrive, NxStage said we can continue using SAK 302 but...at the same lower speeds that we had used on the System One. Everything seems to be going okay except that I notice that about halfway thru a treatment, we get a "New" Yellow Caution 53 alarm telling us "Low Fluid Temp". No action required. What's interesting, is that our Pureflow heater is set at 13 (quite warm) and because of 100 degree weather, it's been 78 degrees inside our apartment, even with the air conditioner on! So why the new S cycler is telling us the fluid temp is too low when we are sweating indoors, I don't understand. But, we only get the YC53 once and it goes away and nothing else becomes of it. So far, everything seems to be running smoothly on it, with the exception that right from the get go tonite, he had very high venous pressure 290 and we were still only at a blood flow rate of 200! It didn't alarm but nonetheless, that is quite high for him. We suspect his fistula is acting up again. Was not an easy needle stick tonite. He had an angioplasty 3 weeks ago and we are feeling the same signs/symptoms as before, so off we go to the vascular surgeon tomorrow! We tried to run him as long as we could tonite, staying at a Blood Flow Rate of 200 but when the venous pressure got up to 322, I said "enough" and made the decision to do early rinseback and get him off the machine. I did not want to end up with cascading Red Alarms and risk losing the whole circuit of blood, the man has enough to worry about (and so do I!).  So, won't be surprised if he needs another angioplasty tomorrow but then maybe we'll get to come home and get back to singing the praises of doing home hemo again by tomorrow nite. We shall see...

As for other things with the S cycler, altho trivial, I don't like the "Troubleshooting" section in the new manual. It lists all the different kinds of alarms (red or yellow) and possible triggers and remedies but not as easy to understand or (in my opinion) as thorough as the alarms section in the old manual for the System One, so be careful when you get alarms. Don't just rely on the old manual. 

As for not using bags at the new higher flow rates/volume on the S cycler, my guess is that this is a safety issue (I think the manual discusses it) and that they want the dialysate to be allowed to pass thru a warmer and actually be warmed up to a certain temp to avoid dangerous effects to the tubing, the dialyzer and membrane and to avoid hypothermia and hemolysis to the blood. If the fluid is passing thru at a fast rate, it probably doesn't have a chance to be warmed up to a safe temp rushing thru a warmer bag or warmer, altho I wonder if a person could use bags that they know are already very warm from a source other than the warmer before hanging them.   Anyways, guess if we ever have to use bags, we will go at the slower rates/lower volumes. As for going at higher rates/more volume using the Pureflow, this will all hinge on the results of my husband's aluminum level. I cringe at the thought, I do not want my husband being poisoned. However, hanging 6-8 bags each treatment might also not be doable for us, either. I would not mind having to make a new batch/SAK every nite and going a little longer to do more volume but regularly hanging that many bags would hurt me and I am already living with pain 24/7 without meds. But I do not want my husband experiencing the ill-toxic effects of aluminum poisoning! Dang! Just when you think something wonderful, really wonderful has been invented, it all comes crashing down! It is so worrysome and scary. But I think everything about kidney disease and doing dialysis is worrisome and scary. Hard to stay focused without letting it scare the bee-jeezuz out of ya! 

Meanwhile, if anyone else is getting high venous pressures and YC53 alarms on the new S, I'd be curious to know.

I havent bought into all the hysteria here about aluminum yet. We are still using the pureflow. I am not convinced there is a big issue anymore with aluminum. We will moniter my wife monthly for now. We are drinking filtered water now as our well is quite high in aluminum.
The hanging bags were not really designed for every day use at the high numbers we do now ( 6 to 8 per treatment) . When the system was designed they were doing much lower levels of dialysate , like 20 liters rather then the 30 to 40 or more we now do. So they came up with pureflow to increase the dialysate volume  ability  over the hanging bags. It is much more efficient with pureflow. The heating is better also. Now everone is in an uproar over the aluminum and trying to use the bags at high volumes and hanging 6 to 8 bags. To me thats NUTS. Doing it every day will wear out people . It also creates issues with storage and trash. I just dont like it and at this point wont do it. I think this is an over reaction .
Has anyone realy been harmed significantly by the aluminum? I still havent been convinced . I am not saying it wasnt an isue as it shouldnt have ever happened. I still want to moniter nxstage carefully , and moniter my wifes aluminum. But Icant imagine hanging 6 or more bags every day . no way.

[PrimeTimer]

In regards to the new Yellow Caution 53 "Low Fluid Temp" Alarm: I haven't talked to NxStage about this yet but I think I've figured out this new mysterious Yellow Caution 53 "Low Fluid Temp" alarm. During a 3.50 treatment, it seems to occur almost exactly halfway thru treatment AND...when we are using the last 30 liters of a 60 liter SAK. I've noticed that we don't get the alarm during treatment when first using a new batch of a 60L SAK, so I am guessing that as we use up dialysate from the SAK, the new S cycler senses a change in temp. By the way, our Pureflow Heater setting is at 13 and our thermostat indoors is about 75% F, so it's fairly warm indoors. The other day when we got the YC53, we were also down to our last 30L of a SAK and the indoor temp was 78% F. And yet, when we started using a new batch at a full 60 liters, our indoor temp in the living room and the Pureflow Heater setting were the same as before (setting 13, thermostat 75-78% F) but no YC53 occurred. 

Just an fyi: We are still using SAK 302's on the new S cycler and per NxStage, that is okay so long as we stay at the lower flow/volume rates we were using when we had the System One. We have the new SAK 402's to be used at higher volume/flow rates but waiting on the Neph to give my husband his new prescription (time, volume, rates, etc). Also still waiting for his aluminum level to be tested, which they assured us would be performed at his next appt.

[obsidianom]

In regards to the new Yellow Caution 53 "Low Fluid Temp" Alarm: I haven't talked to NxStage about this yet but I think I've figured out this new mysterious Yellow Caution 53 "Low Fluid Temp" alarm. During a 3.50 treatment, it seems to occur almost exactly halfway thru treatment AND...when we are using the last 30 liters of a 60 liter SAK. I've noticed that we don't get the alarm during treatment when first using a new batch of a 60L SAK, so I am guessing that as we use up dialysate from the SAK, the new S cycler senses a change in temp. By the way, our Pureflow Heater setting is at 13 and our thermostat indoors is about 75% F, so it's fairly warm indoors. The other day when we got the YC53, we were also down to our last 30L of a SAK and the indoor temp was 78% F. And yet, when we started using a new batch at a full 60 liters, our indoor temp in the living room and the Pureflow Heater setting were the same as before (setting 13, thermostat 75-78% F) but no YC53 occurred. 

Just an fyi: We are still using SAK 302's on the new S cycler and per NxStage, that is okay so long as we stay at the lower flow/volume rates we were using when we had the System One. We have the new SAK 402's to be used at higher volume/flow rates but waiting on the Neph to give my husband his new prescription (time, volume, rates, etc). Also still waiting for his aluminum level to be tested, which they assured us would be performed at his next appt.

The air temp in the room may be warm at 75 but remeber the body core and blood temp is about 99 , so there is quite a bit of warming to the fluid.
AS the volume drops there is more effect of heat loss then in a larger volume . We run our setting at 18 and never have a problem.

[PrimeTimer]

In regards to the new Yellow Caution 53 "Low Fluid Temp" Alarm: I haven't talked to NxStage about this yet but I think I've figured out this new mysterious Yellow Caution 53 "Low Fluid Temp" alarm. During a 3.50 treatment, it seems to occur almost exactly halfway thru treatment AND...when we are using the last 30 liters of a 60 liter SAK. I've noticed that we don't get the alarm during treatment when first using a new batch of a 60L SAK, so I am guessing that as we use up dialysate from the SAK, the new S cycler senses a change in temp. By the way, our Pureflow Heater setting is at 13 and our thermostat indoors is about 75% F, so it's fairly warm indoors. The other day when we got the YC53, we were also down to our last 30L of a SAK and the indoor temp was 78% F. And yet, when we started using a new batch at a full 60 liters, our indoor temp in the living room and the Pureflow Heater setting were the same as before (setting 13, thermostat 75-78% F) but no YC53 occurred. 

Just an fyi: We are still using SAK 302's on the new S cycler and per NxStage, that is okay so long as we stay at the lower flow/volume rates we were using when we had the System One. We have the new SAK 402's to be used at higher volume/flow rates but waiting on the Neph to give my husband his new prescription (time, volume, rates, etc). Also still waiting for his aluminum level to be tested, which they assured us would be performed at his next appt.

The air temp in the room may be warm at 75 but remeber the body core and blood temp is about 99 , so there is quite a bit of warming to the fluid.
AS the volume drops there is more effect of heat loss then in a larger volume . We run our setting at 18 and never have a problem.

Ahh! Makes perfect sense now! Thanks for the info, obsidianom! I was thinking the drop in volume during treatment had something to do with it but didn't consider how NxStage might have figured in average body temp as well. Needless to say, we bumped up the heater temp on the Pureflow now. 

[PrimeTimer]

A couple of updates: You were definitely right about temp, obsidianom. We bumped up our Pureflow Heater setting just one notch from a 13 to a 14 and...no more YC53 alarms! Meanwhile, we are still waiting for my husband's "new prescription" from the Neph for the new S cycler. At his appt yesterday, he was told that as soon as we use up the rest of the SAK 302's that we have and are ready to start using the 402's (that they already had NxStage deliver to us), they will let us know what his new "volume/time/rates" will be. In other words, I don't think they know.

[PrimeTimer]

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.

Just wondering how you were getting along with the new S Cycler. Hope it's continuing to go well for you and that you're getting good labs and feeling well. My husband will be starting on 402 SAK's pretty soon, at which time his Neph will be giving him his new prescription (rate, volume, etc).

[PrimeTimer]

Anyone else using the new System One "S" cycler? Just wondering how people are liking it and their thoughts or experiences on it. We are using it but not necessarily at the higher rates/higher volumes. We are still going at a low flow fraction (42-44) for 30 liter treatments just a tad bit faster (3:15 hour treatments versus 3:50 hour treatments) at a blood flow rate of 350-380. We think going slower and longer was/is better.

Even tho we aren't going much faster, my husband's blood pressure started becoming a little unpredictable. Sometimes high during treatment to suddenly very low and needing to get off the machine. As the carepartner, I've learned how to make necessary adjustments during treatment to deal with high/low blood pressure and pulse rates but seems ever since we started on the S cycler, his BP has been all over the map. Of course, there could be other factors that are affecting his BP so we aren't ruling those out, either.

Anyways, we were given a chart with the old cycler to calculate and estimate UF rates/treatment time based on dry weight and amount of fluid needing to be removed but no chart for the S cycler. I know I can call NxStage about it but I think if they do have a new chart, it will probably be for the higher rates/higher volumes, which is not what we want. So, I've been keeping a journal and kind of creating my own chart as we learn what rates work for my husband and which rates don't, meaning that I keep track of what rates we were using when his BP acted strangely, as well as tracking what rates were in effect when the dialysate "zeroed out" and finished versus when the UF goal was met. I try to get both the dialysate and UF goal to zero out/finish at the same time, if not very close or within a few minutes of each other. As for the new SAK's (we use SAK 402, which is the equivalent of the 302's except that the 402's can be used at higher rates), the added dialysate line and tubing is a bit clunkier/fatter/stiffer and not as easy for me to handle in my hands but like anything new, I am getting use to it. Overall, we like the new S cycler but would have been just as happy to have kept the old cycler. I'm not complaining in fact, we are grateful to be able to be doing home-hemo. I think like with anything else, we were starting to get comfortable with the old cycler when suddenly we were given the new S cycler and it kind of threw us off a bit. But overall, my husband is still doing/feeling good and his labs still look good, altho at longer treatment times, the amount of blood liters processed (BLP) was closer to 80-81 and now at 71-75. Not much difference but after reading up on what Australia's Dr. Agar says, time and frequency DO matter.

Thanks for letting me post such a long one. I hope anyone else using the S cycler will post about their own experience on it.