Syringe Brand

[Vt Big Rig]

While we were training we were using BD syringes. Now that we are home the clinic sent us NIPRO. They are HORRIBLE 

I defy anyone to draw saline into it without bubbles. It always seems to stick when it is fully plunged and you are trying to draw back. Therefore difficult to see if access is smooth and to draw saline without yanking on it. And when I do get bubbles I can never seem to get them to completely rise out.

I did not have these problems with the BD. Anyone else experience this??

[Simon Dog]

I was also forced to switch from BD to Nipro syringes.   The was the result of switching home patients from the Fresenius internal supplier (same supply bank as clinics) to MMS pharmacy - a specialty dialysis pharmacy.  This also explains why you where trained on BD and got Nipro at home.  It seems it is cheaper for Fresenius to buy externally than from themselves due to the high delivery charge they charged themselves (go figure).

I am not having any problems with them - they seem almost the same as BD except for the extra "11 cc" marking.  I noticed they are from a Japanese company (good) but made in China (possibly bad).    You might want to try moving the plunger back and forth before you actually draw the saline to "unstick" the rubber plunger from the body of the tube.

I have been using JMS 15ga blunts, but the new default is Medisystems.  I *Hate* the Medsystems scab picker - it is wider (harder to get into a buttonhole with a recessed scab), and harder to hold (much shorter handle).  The RN at my clinic says she can get JMS as well, so I am glad I had her order a small quantity of Medisystems needles for me to try out.

And remember, we are talking "low bidder" here 

[Simon Dog]

One more detail - according to the product list the RN gave me for the new supplier (MMS pharmacy), the antibiotic will be grocery store grade .15% triclosan rather than the Medline .5% triclosan that FMC/TrueBlue was supplying.    Not sure if it makes any difference, however, I suspect the decision on this (and other supplies) was based on low bidder rather than medical criteria.

[caregivertech1]

Yeah, we were switched as well. They do "feel" cheaper but other than the extra step of removing the steril plastic insert I've had no problems. Only used them a few times so I'll report back with more uses.

[Simon Dog]

Yeah, we were switched as well. They do "feel" cheaper but other than the extra step of removing the steril plastic insert I've had no problems. Only used them a few times so I'll report back with more uses.

I assume you are talking about the fistula needles.   It's worth noting that the Medisystems one are polarized - only the arterial line has a backeye.   You use the one with the green clamp in the arterial site and the translucent yellow on in the venous.  I believe Medisystems has reserved the obvious blue/red coding for sharps.

[Vt Big Rig]

I assume you are talking about the fistula needles.   It's worth noting that the Medisystems one are polarized - only the arterial line has a backeye.   You use the one with the green clamp in the arterial site and the translucent yellow on in the venous.  I believe Medisystems has reserved the obvious blue/red coding for sharps.

Actually I was talking about saline syringes for checking placement and part of the rinseback

[Simon Dog]

Actually I was talking about saline syringes for checking placement and part of the rinseback

I'm puzzled by your reference to the "sterile plastic insert" - I didn't notice anything extra in the Nipro packaging or needles over the BD.   What exactly are you referring to?
 
I don't have any problems with placement, but I still consider the line flush essential.  When I let the blood up into the line, I sometimes get a bubble.   I put 7ml in the syringe which allows me to pull any bubbles out of the line (2.6 ml volume in the line attached to the fistula needle) and avoid pushing air into myself.

Just curious - are you using Medisense or JMS needles at home?    That was a bigger differnece for me than BD vs Nipro.

[Vt Big Rig]

I did not mention the sterile insert. I believe the other poster meant the little white tip on the end of the NIPRO.

We were supplied JMS needles at home. We continue to do sharps.

And obviously I need to brush up on how to quote a previous post.

[PrimeTimer]

My husband saw those Medisystems fistula needles that folks are talking about when he recently traveled and had to go in-center. He said he took one look at them and knew they'd be horrible. He was glad that he packed some of his JMS needles for the trip. If his center makes him switch, he's going to be very upset and insist that his Neph write a special prescription for the JMS needles he's been using. Wonder what's going on with Fresenius....they don't have "home" hemo supplies delivered to the "home" anymore (have to drive and pick everything up at the clinic, including saline) and now I come here and read they are switching to cheap needles and syringes. WTH is up with that? 

[obsidianom]

My husband saw those Medisystems fistula needles that folks are talking about when he recently traveled and had to go in-center. He said he took one look at them and knew they'd be horrible. He was glad that he packed some of his JMS needles for the trip. If his center makes him switch, he's going to be very upset and insist that his Neph write a special prescription for the JMS needles he's been using. Wonder what's going on with Fresenius....they don't have "home" hemo supplies delivered to the "home" anymore (have to drive and pick everything up at the clinic, including saline) and now I come here and read they are switching to cheap needles and syringes. WTH is up with that? 

We have been using Medisystems sharp 3/5 inch short fistula needles for 2 years and prefer them over any others. I bring my own to the hospital when my wife was in patient recently . I don't like the JMS needles.
Fresenius is becoming a real pain to deal with.  I got half the number of rolls of tape I need recently and let them know how unhappy I am with that. My wife has a movement disorder and I have to heavy tape her to keep the needles in.

[Simon Dog]

Wonder what's going on with Fresenius....they don't have "home" hemo supplies delivered to the "home" anymore (have to drive and pick everything up at the clinic, including saline) and now I come here and read they are switching to cheap needles and syringes. WTH is up with that? 

This is not universally true.   My FMC clinic has supplies shipped from MMS Pharmacy to my home.  The exception is EPO which I now have to pick up at the clinic.

What is surprising is that the branding is not consistent - you would think that NiPro vs BD and JMC vs Medisystems would have the same answer for "which is cheapest" for both the clinics and home shipments.

I did not like the Medisystems at first (different scab pick), but my dislike is fading now that I have done a few treatments with them.

[PrimeTimer]

Wonder what's going on with Fresenius....they don't have "home" hemo supplies delivered to the "home" anymore (have to drive and pick everything up at the clinic, including saline) and now I come here and read they are switching to cheap needles and syringes. WTH is up with that? 

This is not universally true.   My FMC clinic has supplies shipped from MMS Pharmacy to my home.  The exception is EPO which I now have to pick up at the clinic.

What is surprising is that the branding is not consistent - you would think that NiPro vs BD and JMC vs Medisystems would have the same answer for "which is cheapest" for both the clinics and home shipments.

I did not like the Medisystems at first (different scab pick), but my dislike is fading now that I have done a few treatments with them.

Maybe one brand's cost of doing business is more expensive than the other or it has to do with logistics.

[PrimeTimer]

My husband saw those Medisystems fistula needles that folks are talking about when he recently traveled and had to go in-center. He said he took one look at them and knew they'd be horrible. He was glad that he packed some of his JMS needles for the trip. If his center makes him switch, he's going to be very upset and insist that his Neph write a special prescription for the JMS needles he's been using. Wonder what's going on with Fresenius....they don't have "home" hemo supplies delivered to the "home" anymore (have to drive and pick everything up at the clinic, including saline) and now I come here and read they are switching to cheap needles and syringes. WTH is up with that? 

We have been using Medisystems sharp 3/5 inch short fistula needles for 2 years and prefer them over any others. I bring my own to the hospital when my wife was in patient recently . I don't like the JMS needles.
Fresenius is becoming a real pain to deal with.  I got half the number of rolls of tape I need recently and let them know how unhappy I am with that. My wife has a movement disorder and I have to heavy tape her to keep the needles in.

VERY glad to see you here, Obsidianom! Hope you and your wife are doing well!

I don't know what is going on with Fresenius but it concerns me. I'm glad my husband is able to do home hemo but having to pick up supplies from the clinic has now become just another added chore and frustration for us. He went to his monthly appt with a list of the supplies we need and he forgot to bring them home. Not his fault (he's overwhelmed) but it means another trip to the clinic tomorrow.

[micron]

Pretty much all the supplies we now get from Metro (instead of Fresinius) are cheaper seeming quality.  The Nipro needles are the least annoying of the lot.  I really miss the thicker alcohol pads and a few other of the ancillary supplies.

[Simon Dog]

Pretty much all the supplies we now get from Metro (instead of Fresinius) are cheaper seeming quality.  The Nipro needles are the least annoying of the lot.  I really miss the thicker alcohol pads and a few other of the ancillary supplies.

Paper table is 3M Micropore rather than Micropore+.   The only difference according to the web is more/stronger adhesive on the + variety.

[obsidianom]

Even the hand soap is cheaper with consumer brand dial soap with 1/3 the triclosan then the old soap which was medical grade. This really SUCKS!!
Everything we get now is cheaper. Fresenius really has turned CHEAP/

[Vt Big Rig]

I agree with alcohol pads. We wind up using two where we used one so I can't believe this is cost effective.  We have not had trouble with tape but they keep trying to tell us we do not need so much. Luckily our nurse gives us some extra.

On the soap ... they have never given us that. We have always bought our own.

Needles .... my wife actually likes the ones delivered (JMS) better than those we used in training.

It is still the syringe that drives up NUTS!!

I understand cost effectiveness but why continue to make this harder!!!!

[Simon Dog]

To summarize, Home vs. In center/old TruBlu delivery

• Nipro instead of BD syringes
• Generic instead of McKesson alcohol wipes
• .15% triclosan instead of .5% hand soap
• Micropore instead of Micropore Plus tape*
• Medisystems instead of JMS needles - ordered by # of needles instead of by the case
• 8% bleach instead of 6.25% bleach, gallons instead of 3qt bottles
• Different Saline brand
• Different brand gauze

* - I've been assured if I do not find this tape adequate, the RN will arrange for me get other tape

We have not had trouble with tape but they keep trying to tell us we do not need so much

I have been very fortunate.   The home care RN who handles my case is responsible for setting limits on supplies and she has never told me to "cut back" or that I am "using too much" of anything.    I also try to keep enough stock on hand so I can order any resupply when I am down to a two week inventory.

She also told me I will be using a LOT more tape once I go nocturnal.

And a p.s. to RN "KS" who is probably going to see this .... you are doing a great job of keeping me alive.  Thanks.

We have not had trouble with tape but they keep trying to tell us we do not need so much

Did you ever ask for it?   TruBlue/FMC supply and the MMS pharmacy (old and new supplier) both carry it.  The only reason you would be refused is if the RN did not put it on your Rx.

Needles .... my wife actually likes the ones delivered (JMS) better than those we used in training.

Are you sure you don't have that backwards?   JMS is used in the clinics and training; Medisystems is used in clinic.

We wind up using two where we used one so I can't believe this is cost effective.

I use 9 per treatment (of the McKesson).  3 to wipe the saline for flushes (I use the extra one to wed gauze I tape to the buttonholes an hour before treatment to soften the scan), 2 for pre-wiping the button holes, and one each before scab picking and puncturing.

[cbatsea]

Agree BD is MUCH better.  Had to use the Nipro for a month...hated them! Finally got the BD's back in stock....hooray!