What is the slowest effective pumpspeed I can run on Nxstage?

[cassandra]

Hi all, maybe this has been asked before, but how low can I go with bps? I know when I once forgot to increase the pumpspeed to 280 and stayed on 200     I only processed 29 litres, in stead of my normal 40+ litres in 2,5 hours. But I felt great to be honest. No poisoned feeling (K+) either before my next session.

I've lowered my BPS now to a 'constant' 260 for 2,5 hours to see what my next bloodtest will reveal. I feel the same, no poisoned feeling.
Has anyone else tried lower than 250 for 2,5 hours?

Thanx already, love and luck, Cas

     
         

[Simon Dog]

Talk with your RN first.   In addition to the obvious issue of effectiveness of treatment, slow pump speeds can be prone to clotting.   

[obsidianom]

I have often wondered the same. We run 340 blood speed to process 74 liters in 3.5 hours. That works for my wife. I have often wondered if I could lower the blood speed and still get effective dialysis on the same 30 liters of dialysate.  I honestly don't know the answer . I am not sure anyone really knows. It may come down to what works for you. Don't forget we are all different in our physiology and needs from dialysis .

[cassandra]

Hi Obsi thanx for answering, however in spite of people being so individual I actually think it must be possible to 'sort of' have a calculation for that. As in: the flow of the fistula divided through the pumpspeed has to be above 3 or something. The pumpspeed has so much effect on the veins, and heart, but also. And therefore quality of life, that I can't believe the answer isn't on a graph hanging in the nephrology department   

Talk with your RN first.   In addition to the obvious issue of effectiveness of treatment, slow pump speeds can be prone to clotting.   

The RN ''doesn't know really", and I will keep an eye out for clots in my quest for the right answer in my individual case, and 'for the benefit of the wider public' 

[Maggie and Jeff]

Hi all, maybe this has been asked before, but how low can I go with bps? I know when I once forgot to increase the pumpspeed to 280 and stayed on 200     I only processed 29 litres, in stead of my normal 40+ litres in 2,5 hours. But I felt great to be honest. No poisoned feeling (K+) either before my next session.

I've lowered my BPS now to a 'constant' 260 for 2,5 hours to see what my next bloodtest will reveal. I feel the same, no poisoned feeling.
Has anyone else tried lower than 250 for 2,5 hours?

Thanx already, love and luck, Cas

     
         

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We run at 200 for 8 hours each night 6/week
20L @ 2.5L/hour

1-3L ultra filtrate no faster than .4/hour to come off over 7 hours.
I do the math but should make a chart.

So if we take off 2.4L of fluid we take it off at .34/hour so it takes 7 hours so we can sleep. no cramps.

We use CAR172-C and bought a Medifusion 2010 to pump heparin.

Bought a dynomap to take her BP and had to get a Y adapter to use a non-disposable cuff with one tube.

Thank God for ebay as we got the used equipment and sent the medifusion in to be refurbished all of it cost under $1000 and should be provided but the red tape remains uncut.  Even though FMC will no longer support home hemo nocturnal on the baby k as the fda never approved it for that use and it was brought into the light with NxStages approval.  They remain reluctant to use the NxStage for nocturnal even though it received fda approval for nocturnal last year.


Maggie has been taken off phosphorous binders.

Use the calculator it is very accurate.

You'll need some of your lab numbers don't just guess.

Maggies kt/v has been 2.8ish

We will need to increase her ff Filtration Factor from 24 to get kt/v of 3.0

To do this we could run for a shorter time with a faster pump rate or add more dialysate.

FMC says kt/v of 2.0 is adequate and 1.9 is to low.

I think you'll find you need more dialysate to run slower and keep the same clearance.
More dialysate could add time to have the right ff to achieve the desired kt/v.

You should print out the results from the calculator and show them to your Dr.

I tried  a few variables before I picked a result we liked.

 

[Simon Dog]

The FMC clinic bought a Graseby MS16A infusion pump and a Contec ABPM50 BP machine (measures pressure automagically at set intervals) and issued them to me at no charge.

Bought a dynomap to take

Looks like a very nice unit but overkill.   This is what I was issued: http://www.amazon.com/ambulatory-pressure-BLUETOOTH-continuous-monitoring/dp/B006NSQ9VW

[Maggie and Jeff]

The FMC clinic bought a Graseby MS16A infusion pump and a Contec ABPM50 BP machine (measures pressure automagically at set intervals) and issued them to me at no charge.

Bought a dynomap to take

Looks like a very nice unit but overkill.   This is what I was issued: http://www.amazon.com/ambulatory-pressure-BLUETOOTH-continuous-monitoring/dp/B006NSQ9VW

We got tired of waiting on FMC here in Columbia TN.

We got the used dynomap for $93.59 shipped.


What FMC do you use?

Maybe I can get my FMC to contact your FMC so yours can tell mine what they need to know to be able to provide the equipment.  As it is we have no warranty so when the medifusion dies it cost about $600 + takes 2 weeks to get it refurbished.  They do give a 1 year warranty after refurbishing so I guess we have a couple months before that runs out.
FMC could get me a replacement sooner than what we can afford.

How long are your treatments?

[cassandra]

Thank you for the info Maggie and Jeff. I don't use any 'gadgets' bar a BP wrist meter (£4,- Macro) which I use before and after a session. I usually do 2hrs30 sessions on 30 litres, bps 270 for 2 days, a 60 litres from 5 hrs, or 60 litres from 7 hrs when poss, usually 1 or 2 times a week.

Easier said I really try to do 17 hrs a week ( Dr J Agar's mantra) with a BPS of 270. My fistula is still blocked, so dialyse on collateral veins. I use 3,500 unit Tinzaparine per 2hrs30.

So far it works, I feel better now (3+ years Nxstage than I did on a 11+ years in-centre HD, and not much worse than on the 5 years PD). I don't think I will ever feel as good as with my dad's kidney, but it's getting difficult to remember anyway   

Thanx for replying Maggie and Jeff, Simon Dog, and Obsidianom. Wishing you all a good or better New Year!

Lots of love, Cas

[Simon Dog]

How long are your treatments?

I sent the clinic contact info by PM.

I run 40L treatments at 450 (hoping to reduce that) that take about 3.5 hours, 5 treatments per week.   I am prescribed the option of 60L treatments over 6.5 - 8 hours (my choice) 5 nights a week, but had insomnia issues when trying that.  I am going to try nocturnal again though.

[Maggie and Jeff]

Thank you for the contact info.

Switching to the long treatments took an adjustment period but now it is so nice to have almost all of the day free.

Even if we sometimes take a nap.

Running with a 200 pump speed has been good for the fistula.

I feel for you.  I hope and pray your fistula gets running again soon.

[PrimeTimer]

Thank you for the info Maggie and Jeff. I don't use any 'gadgets' bar a BP wrist meter (£4,- Macro) which I use before and after a session. I usually do 2hrs30 sessions on 30 litres, bps 270 for 2 days, a 60 litres from 5 hrs, or 60 litres from 7 hrs when poss, usually 1 or 2 times a week.

Easier said I really try to do 17 hrs a week ( Dr J Agar's mantra) with a BPS of 270. My fistula is still blocked, so dialyse on collateral veins. I use 3,500 unit Tinzaparine per 2hrs30.

So far it works, I feel better now (3+ years Nxstage than I did on a 11+ years in-centre HD, and not much worse than on the 5 years PD). I don't think I will ever feel as good as with my dad's kidney, but it's getting difficult to remember anyway   

Thanx for replying Maggie and Jeff, Simon Dog, and Obsidianom. Wishing you all a good or better New Year!

Lots of love, Cas

Sorry to hear about your fistula, cassandra! Hope it can be fixed soon! (sorry I didn't read this sooner). Sounds like a very rough time but you have one of the best attitudes I've seen on here so really pulling for ya! Hope better times come your way for the New Year (and for ALL of us!) 

If it's not too personal, I am curious about what collateral veins are and how they can be used for dialysis. Searching the internet didn't help me much and I'd like to know about these things. 

[Maggie and Jeff]

Sorry to hear about your fistula, cassandra! Hope it can be fixed soon! (sorry I didn't read this sooner). Sounds like a very rough time but you have one of the best attitudes I've seen on here so really pulling for ya! Hope better times come your way for the New Year (and for ALL of us!) 

If it's not too personal, I am curious about what collateral veins are and how they can be used for dialysis. Searching the internet didn't help me much and I'd like to know about these things.

I believe this is what is being referred to as collateral veins  I could be wrong but it was my first thought.

https://en.wikipedia.org/wiki/Dialysis_catheter

[cassandra]

If it's not too personal, I am curious about what collateral veins are and how they can be used for dialysis. Searching the internet didn't help me much and I'd like to know about these things. 

Imagine the fistula as a straight line vein. But that vein has little veins branching from that, spreading throughout the arm and shoulder. My fistula had lots of narrowings since the start (through scarring from previous catheters mainly) Those narrowings were regularly stretched. But than one of them closed completely and could not be stretched open. But before that was discovered my 'amazing' body realised that my blood hád to go through a machine, and made all those tiny veins big enough to transport the blood. So those tiny veins have become pretty big. Big enough to work together and be a huge 'fistula'.
They are my collateral veins

 

Lots of love, and have a good New Year

[PrimeTimer]

If it's not too personal, I am curious about what collateral veins are and how they can be used for dialysis. Searching the internet didn't help me much and I'd like to know about these things. 

Imagine the fistula as a straight line vein. But that vein has little veins branching from that, spreading throughout the arm and shoulder. My fistula had lots of narrowings since the start (through scarring from previous catheters mainly) Those narrowings were regularly stretched. But than one of them closed completely and could not be stretched open. But before that was discovered my 'amazing' body realised that my blood hád to go through a machine, and made all those tiny veins big enough to transport the blood. So those tiny veins have become pretty big. Big enough to work together and be a huge 'fistula'.
They are my collateral veins

 

Lots of love, and have a good New Year

Thanks for answering, cassandra. I was trying to picture collateral veins in my mind and wasn't sure. Now I get it (and the need for slower blood pump speed). Kind of like a river tributary in reverse. Your body discovered "where there's a will, there's a way!" Must be all that goodness in your heart that it keeps working for you! My husband has a working fistula and goes no higher than 380 blood pump speed for 3 1/2 hour treatments 5x week removing an average of 1.5 kilos of fluid at 0.50 an hour at a dialysate rate of 8.4 using 30 liters on his NxStage cycler. Works well for him.

   Happy Wonderful New Year!

 



EDITED:  Corrected smiley tag error - Charlie B53 - Moderator