Fresenius Saline Bags & Bubbles

[PrimeTimer]

Anyone notice something different about Fresenius saline bags lately? Or am I becoming a weakling? A wimp perhaps? They were always hard to spike and now...they just got harder. Also getting a lot of bubbles in the arterial line at rinseback and then of course, the dreaded red alarms once the blood hits the pressure pod (on the NxStage cycler). Sometimes if I gently tap the saline bag just before rinseback we are able to avoid bubbles and alarms but this seems to be a new problem and not something we had to frequently deal with in the past. It is a struggle and so far I have been able to overcome "cascading alarms" and remove air from the blue venous header with a syringe but dang...getting tired of it. By the way, this problem does not seem to be unique to one specific lot number for the saline bags.

[Simon Dog]

Have not noticed any difference lately with mine.

I was surprised - when Fresenius switched home patients to the MMC pharmacy, I was expecting Baxter or another mainstream brand of saline, but they are still sending Fresenius saline.

[Vt Big Rig]

Interesting ....... I have not had alarm but I have noticed a significant increase in bubbles in the lines when I do snap and tap; and at end of treatment when I take a syringe down that has been filled since we started ( to do rinseback) .. there are lots of tiny bubbles in it that I have never noticed before. I can get them to go to top with some tapping. But there are more of them ?

[PrimeTimer]

Interesting ....... I have not had alarm but I have noticed a significant increase in bubbles in the lines when I do snap and tap; and at end of treatment when I take a syringe down that has been filled since we started ( to do rinseback) .. there are lots of tiny bubbles in it that I have never noticed before. I can get them to go to top with some tapping. But there are more of them ?

Yup. That's what I'm talking about. At prime stage (pre-treatment), I do "snap-n-tap" 3 times around. Later, during treatment, I've noticed little micro bubbles in the saline bag and that short section of the arterial line where I hang a filled syringe to use at end of treatment (just like you mentioned). And in that same spot, I've also seen a bubble or two running down the arterial line at rinseback that is large enough to set off a red alarm once it hits the pressure pod. Not good! Now I've been gently tapping the saline bag and that short segment of tubing on the arterial line (where I said that I hang the pre-filled syringe) to get those bubbles to surface to the top before I press the rinseback button but...still sometimes get a bubble that sets off an alarm.

[Simon Dog]

A trick I use is to close the red clamp for about 30 seconds after prime completes but before snap&tap.  Cavitation creates large bubbles in the red line.   When I open the red clamp, these bubbles go "whoosh" and sweep most of the tiny bubbles with them.

[Vt Big Rig]

A trick I use is to close the red clamp for about 30 seconds after prime completes but before snap&tap.  Cavitation creates large bubbles in the red line.   When I open the red clamp, these bubbles go "whoosh" and sweep most of the tiny bubbles with them.

I will try that on the next treatment!

I love this site!!

[PrimeTimer]

A trick I use is to close the red clamp for about 30 seconds after prime completes but before snap&tap.  Cavitation creates large bubbles in the red line.   When I open the red clamp, these bubbles go "whoosh" and sweep most of the tiny bubbles with them.

Does it matter which red clamp? I'm assuming both...  The small one closest to the saline bag or the larger one that they refer to as "patient side"? 

[Simon Dog]

Doesn't really matter - I close the small one.

If you do this, you need to wait a couple of minutes so the bubbles that go with the "whoose" make it all the way through the system.   I typically prime, then have diner, the pick up at snap & tap later in the night.

[caregivertech1]

If you're getting a lot of red 11's at the beginning of rinseback you might try to refill the 10cc syringe first. That would clear any bubbles in the short saline line (and syringe) that may have accumulated. Also like Simon Dog's closing the red clamp idea. I'll try that.

[Vt Big Rig]

Tried the red clamp trick. I think I chickened out on the 30 secs and opened it too early. Most of air collected in dializer. But it did work for red line. Will use that again.

I have not  gptten alarms at rinseback. Just bubbles in the syringe.

[PrimeTimer]

Doesn't really matter - I close the small one.

If you do this, you need to wait a couple of minutes so the bubbles that go with the "whoose" make it all the way through the system.   I typically prime, then have diner, the pick up at snap & tap later in the night.

Thanks. Normally I wait too (10-15 minutes) after priming before doing snap-n-tap. I'm also going to give your red clamp idea a try.

[PrimeTimer]

If you're getting a lot of red 11's at the beginning of rinseback you might try to refill the 10cc syringe first. That would clear any bubbles in the short saline line (and syringe) that may have accumulated. Also like Simon Dog's closing the red clamp idea. I'll try that.

Thanks for the idea. I've thought of doing that very thing or waiting to fill the syringes until we're ready to rinseback in hopes that I can suck out air that way.   

[PrimeTimer]

Okay...so I tried Simon Dog's red clamp trick. It worked. WHOOSH! Bubbles-Be-Gone! Well, most of them anyway. Seems to be less bubbles to snap and tap out of the lines. Next, I am also now waiting to fill the "post treatment flush syringes" until just before rinseback. I very gently tap the short lines that are connected to the saline bag, watch small bubbles surface up into the saline bag and then hook up the syringes and syphon any more possible air out and continue on with filling them with saline. If I can stay alarm-free my husband gets to keep his blood. A win-win for both of us. 

[micron]

I've been using the quick red clamp method for a while since I read it here on a different post.  It does help quite a bit.  We've noticed that the machine/bubble issue is much better if you let it cycle at the 23/000 for a while before snap&tap.  My husband does his set up and the initial snap and tap before i get home.  Then I'll pull saline for his cath and do another snap&tap.  I always check one more time before stopping the cycler, air will gather at the top of the filter.  We're getting pretty good at it, rarely get the Red 11, and if we do it's from the unavoidable air pocket from hooking up the cath.

I also make sure to tap the saline bag and try to get the bubbles out/settled whenever I see them forming.

[cbatsea]

We never get air alarms....there is never air in the lines after prime, but it does take a while to get all the air out of the filter.  I slap it on my hand, tap the end....takes about 5-7 mins of total slapping and banging on my hand.  Once I see no more air bubbles, I snap and tap once more, to be sure, then re-check the filter.  If NO more bubbles appear, I proceed to the rest of the set-up. 

When treatment is over, and I'm returning his blood to him, I connect the arterial line, and let any bubble rise back into the saline bag....NO alarms!  A small bubble won't usually set an alarm.

[cassandra]

Thanx for the 'avoiding' red 11 alarm tips during the beginning of rinse back.
My tip to remove most air from the filter during snap and tap is to pull the filter tight away from the machine so  the blue line is tight, most air will leave the filter. Only a few taps needed than.




Love y'all, Cas