Expired PAK

[caregivertech1]

After 4 years on NxStage I learned something new that probably everyone but me knew. Here's what happened. I went to make a batch and got a warning that my Pak was expiring in 18 hrs. OK plenty of time to make one more batch which I did successfully in 7 hours. Later the next afternoon I'm preparing the for treatment. The control unit says check chloramines like it always says. After hitting go to dispense the dialysate I get A11 alarm (PAK expired) and I go immediately to drain which is not reversible. I'm thinking I had 18 hrs. to make a 7 hr batch. I called Tech Support and found out that your new batch in not complete until after you check the chloramine...sooo the clock kept ticking past the 18 hrs and expired even though I had a made batch. Lesson learned, if short of time check your chloramine level to stop the expiration clock.

[Simon Dog]

Doesn't the expiration clock continue run even after you have checked chloramines?

[PrimeTimer]

We had that happen one time after performing the chloramines test and it really ticked me off. I figured I missed seeing (on Pureflow machine) the C-5 "Last Batch" and/or C-9 "PAK Exhausts in xxx L" that pops up on the Pureflow control unit after using up a SAK. Haven't had that happen again and whenever we get the A-11, we get it at a time we are expecting it. We like to make a batch overnite while we sleep so if in the morning it fails the chloramines test or something crappy happens, we still have time to make a new batch for treatment later that nite. I've also learned to only drain a SAK down to a weight where I can lift it out of the tub, carry it to a sink or bathtub, cut it open and let it finish draining there while I move on with the making of a new batch. I use to actually wait for a SAK to be completely empty..    Thanks for sharing the info...we learn!

Also wanted to add that (and this will differ depending on what region you live in and water quality, minerals, chlorine, city water or well water) but I've learned the average "lifespan" for our PAK's and I mark it on a calendar. I know this sounds anal but I keep the calendar on the wall next to where I sit at our kitchen table and every morning as I sit with my coffee, I check it...for dr appts, med refills, successful treatment days and when I last primed a PAK and estimate of when I will need to prime a new one. This may sound like too much to do but keeping the calendar sort of helps mentally prepare me for the day/week. Some people use a day planner, I prefer a big calendar with big blank squares I can write stuff on. 

[Simon Dog]

What kind of life are people getting from PAKs?

I was getting 12 50L SAKs per PAK.  After a long wait on back order, NxStage sent me a Linx filter to increase PAK life and I am currently at 15 SAKs and counting.   I don't keep a calendar, but I put a hash mark on the PAK label at each SAK fill.

I've been told the clinic is billed $500 per PAK.

[cassandra]

My PAKs last about 4 wks too (eod 60 liters (3,5 x 4 > 14)

[caregivertech1]

Yeah, Simon Dog, the clock continues to run but my problem was even though I made the batch in time I didn't check the chloramine until I was ready for treatment which was past the 18 hrs. so the entire 60L batch went to drain. Technically a batch is not "made" until the chloramine is checked. My paks typically last 2 1/2 months so 5 days/week at 30L/treatment is about 25 60L batches per pak....assuming my math is correct. I simply write the date on the pak when I install it. I understand the control unit will not let you go past 3 months regardless.

[Simon Dog]

My PAKs last about 4 wks too (eod 60 liters (3,5 x 4 > 14)

I assume you mean 3.5 hours every other day - are you running 60L or 30L  per treatment.

Prior to the Lynx I was changing PAKs every 2.5 weeks - running 40L treatments on a 50L sak (no 40L SAK with 40 lactate concentration)

[PrimeTimer]

Husband does 3.50 hour treatments using 30L per tx (60L SAK's). Our PAK generally lasts 17-20 treatments and/or 27-29 days. I count the day I prime a PAK as Day 1.

NxStage told me that the lifespan of a PAK can be affected not only by the quality of your water (minerals and such) but by how much/when your city treats their water with chlorine (for those on city water). Generally, a city might treat the water with chlorine twice a year and the amount may be stronger the first few days/weeks that they do that. That makes sense because one time I had a PAK that only lasted a few weeks but as the year went on, the PAK's gradually lasted longer. I also mark it on the calendar when I last received and installed a sediment filter from NxStage. Those should last a year.

[Simon Dog]

Husband does 3.50 hour treatments using 30L per tx (60L SAK's). Our PAK generally lasts 17-20 treatments and/or 27-29 days. I count the day I prime a PAK as Day 1.

That is only about 9-10 SAK fills.  That is within guidelines to have a Linx pre-filter supplied by NxStage.  I never got more than 12 before I got the Linx, and am on 16 and counting now (first PAK with the Linx).  The Linx takes up a bit of space, but is an install & forget unit - the only thing I will have to do to it is change the filter when NxStage automagically incldues one in my delivery.

[PrimeTimer]

Husband does 3.50 hour treatments using 30L per tx (60L SAK's). Our PAK generally lasts 17-20 treatments and/or 27-29 days. I count the day I prime a PAK as Day 1.

That is only about 9-10 SAK fills.  That is within guidelines to have a Linx pre-filter supplied by NxStage.  I never got more than 12 before I got the Linx, and am on 16 and counting now (first PAK with the Linx).  The Linx takes up a bit of space, but is an install & forget unit - the only thing I will have to do to it is change the filter when NxStage automagically incldues one in my delivery.

I googled the NxStage Linx filter and found a picture of it in a pdf titled "Dowload Therapy Handbook" for NxStage. Their picture shows the Linx sitting underneath a sink cabinet. I can't tell by their picture what it connects to tho. Is that something a plumber has to do? We live in an apartment so can't mess with the pipes.

[Simon Dog]

I googled the NxStage Linx filter and found a picture of it in a pdf titled "Dowload Therapy Handbook" for NxStage. Their picture shows the Linx sitting underneath a sink cabinet. I can't tell by their picture what it connects to tho. Is that something a plumber has to do? We live in an apartment so can't mess with the pipes.

The linx is self install and requires no plumbing fittings.  You connect a tube (the same kind as the blue one you use now, but green) from the water supply to the Lynx, and the blue tube to the Linx.  There is one more line - a white tube (same type as the blue) for the waste water (which I believe is from when the Linx automatically back-flushes the filters).

It's an easy install, no tools required.

Since the Linx is not medically rated for EMI emissions, NxStage recomments it be positioned at least 6 ft from the NxStage equipment.

I did my 20th SAK this AM; never got more than 12 pre-Linx.

[PrimeTimer]

The Linx sounds like it would need to stay hooked up to a water source and never disconnected between treatments.

[Simon Dog]

The Linx sounds like it would need to stay hooked up to a water source and never disconnected between treatments.

You can disconnect it the same way you would disconnect the NxStage from the water source.   I turn off the water source (but leave the tubing connected) when not in treatment or filling/flushing/priming a PAK.

You have nothing to lose by asking for one.  If it does't work out, call NxStage and they will have UPS pick it up at their expense.

[cassandra]

My PAKs last about 4 wks too (eod 60 liters (3,5 x 4 > 14)

I assume you mean 3.5 hours every other day - are you running 60L or 30L  per treatment.
[/quote]

No Simon I do 5-6 hrs 60 liters eod sorry for being unclear.
Just asking, how do I know if The sediment filter needs changing, cos mine has never been changed (3+ years)?

[Vt Big Rig]

I looked over the Linx connections and the way I have things laid out in the treatment room I could not figure a way to get the drain installed. They told me I cold not tee it into the existing drain. My existing drains run under the floor back to the waste pipe. I did not want lines on the floor.

I sent it back. We use up a PAK in about 12-14 treatments.

[Simon Dog]

Just asking, how do I know if The sediment filter needs changing, cos mine has never been changed (3+ years)?

The sediment filter on the back of the PureFlow is supposed to be changed annually, and it's an easy "self service" process.

You need to ask for a sediment filter with your next monthly order.

No Simon I do 5-6 hrs 60 liters eod sorry for being unclear.

I've been offered the option of 60L 6.5 hours 2 days on/1 off, but haven't figured out how to sleep through treatment yet.   My daytime option is 40L 3.5hour 5 days/week.

[PrimeTimer]

My PAKs last about 4 wks too (eod 60 liters (3,5 x 4 > 14)

I assume you mean 3.5 hours every other day - are you running 60L or 30L  per treatment.

Just asking, how do I know if The sediment filter needs changing, cos mine has never been changed (3+ years)?
[/quote]

Sediment filter should be changed annually. I don't know if it's the same in your Pureflow manual but for us, it's listed under one of the "Probable Causes" for Alarm 50 (A50) Inlet Pressure Low (Exhausted Sediment Filter).

If you tell NxStage it's been 3 years, I am sure they will send you out a new one right away. Our Pureflow machine had originally been used by the clinic so I didn't know how old the sediment filter was. Altho I wasn't getting any alarms, I called NxStage as we neared our 1 year anniversary using the Pureflow and they kindly sent us a new filter. It is very easy to install. 

Re my edit: According to my old post back in 2014 about Sediment Filters, I see that our nurse had to submit approval to NxStage before they would send us a new one. My guess is that they are very expensive and maybe at the time NxStage knew the filter wasn't a year-old yet. All I knew was that we didn't know how old it was when we got it from the clinic and I didn't want to wait and get an alarm and not be able to use the Pureflow.

[PrimeTimer]

The Linx sounds like it would need to stay hooked up to a water source and never disconnected between treatments.

You can disconnect it the same way you would disconnect the NxStage from the water source.   I turn off the water source (but leave the tubing connected) when not in treatment or filling/flushing/priming a PAK.

You have nothing to lose by asking for one.  If it does't work out, call NxStage and they will have UPS pick it up at their expense.

We use a Pureflow Faucet Adapter at our kitchen sink. I disconnect the blue water line when not in use. I would have to put the Linx either up on our kitchen countertop next to the sink or use an adapter connection below the sink...not sure I want to do that. But the fact that you get more life out of a PAK with the Linx is very tempting.

[Simon Dog]

We use a Pureflow Faucet Adapter at our kitchen sink. I disconnect the blue water line when not in use. I would have to put the Linx either up on our kitchen countertop next to the sink or use an adapter connection below the sink...not sure I want to do that. But the fact that you get more life out of a PAK with the Linx is very tempting.

Or, you could put the Linx on the floor next to the sink.   I'm up to 20 SAK fills with the Linx and counting (life without the Linx was 12 fills).   I put hashmarks on the SAK to keep track.

[cassandra]

Thanx Prime Timer and Simon, I'll call Nxstage tomorrow and ask for a new sediment filter

Love, Cas

[Simon Dog]

All I knew was that we didn't know how old it was when we got it from the clinic

Proper procedure is to write the installation date on the filter (Sharpie works nicely).

RN approval is often needed for things that are not 100% broke since the clinic gets billed.   My RN has a great attitude towards this sort of thing - "not a problem, I don't worry about that stuff".   One of the advantages of being one of only 3 out of 90 or so clinic patients on home hemo.

[cassandra]

Thanx again Simon Dog, and PrimeTimer, I called Nxstage USA (goes automatically when you call Nxstage tech support (1 of the reasons Nxstage isn't 'promoted' in the UK) who then emailed the NXstage supplier here, who then rang me to agree on delivery of filter coming tomorrow.

 Love, Cas

[PrimeTimer]

Funny...all this talk about PAK's and sediment filters made me check ours...wasn't on my hand-dandy calendar I boasted about. Ordered a new sediment filter yesterday. 

[Simon Dog]

Funny thing about the sediment filter - it seems to be the one maintainence item not on an automatic system.

The quarterly cleaning of the drain line with the special kit is automatic - it just shows up in your monthly order.

The PurePlow notifies you when it is time to do a conductivity check.

NxStage sends Linx users new filters on a periodic basis.

The NxStage System One and System One S have 4000 hour countdown timers until it is time for a preventative maintenance swap-out (you can see this timer on the Nx2Me iPad software)

But, when it comes to the sediment filter, it's up to the user to ask for a new one each year.