NxStage Cycler Issues

[Hootie]

Well...things just happen sometimes...We have been battling two issues with our NxStage cycler. First issue is running out of Dialysate on second treatment. We use 50L bags with treatment at 25L per session. Seems like always we run out of dialysate. Most of the time its 2-2.5 L. Seems like this has been an ongoing issue for several months. Nxstage has said two things...there is more than 50L in a sak with about 1L extra. Another time they said its "within the 10% parameter" of their standards. I do not agree with that. The nephrologist says 25L and that is what we should use. We may have to move back to 60L saks. I just hated wasting to extra and waiting for it to pump out at the end of treatment number 2.

Next issue is more troubling...the example today...I was out of town for past two days so we did not do treatment (previously has done three in a row). Dry weight for the wife is 76.0K. She had gone up to 79.0K over the two days when we started this afternoon. A little higher than normal but okay for once in a while. We set our S machine up for UF rate of 1.0 (normally run it at .7 to kept Blood Pressure stable) and a volume of 2.5L. After three plus hours of treatment machine says we took 2.5L off. Wife has not eaten or drank anything during treatment. She steps on scales and we took off only 1L. Ugh! So she is at 78.0K. We have had the weight discrepancies for months but its usually .3-.5L. I can handle .3L but 1L discrepancy does not work for us. I have talked to NxStage about the two issues several times as has our HHD nurse. Last week NxStage offered us a thumb drive to pull data for the machine. They have it now and are going to analyze contents of the machine data files for both issues. I will let everyone know what we find out from NxStage.

  Anybody else having these two issues?

We have now completed our 3rd week with catheter since her fistula was not able to be balloon out. It has worked fine except for some occasional positional requirements to keep the arterial pressures in range. Movement from left upper arm to right upper arm fistula surgery was two weeks ago. Check to see if its mature enough around US Labor Day. The catheter is an experience with the cleanliness needed. I am going through about a dozen or so gloves each treatment. Wife likes the no sticking but hates no showers. We realize there are shower covers etc but we will wait since we hope the catheter is short in time of duration.

Have been on the transplant list (see below) since November 2015. We have started getting another center on line this past week to improve our odds and timeframe. We will see where that goes. This whole ESRD is a world into itself. We are doing 100% of what is asked and keeping in good spirits along the way...its the only way to go...

[caregivertech1]

We're in our 5th year with NxStage well over 1000 treatments and I can honestly say we have never run out of dialysate. We use 30L per treatment with 60L sak 302. That 10% is BS in my humble opinion....that's plus or minus 6 liters on my 60L sak. Demand a new cycler if it continues. Good Luck.

[Hootie]

Talked to 10 year veteran at NxStage today on the two issues. First, issue on dialysate running out...he said if bag is dry then we received the 25L at each treatment. It's a pump issue correctly  measuring the dialysate used. He is changing out cycler for that reason. I wanted to be able to know exactly how much we are using so we can make pulling co terminus with cleaning.

On second issue he took down many notes and had many questions. He thought that the machine was pulling but for body chemistry reasons the fluid was not coming off. We discussed my wife's issue with low sodium. She takes salt tablets each day for low sodium. I know that is strange being a low sodium person but labs point to that each month. The machine appears to try to pull but there is nothing to pull. However, no BP issues. Those were his thoughts but he was referring that issue to a clinical person who could better evaluate and then talk to HHD nurse for consultation.

Anybody else seeing low sodium as a potential for low volume of pulling?  She does not eat or drink nor do boluses during treatments.

[Xplantdad]

We've had issues with the cycler as well....having had one replaced already due to exactly what you are describing.

Quite a few times in the past I have set up the machine to take off the necessary amount to get to my daughters dry weight of 73.5-with a starting weight of 76...and after 2H 30min....we end up at 75.1? I've been told by the Fresenius folks that "that is okay" and I said that doesn't make sense. They said that they don't even have to report anything under 1L in center?

I have even tried adding the .3L for the rinse back even though it's supposed to be figured in  on the cycler settings....

My daughters clearance is great...so I don't pay much attention to the "numbers" anymore.

Like today, she started at 76.2 and needed to get to 73.5-I did the math to set up for removing the right amount without adding the extra .3 and when she was done...she weighed 73.7...LOL

[Vt Big Rig]

Apparently it depends who you talk to!!   I have had fluid removal issues in the past and got the same 10% BS. Hold on buddy, do the math. Asking for 1.5 and taking off 1.0 is 30 percent not ten percent. After several times they finally swapped out the cycler.

Yesterday I called them with documentation that in 6 out of last 8 treatments the fluid removal has been off by more than 25 percent. Expecting an argument I had only gone through their form for one treatment,when he asked  is this is what happened each time. Yes .... OK , they are sending a new cycler today.

[Hootie]

Got new cycler yesterday...we will see if the dialysate measurement is accurate on this one. He stated we were getting 25L on both treatments as bag is empty at end of second treatment. He stated The connectivity test would not pass unless there was 50L in at start.

He did not think the UF pull volume issue was a problem with cycler but body chemistry. Still waiting on consulatation between clinical people at Davita and NxStage...His theory is some people are much harder to pull when you get close to dry weight. I think I agree as the lack of UF volume has happened on other cyclers. In the end I need them to explain how the "the body chemistry issue" works if that is case. We have ramped bps up to 380 to see if that makes any difference. We use a CVC for now until new fistula matures.

I put the new snap and tap settings in and used this am. I like them. Only one snap and tap required for us. Zero bubbles on second snap. Minimum bubbles on first snap. Takes 23 minutes but we are doing other start up things anyway.

[Xplantdad]

Thanks for the follow up. I think that you may be on to something with the "getting harder to pull when getting closer to dry weight. I was trying for 73.5 tonight for my daughter and after completing the treatment (and cramping a bit towards the end) she ended up at 74.2....


I will change the settings for the snap and tap tomorrow. Seem the Fresenius center were are based out of is behind everyone else. I got a call today asking if we had an Ipad. I asked the lady if she was referring to the NX2me program (that Simondog let me know about). She said, yes...how did you know? I said...I asked the center about this 2 months ago...LOL


Also, I asked them if they knew about the new snap and tap settings and they said the got them yesterday

Finally, I had to call the local NXStage rep so he could get the process started for the Linx filtration system...He said that 2 weeks is unacceptable for PAK life....


And so it goes!

[Hootie]

Both issues have improved with the new cycler. Dialysate was right on target with 25L with both treatments with about 1L left in bag as it is supposed to have at the end. On the pulling the UF target was within .1L so we are good for now. From what others have said on other sites, it appears if a person has congestive heart failure then the UF pull does not go as fast as the heart cannot replenish the blood to blood stream as fast as normal heart. As stated above the closer you get to dry weight the hard it is to pull.

NxStage was great to talk with about the issue and new cycler arrived the next day. Great service! Love those people.

[Xplantdad]

I talked to a long time tech guy at NXStage (Carlos) yesterday and he agreed with me that something is up with our cycler, too. So today, they will be bringing out a new one!

Carlos was instrumental in us getting the LINX system on order as well. He's a great guy...and gave me his personal cell and work email...so I can just contact him directly. THAT'S what I call great customer service!

[Xplantdad]

And as an update....UPS dropped the ball and didn't deliver the unit to the courier service. It was supposed to be delivered to us between 12-3pm. At 2:45pm, NXStage called and let us know what happened...so we wouldn't have to wait around all afternoon, LOL!

Anyhow, they said another one would be delivered on Monday, then called back 15 minutes later and said another one was being flown out and would be delivered today. The tech support folks care cool.

I guess we'll see! It seems like the only luck we have is bad luck!

I just hope that 3 cyclers don't show up....

[Xplantdad]

Well the new cycler is here....and I have entered all of the settings. In the meantime...we sprang a leak in the blue water line....so one of those will be overnighted and arrive on Tuesday!

Which reminded us that when we go on any short vacations, to turn OFF the water line to the cycler!!

[Simon Dog]

In the meantime...we sprang a leak in the blue water line....so one of those will be overnighted and arrive on Tuesday!

The short section of blue line that runs from the sediment filter on the back of the pureflow to the main controller vibrates considerably when a PAK is being charged or a batch is being made.   If you let it lean against anything (particularly the black drain line), the vibration will wear into the blue line until it springs a leak.  It is important to check the positioning of that blue line to make sure it is not touching anything while it is vibrating.

[Xplantdad]

Good to know...Now I have to call NXStage...as all they sent was the blue line and no connectors. I will have to figure out how to disassemble

[Simon Dog]

Good to know...Now I have to call NXStage...as all they sent was the blue line and no connectors. I will have to figure out how to disassemble

Is the part that sprung a leak on your machine the part that goeth from the white sediment filter output to the back of the control unit?  If so, you need a special part which consists of a few feet of blue line with a special chrome colored connector permanently attached to one end.  If they just sent blue drain line and you leak is in this section, you need a new part.

[Xplantdad]

Hi Simon Dog, it was the blue water supply line that connects to the backflow "pex" connector. I finally figured out that you have to remove the red clip, then push the blue supply line in towards the center of the connector, then pull the supply line out. Re-installation goes the reverse of the removal

Here are pics after the redo....backflow "pex" connector...HINT: there is an arrow on this connector...and it has to point towards where the water is flowing (i.e. into the machine)



And a pic of further up...where you can see the elbow connector. 

[Simon Dog]

You have it easy - no special connector, and can just use a section of blue line.

If you have any difficulty you will find the NxStage customer support people will be glad to talk you through the process.

Just be careful not to lose that little red clip in the process.

[Xplantdad]

You have it easy - no special connector, and can just use a section of blue line.

If you have any difficulty you will find the NxStage customer support people will be glad to talk you through the process.

Just be careful not to lose that little red clip in the process.

They are the best...and they are sending a back up set up!

[Maggie and Jeff]

We pull uf no faster than .40 with a bps of 200.

Run for 8 hours over night 6 days per week.

No real issue reaching dry weight since we started nocturnal.

No cramps since we stopped pulling faster than .40

Maggie has had several heart issues. 5 bypass in 1999

We have been using NxStage for 10 years now.

[Xplantdad]

Well....the newest cycler lasted 1 week and 1 day before taking a crap. Red 89 error that will not go away. Wasted 3 cartridges while online with the tech support guy, Mark. So-they are overnighting another machine which will be here tomorrow-if it gets here...see above for how this worked out for us last week...LOL

And so it goes. So, no dialysis tonight for my daughter...who had quite a bit to pull off...and no blood tests pulled either. 

[Xplantdad]

And NXStage comes through again. They located a cycler locally and had it delivered this afternoon...on Labor Day!


Currently running okay on the new cycler....and will be done by 10pm AZ time 

[Lis]

 This thread is now a month old but I feel the need to respond. I too was running out of dialysate right before end of treatment and I also use 25 liters per treatment with a 50 liter Sak. It was very frustrating because we couldn't get the manual rinse back to work and I forfeited my blood.   When this happened a second time at the end of treatment, I called NxStage and they gave us this advice: they told us to hit the pause button on the Pureflow the second the 000s appear at end of treatment. So we do that now and it hasn't happened again. They also told us how to clear the alarm so the machine gets to the automatic rinse back stage which is helpful. Yes, we would miss out on a little bit of dialysate, maybe a liter or two but that's ok with me. Finally, they told us that if this problem continues we could change the settings on our machine so that alarm wouldn't occur.  But it's been okay since we hit the pause button the second treatment is over.

[cassandra]

Good tip with the pause button Lis Could you also tell us how to clear the alarm to go to automatic rinseback?

Thanx already, Cas

[KatieV]

This thread is now a month old but I feel the need to respond. I too was running out of dialysate right before end of treatment and I also use 25 liters per treatment with a 50 liter Sak. It was very frustrating because we couldn't get the manual rinse back to work and I forfeited my blood.   When this happened a second time at the end of treatment, I called NxStage and they gave us this advice: they told us to hit the pause button on the Pureflow the second the 000s appear at end of treatment. So we do that now and it hasn't happened again. They also told us how to clear the alarm so the machine gets to the automatic rinse back stage which is helpful. Yes, we would miss out on a little bit of dialysate, maybe a liter or two but that's ok with me. Finally, they told us that if this problem continues we could change the settings on our machine so that alarm wouldn't occur.  But it's been okay since we hit the pause button the second treatment is over.

I had this happen too!  We were able to get it into rinseback, and it's only happened the once so far.

Something I have noticed: I use 25L a treatment with a 50L Sak.  The Sak is always bone-dry when the second treatment is done.  When I was using 20L/treatment with a 60L Sak, there always was a little extra in the Sak at the end.

[Simon Dog]

It was very frustrating because we couldn't get the manual rinse back to work and I forfeited my blood.

Did your RN teach you the "squeeze the bag" rinseback?   Turn off the cycle, open the door, close yellow and green clamps and squeeze the saline bag while watching to make sure no bubbles go into your arm.   This gets the blood back with no use off the cycler or power.

[caregivertech1]

You can get to the auto rinse back any time by 1) hit stop 2) press stop agaiin (stay pressed) until 000 appears  and 3) hit stop once more.