usisng Fresenius K machine instead of nxstage

[fuzzyL]

I posted this on the nxstage forum but it applies to any home hemo users--on home hemo for almost five years using nxstage machine but having problem after problem with them--we are on our 4th cycler machine in 2017-we are told that they don't make new ones of the type we use and we are constantly getting rebuilds-beside the pain in the butt this causes, it also makes me nervous as the patient that the machine will fail during a session-so my Fresenius clinic is suggesting their K machine for many reasons-I looke it up online and it is appealing--just wonder if any home hemo people on line use it??  thank you

[Simon Dog]

I started with the Baby K, but found the NxStage frequent dialysis/low fluid drain per treatment worked better for me.   My wife kicked the Baby K out of the house after  I collapsed at the end of a treatment.

The Baby K takes longer to setup and teardown (the setup is about 40 minutes, with a new task to perform every 10 minutes or so).  It also requires a LOT more water, a huge RO  filtration system, and a dedicated 20A circuit (the manual says 15A, but Fresenius policy is to require dedicated 20A).  The bulk of supplies, and recycling volume, is vastly larger with the Baby K.   (Home version of the Fresenius 2008k).   I found my Baby K to be more "finnicky" than the NxStage - there were times if failed self test for no apparent reason and I had to re-start the prime process.   I found that the extra setup/teardown time on the Baby K meant there was no overall time savings over the NxStage in terms of hours per week.

You will NOT get 24x7 factory support from Fresenius.  Just the on-call home care RN, or a service person who only deals with machine repairs.

A factory tech has to come to your house once a month to clean the RO unit.   Once, I told him "I think the alarm calibration may be off a bit" .... and he then proceeded to spend 6 hours in my house calibrating the machine to spec.

I know of three NXStage systems -

1. Original System 1 (12L/hr max dialysate flow, LED screen)
2. 1S (18hr max dialsate flow, LED screen)
3. New system 1 - touch screen, not sure  max dialsate flow

(plus variants of the above for in-hospital use)

If getting a "rebuild" is an issue, perhaps they should just send you one of their new model machines.   The problem is that Fresenius buys their NxStage machines and has them on service contract, so it would cost more to upgrade you to a new model.  My guess is that the service contract with Fresenius only covers swapout with a like model machine.

I wouldn't worry about fail during a session - worst case is a manual squeezeback of blood (covered in training) and a replacement machine in a business day and maybe one in-center treatment to make sure you don't fall  behind.

If you use the iPad Nx2Me software, you can see how many hours on your NxStage until the next scheduled PM (a runtime counter start at 2000 hours and runs down, when it gets to zero, the machine alarms and it's time for a swapout even if you are not having any problems with the system).

If you go with the BabyK, the neph will probably suggest a standard 3 day/week treatment.   The proper response to that is "Not unless you can explain why every other day is not a medically better protocol.".

4 years on home hemo, 3.5 on Nxstage.     On my 2nd cycler and 5th PureFlow control unit.

[Blake nighsonger]

I started with the Baby K, but found the NxStage frequent dialysis/low fluid drain per treatment worked better for me.   My wife kicked the Baby K out of the house after  I collapsed at the end of a treatment.

The Baby K takes longer to setup and teardown (the setup is about 40 minutes, with a new task to perform every 10 minutes or so).  It also requires a LOT more water, a huge RO  filtration system, and a dedicated 20A circuit (the manual says 15A, but Fresenius policy is to require dedicated 20A).  The bulk of supplies, and recycling volume, is vastly larger with the Baby K.   (Home version of the Fresenius 2008k).   I found my Baby K to be more "finicky" than the NxStage - there were times if failed self test for no apparent reason and I had to restart the prime process.   I found that the extra setup/teardown time on the Baby K meant there was no overall time savings over the NxStage in terms of hours per week.

You will NOT get 24x7 factory support from Fresenius.  Just the on-call home care RN, or a service person who only deals with machine repairs.

A factory tech has to come to your house once a month to clean the RO unit.   Once, I told him "I think the alarm calibration may be off a bit" .... and he then proceeded to spend 6 hours in my house calibrating the machine to spec.

I know of three NXStage systems -

1. Original System 1 (12L/hr max dialysate flow, LED screen)
2. 1S (18hr max dialsate flow, LED screen)
3. New system 1 - touch screen, not sure  max dialsate flow

(plus variants of the above for in-hospital use)

If getting a "rebuild" is an issue, perhaps they should just send you one of their new model machines.   The problem is that Fresenius buys their NxStage machines and has them on service contract, so it would cost more to upgrade you to a new model.  My guess is that the service contract with Fresenius only covers swapout with a like model machine.

I wouldn't worry about fail during a session - worst case is a manual squeezeback of blood (covered in training) and a replacement machine in a business day and maybe one in-center treatment to make sure you don't fall  behind.

If you use the iPad Nx2Me software, you can see how many hours on your NxStage until the next scheduled PM (a runtime counter start at 2000 hours and runs down, when it gets to zero, the machine alarms and it's time for a swapout even if you are not having any problems with the system).

If you go with the BabyK, the neph will probably suggest a standard 3 day/week treatment.   The proper response to that is "Not unless you can explain why every other day is not a medically better protocol.".

4 years on home hemo, 3.5 on Nxstage.     On my 2nd cycler and 5th PureFlow control unit.

     Mine Nxstage system one uses 4o liters( my Prescription ) 405 type Saks . In 3 months 0 control units. Takes me Appx. hr. anda half to set up. 15min, to break down or so.  Going very well with Minimal alarms  once i am pain stacking  to Correctly Exact. Support from Nxstage is Phenomenal. Thanks for the post, i really like mine Machine.

[Simon Dog]

Mine Nxstage system one uses 4o liters( my Prescription ) 405 type Saks . In 3 months 0 control units. Takes me Appx. hr. anda half to set up. 15min, to break down or so.  Going very well with Minimal alarms  once i am pain stacking  to Correctly Exact. Support from Nxstage is Phenomenal. Thanks for the post, i really like mine Machine.

What are you doing for the hour and a half?  It takes me less than 3 minutes to get to the start of the prime cycle which runs for 23 minutes.   I do the needle prep during the prime.  After prime, it's 10 minutes or less to place my needles, snap & tap the lines, and get cookin.     Breakdown is no more than 5 minutes, 15 if you count final vitals and weight.

I use 40L per treatment, but the smallest SAK size for 40 lactate concentration is  50L so I waste 10 liters.

I notice you have a 400 series SAK.  Do you use a System 1S and if so, do you run the lactate faster than 12L/hour?  Generally, Systgem 1 users get 3xx SAKs and system 1S users get 4xx SAKs.

[Blake nighsonger]

What, slow down!.   lol.  I open door turn cycler on , put cartridge in , check h2o sensor, check it off my list, change gloves put spike in saline bag, check off list,  hit add fluid ,check off list. OK that was today,..... had 6 mins. to wait for prime to finish!    a first.    Then i hit stop, and prime T. snap and tap,     hook up my fluid Connections. Check off my list.   Change gloves again, Male to male coupling on Arterial patient line,Set aside hang. Get a syringe full of sailing and set-aside, Do the same thing with Venus,Getting syringe full of sailing and set-aside,
Connect Venous and arterial patient lines and drape over arm chair, Check off list. Then put volume and rate In Cycler , check off list. Wash Arm thoroughly  , Scrubs  with Dyna-Hex 2 , for 2mins. then Cannulate,  then stick. That takes me  near  7-5 mins. So that is alot of checks most days goes smooth.(Got 3 months in doing  this ) . Labs take Couple extra minutes,,....... i maybe have 1/2 a liter to a liter When finished, have 405 type sak.....( Saline in Syringes, for the flush of access lines afterwards, said earlier.)     Not sure I understand the question about the lactate. ..... Maximum dialysate flows 18     .  I'm just methodical I suppose takes me awhile , .Do it totally by myself as you . Care partner in another room.  In case of emergency. Okay thanks a lot.                         

[Blake nighsonger]

45 is lactate. Just talk to my home hemo nurse shes the worlds best. Something about glucose?

[Simon Dog]

Not sure I understand the question about the lactate. ..

NxStage offers 40 lactate and 45 lactage SAKS.  If your bicarb is low, you can be prescribed the 40 lactate sak.

3xx Saks are for use with up to 12L/hr flow; 4xx Saks are for upto 18L/hr flow (NxStage system 1S only).

What dialysate rate are you prescribed that rates a 1S?

[Blake nighsonger]

 18 L/hr our flow. what's that tell you. Nxstage System one. S1 .. Another thing I don't understand is how that dialysate Comprised of lactate,Bicarbonates And all....Compartmentalized elements combined can pull minerals,Potassium, phosphate ,Sodium? . that's all formulated in Prescribing a prescription? based on what?...Electrolysis? who my doctor figures that? what are all the Increment. Where would one find that?  I wonder.   

[Simon Dog]

Did they find the regular System 1 insufficient, or did they start you off with the 1S?

I run a 40L Rx, but at 12L/hr (the max on the system 1).   I have to use a 50L SAK (the smallest 40 lactate one made), which means draining the leftover 10L when done.   If they would give me a 1S, I'd run at 15L, but I am significantly exceeding goal on the 1, so that's not going to happen.

NxStage only makes two SAK formlations - 40 lactate and 45 lactate,y so there is not a lot of tuning.  The conventional Fresenius machines allow fine tuning the bicarb and sodium level by ajdusting the mix of water, bicarb and acid (as well as selection of the specific acid solution).







sp mod Cas

[Blake nighsonger]

What are you talking about? It matters? How and why.

[cassandra]

18 L/hr our flow. what's that tell you. Nxstage System one. S1 .. Another thing I don't understand is how that dialysate Comprised of lactate,Bicarbonates And all....Compartmentalized elements combined can pull minerals,Potassium, phosphate ,Sodium? . that's all formulated in Prescribing a prescription? based on what?...Electrolysis? who my doctor figures that? what are all the Increment. Where would one find that?  I wonder.   

That's what your blood results say. If your K+ comes back below 3 a few times they are likely to prescribe you a SAK with 2K in stead of 1K. The same for sodium and bicarb and the others.

 

...
I run a 40L Rx, but at 12L/hr (the max on the system 1).   I have to use a 50L SAK (the smallest 40 lactate one made), which means draining the leftover 10L when done.   If they would give me a 1S, I'd run at 15L, but I am significantly exceeding goal on the 1, so that's not going to happen.

Hi Simon, I received a System 1S with my last cycler swap. For no other reason than that there were no more 1's in 'the country'. So I still have sak 301 and I can turn the flow rate up slowly to 14.8.

I hope you get a 1S soon, they must be running out of 1's at some point.

Love y'all, Cas

[Blake nighsonger]

hi Cas, i put that together and i got you fine. .  i have  a S1 use 45 lactate flow rate Prescription rate  18L/ hr. ( "S1 max Dialysate flow,LED screen")have near  a liter left When finished most day, tats petty fine tuned then.                        Sorry fuzzyl                             ..........     kinda got on a roll. Best to you and all. Will be glad to have been doing this as long as you Cas and SimonDog. Thank you.

[SKS]

Wow - so much info I'm amazed.  My LO SO and partner in life Russ has been on hemo since June 30, 2016 had a hemo cath since July 14, 2016.  Two fistula's one shut down, one just not maturing quickly and we want out of in center hemo when we go south this winter as that was a horrible experience so unlike the time in the Ohio center where techs are trained certified/licensed by state and have continuing Ed.  SO transition to PD well CAPD.  Catheter in, In "training" and supposed to be on PD fully as of next Friday the 21st.  I've ask at center and searched online - what range of storage temp for solution???   We have a sunroom with a room air conditioner - this room is actually like a part of the house except the central HVAC doesn't extend to that area.  It shouldn't go below 60 I ask our nurse and she didn't really give me an answer.  I can find a way to narrow the range as room has high efficiency windows, is on east side of home, roof is a part of home roof etc etc.  Also the "training" so far appears that a lot of the Settings will be set by center (DaVita PD)

My mother was on PD in the 90's but that was all manual 4 exchanges vs the Machine aided nightly 8 hours with 2 hours additional dwell time we are now set up to do.

Any hints or comments will be greatly appreciated.  Thanks.

[Simon Dog]

f your K+ comes back below 3 a few times they are likely to prescribe you a SAK with 2K in stead of 1K. The same for sodium and bicarb and the others.

The acid solution for the Fresenius K series comes in various K and CA levels.
The SAKs for the NxStage come in two flavors - 40 lactate and 45 lactate.
Sodium and bibarb on the K series is controlled via a machine setting (the mix of filtered water, acid and bicarb).   
Sodium on NxStage is fixed at 140.

[kickingandscreaming]

I've read that PD fluid storage above 25 (C) /77(F) can be a problem and contributes to the breakdown of the sugar solution.  They talk about "room temperature" but that is a relative term.

[SKS]

Thx - I had been told high temps would allow it to break down but couldn't seem to find what was considered "high" thx

[cbatsea]

I've had to have our pure-flow replaced 3 times....it's a pain, but doable.  The actual cycler is the same one we've been using for 2 years.....so much easier than the K machine.