Really frustrated - red 10 alarms

[KatieV]

It has been an awful week for dialysis... I am really frustrated and beginning to lose confidence because of it.

Started Sunday night (the 15th) fine, but an hour into treatment we got a red 10 and could not get around it.  Did all the troubleshooting - did NOT appear to have air bubbles.  Ended treatment and lost all blood in the tubing.  Flushed needles very well (including several times during PRIME) and restarted a new cartridge.  Got several more red 10s, but could work through them.  Ended up going to bed at 2 am! 

NxStage told us the Venous Air Sensor could be dirty, so we followed their instructions to clean it.  We have only had this machine since the beginning of March.  My old one threw a three-digit "code of death" after 21 months.  Continued having red 10 alarms sprinkled throughout treatments.  Several times we could clear them out after verifying there was no air, but we ended up loosing all the blood in the tubing a 2nd time.  We cleaned the #$%^*! sensor several times, went around extra times during snap&tap, used different Cartridge lots, etc. 

Saturday night (after skipping Friday), we could not get the cycler through Prime!  With 2 minutes left in Prime, it was alarming red 10.  We would reset the machine, it would go back to 4 minutes left, only to repeat the alarm at 2 minutes.  I called NxStage for at least the 3rd time in a week.  After looking at my history of calls, they said they would overnight a new cycler.  It was a rough weekend with extra fluid on me.  I only got 3 of my usual 5 treatments.  I have to say - calling them at 8 pm on Saturday and getting a new cycler by Sunday at 8 pm IS pretty awesome of them (even including "losing" it at Logan International Airport!).  Another night of going to bed at 2 am!  Plus I woke up with a migraine from fluid/toxin shifts!

Last night during our 2nd run with the new cycler, about an hour in - red 10 alarmed!  No visible air in the line (pulled from pig-tail) and was able to keep going.  Treatment finished - had 000 displaying.  Husband pressed STOP and we got red 10 yet again.  It took a bunch of button pushing, but I did get all my blood back last night (with a firm hand on the blue clamp and an eagle eye on the line).  I must admit I freaked out a little.  But I am second-guessing things now, feel unconfident, and generally tentative.  Not a feeling I like!

Any ideas what is going on?  Could the Pureflow be contributing?  Is it something we are doing wrong?

[cassandra]

Hi Katie I really hope you are feeling a bit better in youself now.
I can so get that feeling of frustration when D goes completely out of your controle. In the 6 yrs Nxstage I've had the I AM GOING TO THROW THAT MACHINE OUT OF THE WINDOW feeling a few times. I did not get red 10 but other reds (38's or something) anyway, I agree it can have something to do with the Pureflow.
I will now always in those THROWING THE MACHINE OUT OF THE WINDOW feeling days asume it's the PF. (The controle unit might need replacing?)


I wish you lots of better luck in your next session, and always ring Nxstage Tech. (By the way, I've searched through my note-pad to find the names of the persons who are pretty helpful in those situations, I'll let you know when I've found them (a lot of note-pads))


Love, luck and strength, Cas

[KatieV]

My Pureflow HAS seemed nosier than usual lately...

I spoke to my center again today and the tech suggested "micro clots" may be setting off the sensor.  I have not used Heparin for months due to some really looonnnnggg hold times, so they suggested I tried 1000 units tonight and see if it made a difference.  We will see!

It's especially hard to deal with these issues when you are under-dialyzed, fluid-overloaded, sleep-deprived, AND work full time!  Anything goes wrong, it sets off a chain reaction!

[Simon Dog]

Are you sure you are not talking about red 11s?

[KatieV]

Are you sure you are not talking about red 11s?

Nope!  Red 10s.

Per my center's recommendation, I used 100mls of heparin tonight.  Still received a red 10 about 1 hour into treatment.  No air bubbles seen (drew back from pigtail) and was able to continue.

Of course, I also remembered, after I got off the phone with them, that the prior cycler got stuck in a "red 10" loop during Prime.

[KatieV]

So I have continued to receive red 10s, though not as many each treatment.  I might have them in Prime, Treatment, or Rinseback, it might be only one or a couple per treatment, but never a treatment without at least one.  When we hit "Stop" to go into Rinseback was a very common time.

But then I started regularly receiving red 38s.  I kept running out of dialysate early.  My treatment calendar shows out of 9 treatments in May, 6 were only 93-97% complete.  I got NxStage's standard answer of "within 10% variance", but it *does* add up to less dialysis! 

Monday night we had 13 alarms!  I spoke to my center on Tuesday morning and they offered to switch machines with me.  So my husband brought my machine up to the center and brought home a new cycler.  It worked like a DREAM last night!  The only alarm was a venous pressure when I changed position.  We will find out if it fixed the 38 alarm problem on our next treatment.

[iolaire]

I spoke to my center on Tuesday morning and they offered to switch machines with me.  So my husband brought my machine up to the center and brought home a new cycler.  It worked like a DREAM last night!  The only alarm was a venous pressure when I changed position.  We will find out if it fixed the 38 alarm problem on our next treatment.

Best of luck with the new machine!

[cassandra]

Good luck Katie


   

[Xplantdad]

Good luck Katie. We had similar issues...and it ended up being a bad batch of the cartridge lots...but you already tried that!

Here's to hoping all went well...

[KatieV]

So the cycler from my center worked well and it solved the venous alarm problem.

We were still running out of dialysate during our 2nd run (use 25L out of 50L).  Looking back at my flowsheets, half of my treatments in May were less than 100%.  They were 93 to 97% complete, but it does add up.  And my labs showed it.  I am normally at least 2.3, but was below adequacy at 2.03!  So my center ordered a Pureflow swap.

Last Sunday, I was in the kitchen making dinner while my husband started Prime.  He said "it broke".  "what broke?"  "the cycler" "what did you do?"  (BTW, spouses don't like it when you accuse them of breaking the dialysis machine!)  When he opened the door, one of roller cams sheared off!  We tried Priming a cartridge anyway, but couldn't get it through Prime.  We only used that cycler 3 times!  I got replacement #4 the next day! 

It has been a week and finally everything seems to be smooth again!  Not sure what the issue was - if they had a bad batch of venous air sensors or what?

[cassandra]

O men, Katie just enjoy the sudden normalcy of this. No-one ever knows.




   


Love, luck and strength, Cas

[Donn]

Hello all and thank you for your posts and comments.  As the caregiver for my wife who has been on dialysis for 3 years in-center, we are now in training with the next stage machine.  We are starting the 3rd day tomorrow.  I must say as the caregiver who sets up, cannulates, and monitor the treatment, I am somewhat concerned with what I read.  My wife cannot afford too many incomplete treatments.  We started of last week just using the machine and had 2 cartridge failures but they were older and from the same lot. 

[KatieV]

Hello all and thank you for your posts and comments.  As the caregiver for my wife who has been on dialysis for 3 years in-center, we are now in training with the next stage machine.  We are starting the 3rd day tomorrow.  I must say as the caregiver who sets up, cannulates, and monitor the treatment, I am somewhat concerned with what I read.  My wife cannot afford too many incomplete treatments.  We started of last week just using the machine and had 2 cartridge failures but they were older and from the same lot.

I wouldn't be too concerned - I have been on NxStage for almost 2 years (this time) - over 500 treatments - and most have been smooth.  I just hit a rough patch for awhile.  Since the 4th replacement, everything has been smooth again.  It is SO nice to have an alarm-free treatment!

Welcome to NxStage and good luck with your training!  Dialysis is tough, but NxStage makes it a little easier.  In 2 weeks, we are traveling to MI for a 80th birthday/family reunion.  We will be bringing my machine and supplies along.  After a fiasco involving a traveling treatment in TX (flew so didn't bring the cycler), I am SO glad not to have to arrange treatment in a facility!
 

[cassandra]

Hello all and thank you for your posts and comments.  As the caregiver for my wife who has been on dialysis for 3 years in-center, we are now in training with the next stage machine.  We are starting the 3rd day tomorrow.  I must say as the caregiver who sets up, cannulates, and monitor the treatment, I am somewhat concerned with what I read.  My wife cannot afford too many incomplete treatments.  We started of last week just using the machine and had 2 cartridge failures but they were older and from the same lot. 

I really do get frustated when something goes wrong with my Nxstage. But when something doesn't work with the Pureflow you can use the bags (so always have 3 days of (hanging bags and a fluid warmer). I do everything myself 99% of the time, so when something goes wrong I just can't be doing with hanging bags too. So I do that the next day. I've been doing Nxstage 6 years now, and probably 2 problems a year.


Eventhough not perfect, I seriously wish I could have used Nxstage from when I re-started D 20+ yrs ago.
Don't be concerned.


Love, luck and strength, Cas