Suggestions to make NxStage even better

[Adam_W]

I thought this might be nice. We can put together different suggestions on how the NxSage system could be made even better. Maybe we can send these suggestions to NxStage. Obviously the main thing right now would be to fix the 170s, but here are a few of my ideas for improving future models of the machine itself.

1. Replace the current control panel with an easy to use touch screen.

2. Have a movable screen and control panel (something similar to the Aksys PHD or some Gambro machines) to make operation more convenient for both caregivers AND patients. The angled panel on the current machine is ideal for caregivers to operate, but I find that when I'm seated it's a little awkward to see and operate the machine (my pureflow is on top of a cart so it's raised up about 8 inches). I also have problems with the lights reflecting off of the angled screen and making it hard for me to read it sometimes. For travel, the screen could either be disconnected, removed, and packed separately, or it could be stowed flat against the front or top of the machine.

3. put an integrated swivel on the bottom of the machine or the top of the pureflow so the machine can be turned easily. I put a TV swivel on mine, but it would be nice to see one already there.

4. Maybe some more features such as UF profiling, automatic BP monitering, and maybe an optional integrated heparin pump.

5. More options for dialysate concentrate. When I was in-centre, I used a 3K concentrate, but when I switched to NxStage I had to switch to 1K because that's all they have.

Any more ideas?

Adam

[jbeany]

They need to redesign the handles.  When you lift it right now, there isn't space for your fingers, and they get mashed into the sides of the machine while you are lifting it.  They either need longer handles, or a space scooped out on either side that your fingers would fit in while you are lifting it.

They need a timer delay on the Pureflow.  Given that the batch countdown to expiration starts the minute you start making the batch, I prefer to start the batch as close as possible to 7 hours before I need it, so I have a little leeway on the time I have to use up the batch on day 3.  It's not always convenient for me to be here then to do it.  I want some way to hook up the bag and connections, and then have a timer to set for it to begin making the batch later.  Figuring out a way to make the batch last longer would be good, too.

They should integrate a mini-timer for the heparin and Post-Bun draws as well.

[goofynina]

Awesome idea Adam, i am sure they would appreciate any feedback whether it is positive or negative,  YOU GO BOY 

[Sluff]

Maybe we can print this page out and send it to them.

[Black]

Epoman said they monitor this site.  I believe they do because before Mike started dialysis I posted here about a problem with NxStage - regarding lack of availability in SC - and a NxStage rep called me that afternoon with info about the clinic in Charleston, where we went.

Mike's suggestions:

Twenty pounds lighter

Easily removeable tub in the PureFlow for faster drying after a leak  (Oh yeah, NO MORE LEAKS, anywhere.)

Permanent casters on the PureFlow cabinet

[skyedogrocks]

Easier screen options for your pressures, perhaps having a button for each so you can see it faster. 

Make the buttons easier to press.  I know it's supposed to be child proof, but sometimes it is adult proof too?  THose buttons are hard to push.

This is a total nice to have, blood pressure monitored by the machine.  SO much easier!

[cev]

I would like to see BP on the machine - that would be awsome and

to be able to see all pressures at the same time, not wait for the system to cycle from pressure to pressure

and have the # codes tell which system is the problem, ie venous, arterial, dialysiate, drain

Adam thanks for the idea with the TV turntable - currently I turn the whole table - kinda hard on the floor

[silverhead]

Putting a slightly raised edge around the top of the PureFlow machine, to contain most of the leaks we have with the 170's, our first leak was not detected until it was dripping down the back and getting under the "brains" component in the PureFlow, second leak a week later was caught in time. in the meantime I had made a "dam" across the back with a section of tubing held down with masking tape, might not be pretty, but serves its purpose.

Make the Dyalisate (Green clamp) line from the Cartridge at least 6 inch's longer, at the best position (for us) of the cycler on top of the PureFlow the line just barely is long enough to make the connection, but it is obviously not good to have it hanging from the connectors because of its shortness.....

Does the "Jewel Box" computer attached to the back of the Cycler have to run 24 hours a day?, seems like it could be programmed to "wake up" when it is time for its data collection and call into NxStage with its report, having it in the same room we sleep in and hearing it running all the time is making it difficult to sleep at times......

[Black]

I thought this might be nice. We can put together different suggestions on how the NxStage system could be made even better. Maybe we can send these suggestions to NxStage. Obviously the main thing right now would be to fix the 170s, but here are a few of my ideas for improving future models of the machine itself.

1. Replace the current control panel with an easy to use touch screen.
...
Adam

This is something that needs to be done.  Their logic is that they are "child proof" and can't be inadvertently hit.  But, they are just too hard to push.  They aren't user friendly and they should be.

My hands are used to handling dogs that weigh over a hundred pounds.  I groom very wiggly dogs, including cutting their toenails, and have to hold them still to do so, so my hands are very strong.  If I have difficulty pushing the buttons I can't imagine what it is like for an older person with severely arthritic and weak hands.  There has to be a better design.

[KR Cincy]

A better way to read pressures would be great...waiting around for them to cycle gets a bit tedious...usually it's just one pressure we need to deal with, so some way to default to that at the time would be very helpful.

We've placed the cycler on a TV turntable I bought off amazon.com for about $30 and it's idea. It's a Sanus System TV20 Turntable...well worth the cost...however, after I bought it, I saw there are turntables with a VCR/DVD compartment that would be great for holding supplies, so that's a throught.

[Adam_W]

Another idea would be instead of the blood flow screen saying "vol" when you push the toggle button, it should display the current amount of blood processed.

Adam

[silverhead]

I believe we all have the experience of the "pod" having a lot of coagulated blood in it at rinse back, could they build in a small baffle inside that would "swirl" the blood enough when it passes through, or offset the entrance and exit ports to cause the same type swirl to keep it from having areas that do not move......
Tom

[jbeany]

Silver, my access pod is usually almost completely clear.  Are you on enough heparin?

[Black]

Silver, my access pod is usually almost completely clear.  Are you on enough heparin?

The only time Mike's has been almost clear is when he was anemic.  He was on 4,500 units of Heparin when he was anemic and running 15 minutes shorter time.  He's currently on 6,000 units of Heparin and running almost 3 hours.

[skyedogrocks]

Silver, my access pod is usually almost completely clear.  Are you on enough heparin?

I thought the access pod was supposed to be filled with blood.  If it doesn't fill, Rob's Arterial Pressure is really low. 

[Adam_W]

Silver, my access pod is usually almost completely clear.  Are you on enough heparin?

I thought the access pod was supposed to be filled with blood.  If it doesn't fill, Rob's Arterial Pressure is really low. 

I think she's referring to it being clear after rinseback.

Adam

[Black]

Yes, after rinseback.

[cev]

Our Neph and pharmacists tells us that if there are "clots" in the pod and or in the filter top then patient is not heparinized thru treatment and that is hard on the blood.  Richard is 92k and on 7000 heparin and we get very little in the way of clots.  Try increasing the heparin you should rinseback cleaner  (If we have clots regular then I increase the hep by 500 until I get good rinsebacks)  remember the heparin prescription is calculated on weight

[Black]

... remember the heparin prescription is calculated on weight

Weight is an important factor, but length of the run time, blood count, and individual need also influence the heparin dosage.  Some patients use no heparin.  Our dialysis nurse told us the maximum for Mike is 12,000.

[kidney4traci]

That's a good idea silver has about the raised edge.  That could be why I had a wire blow, it was probably damaged from a previous cartridge overflow.  About the BP, I guess I am alone on this, but I prefer doing it myself than the automatic kind.  I take the cuff off in between and if it was on auto, I may not have enough notice of when to put it back on.  The buttons, I totally agree with everyone.  I have the case on a flat dolly fitted with coasters, so I can turn it that way, but a lazy susan type might be easier too.  And the heater is essential, I don't know how people are doing without one.  I have so many times I use bags, that it is a big deal.  I guess my biggest complaint is the weight, it is a huge pain to travel with.  But it is better than the clinic!!  Especially when you travel, a sub clinic visit was always worse than anything!

[jbeany]

Make the rinseback volume a simple setting, instead of this nonsense with formulas and factors.  If I want to add to the rinseback, it should be as simple as bumping it a few mL.

[Northerner]

I with the rest of you, the buttons need work!

[Roadrunner]

I love the suggestion of a turntable.  I will go out and buy one this week. 

My biggest gripe is that you have to pull the plug on the cycler every night to quiet it.  The Pure Flow can be put on pause and it quiets after about 1 hour.  It seems to me that if you turn off the switch it should also turn off the fan.

My wish is that it can record all the information and that I don't have to come in the room every 1/2 hour and write down all the numbers for the flowsheet.  My husband can't see the numbers from the bed and I seem to be missing the end of every TV show or I have to stop what I am doing.  I know I have to watch the numbers but I come in whenever I have a break. Perhaps they can make a button on the machine that you can hit so that you have to look at it at least every 45 minutes.  My husband takes his  BP every 1/2 hour, so that is OK.  I can just look at the memory in the BP machine.

Having all the pressures showing at once would be the second best way.  I write down one or two and then miss the third and have to wait for the entire cycle to repeat.  It's bad enough I have to wait for the yellow 7 or 8.  It seems that the 2 never goes away.

BTW  My husband doesn't use heparin and the filter is almost always clear and the pod is clear.  The only times I get some clotting is if I run the cycler slower due to a high pressure.  I run it at 450.