nx stage

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Reference Notesfor NxStage in the HomeHemodialysis Environment

Training/reference material. Not intended to replace User's Guide.

©2006 NxStage Medical, Inc. NxStage® is a registered trademark of NxStage Medical, Inc. Patents and patentspending. Detailed reference list provided upon request. FOR PRESCRIPTION USE ONLY.

1TM0091 Rev A

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Contents• Cartridge Diagram• Set-up• Initiate Prime• Manage Treatment Settings• Prepare for Patient Connections• Launch Treatment• Monitor Treatment• Treatment: Common Procedures• Temporary Disconnection• End Treatment and Returning Blood• Troubleshooting• NxStage Customer Service


©2006 NxStage Medical, Inc. NxStage® is a registered trademark of NxStage Medical, Inc. Patents and patentspending. Detailed reference list provided upon request. FOR PRESCRIPTION USE ONLY. 2TM0091 Rev A

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4.1




1TM0091 Rev A

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,)

CAR-160Waste line(yellow clamp) Arterial

patient line(red clamp)

Tberapy fluidinl(green clamp) Venous

patient lin", ~(blue clamp) .~

(\~ .• ~ ~'.1- .;.:h-'" " ~"J.;,....... .,,-.,

'j! .., 1"-::' ~

'J I! _ I ~~ \ J

J,.:..::',a Saline lin(white clamp)

t Arterialpressure podPost-filter port

(blue clamp)



TM0091 Rev A 3

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I ,. .

Set-up

• Wash Hands

• Gather Supplies• Hang bags if needed

• Prepare the Cycler• Open door• Turn ON the power to both the cyclerand fluid warmer. Pure flow will be on.• Tighten patient lines on priming spike,then lift priming spike from cartridge• Insert cartridge (press tubing in to ~squares- air detectors)• Shut door

Cartridge, saline, syringes, fluid and accesssupplies

"Open the Door turn on the lights"

Pure flow never gets turned off.



TM0091 Rev A

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4

Initiate Prime and Alarm Tests• Prime Cartridge:

• Spike saline bag• Hang saline bag from IV pole• Attach access pressure pod• Press ADD FLUID

• Prime Fluid Warmer: For Bags Only• Insert warmer disposable into warmer and shut door• Connect Therapy Fluid MLA lines to DIALYSATE bags.• Break frangibles/cones• Prime and clamp unused MLA lines• Prime the warmer air trap and then clamp• Clamp warmer outlet• Put warmer knob to 12 o'clock position

• Prepare drain line extension (Beginning of the weektie tube on IV pole on back) if using bags.

This starts the 15 minute cycle

Do not need to do this if using thePure Flow cabinet.6 lines

TopFront

(1:00) or what is comfortable

Do not need to do this if usingPureFlow cabinet.



TM0091 Rev A

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5

Initiate Prime and Alarms Test• Complete Alarms Test

• After 18 minutes see all "8's", then press MUTE• See display test (1-4, a-h, 9-1), then press MUTE• See 23.0/000 - Do not press STOP

• REMOVE AIR FROM THE BLOOD CIRCUIT:• See 23.0 and "000" display• Snap/tap arterial patient line to remove air• Invert filter (blue side up) AND venous filter line up,tap to remove air from filter• Put filter in filter holder with venous filter cap portupright, vent post-filter cap port and clamp• Snap/tap venous patient line to remove air• Recheck to be sure air is removed from patient lines• Press STOP


If you put needles in here, then primeVenous needle. Attach heparinsyringe. Inject heparin and clamp.Prime Arterial line and clamp.

This is the Red/ white/ blue to getair out of lines. Red line first, filtersecond, blue line third.


TM0091 Rev A

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6

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Manage Treatment Settings• Enter Treatment Parameters After 10 seconds, screen will go

back to the rate display.

• Press MEASURING CUP, for volume display (VOL)• Green -Verify target volume of DIALYSATE fluid• Yellow -Enter target volume of ultrafiltration (ex. 1.0L)• Red display will read: Vol.

How Much Screen 15~Green- Your Fluid prescription.Yellow -This is your weight youwant to remove.

• Press MEASURING CUP (if needed), for rate displayRed -Verify blood flow rate (ex. 250 ml/min)

, Yellow -Enter ultrafiltration rate (ex. 1.0Uhr)Green - Enter DIALYSATE flow rate (ex. 3.0 Llhr) (Will

do this step later when Blood Flow achieved)

How Fast ScreenRed -This is the starting Bloodflow. 2.00

Yellow-This is how fast Fluid isremoved from you per hour.

f ,g



TM0091 Rev A

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7

Prepare for Patient Connections• Close all 8 clamps. (2 red, 2 blue, 2 yellow,1 green and white)

-. Prime saline "T" (~9-~tfamp) and clamp.Using pure flow, press GO and prime one port on thechicken foot. Clamp small green clamp on line.

• Attach saline line (white) to saline "T" (.a:eaclamp) DO NOT UNCLAMP Wh·l~

• Connect cartridge therapy fluid inlet (green) ~6D vn~to warmer outlet or Pure Flow cabinet (green)and unclamp.

• Clamp and disconnect drain line (yellow)and connect to drain line extension or PureFlow cabinet on front, then unclamp.

• Wash Hands

• Prepare the vascular access If already done, skip this step.

TM0091 Rev A 8



(

wltA U&~6upLaunch Treatment

• Connect to Patient Access:• Clamp and disconnect red and blue patient lines fromthe priming spike. Connect to patient access andunclamp

• Verify: v0~-\1-e...1. Saline line is double clamped ~and white clamps)2. Dialysate fluid lines (green clamps) are unclarnpedAnd if using bags:

The unused MLA lines are clampedThe warmer is turned to the 12 o'clock positionThe warmer air trap vent is clampedThe warmer outlet and fluid inlet line are unclamped

3. Patient lines (red and blue) are unclarnped4. The waste line and the drain line extension or to PureFlow cabinet are unclarnped.

• Start therapy• Press GO on pure flow control panel (If not done)• Press TREATMENT (see 7, then 8 in yellow cautionwindow). Increase to prescribed blood flow and thenDialysate.

Increase dialysate (GREEN arrow)until #3 in yellow display



TM0091 Rev A

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·Monitor Treatment• Document on flow sheet as directed

• Monitor:• Access pressure (i.e. 50 to 200) Access max: 260• Venous pressure (i.e. <250-300) Venous max: 300• Effluent pressure (close to venous pressure) Effluent: close to• Ultrafiltration volume (actual fluid removed) venous pressure• Rates: therapy fluid, ultrafiltration, blood flow• Ensure patient lines are visible• Vital signs and response to therapy.• DIALYSATE bags draining equally• Saline line is primed and double clamped (red and white clamps)• Warmer air trap full, vent if necessary• Arterial pressure pod full - pressures within range• Post-filter cap for air (if so, extract air with a syringe, hold thesyringe upright and inject any blood back through the post filter capport then clamp the post filter cap port securely).• Promptly respond to all Alarms and Cautions



TM0091 Rev A

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10

Treatment: Common Procedures

• Saline Bolus:• Note volume of saline in bag• Open saline line (~'rrfu white clamps) and allowdesired amount of saline to infuse, then reclamp• Evaluate need to add saline bolus volume to fluidbalance calculations

• Bolus/Flush Filter to Check for Clotting: h'I{-e...• Note volume of saline, open saline line (~ and whiteclamps) and occlude arterial patient line proximal tosaline "T" . When complete, remove occlusion to arterialpatient line and reclamp saline line (j:et1 and whiteclamp) vJh~e...• Add saline bolus volume to fluid balance calculations ifnot previously added in to the total UF goal at thebeginning of treatment.


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TM0091 Rev A 1 1

Temporary Disconnection• Recirculation of the Blood Circuit • i.e. difficulty with access

• Complete rinseback, ending with the arterialpatient line (red clamp) connected to the primingspike (red port).

• Clamp and disconnect venous patient line (blueclamp) from the access, attach it to the primingspike (blue port), then unclamp.

• Press TREATMENT and set therapy fluid at 0.1L/hr, ultrafiltration rate to zero and increase bloodflow rate to 250-350 ml/min to create venouspressure of 40 or higher.

• Low venous pressure alarms may occur. If so,reset alarm and increase blood flow rate to increasevenous pressure.



TM0091 Rev A 12

End of Treatment and Return Blood (Routine)• "000" will appear in yellow caution window

• Treatment targets have been met and blood pumpcontinues to run

• Make sure enough saline is available to rinseback the Draw up flushes in the syringes thatblood. (300-500ml) are hanging from the priming spike.

• Press STOP to stop blood pump and move the cyclerinto rinseback mode then press STOP on Pure Flow topause batch.

• Clamp and disconnect arterial patient line (red clamp) Attach syringe to patients arterial linefrom patient and reconnect to red port on the priming and flush.spike, and unclamp.

• Press ADD FLUID to rinseback blood (see countdownto zero and will stop automatically).

• Clamp and disconnect the venous patient line (blueclamp) from the patient and reconnect to the blue port onthe priming spike. Close Green (non reopening) clamp onPure Flow line and clamp small green clamp.



TM0091 Rev A 13

End of Treatment and Return the Blood(Operator End)

• Press and hold STOP for 2 seconds to see "000" inyellow display (therapy fluid and UF rates go to zero, butblood pump stays on)


• Press STOP to stop blood pump. Press STOP on PureFlow to pause batch.




TM0091 Rev A 14



Return the Blood (Rinseback) - Alternate• To be used when the rinseback is unplanned • i.e. still in treatment mode and there is

time to move the arterial patient line.

• Make sure enough saline is available torinseback the blood. (300-500ml)

• Press STOP

• Clamp and disconnect arterial patient line (redclamp) and reconnect to priming spike (red port),and unclamp.

• Press TREATMENT

• You may decrease blood flow rate to 200ml/min ·A low venous pressure #20, #21 may-You may need to decrease therapy fluid rate in occur with the blood pump rate turnedorder to decrease blood flow rate. down).

• When venous patient line (blue clamp) is clear,press STOP.

• Clamp and disconnect venous patient line (blueclamp) from patient and reconnect to the blueport on the priming spike.

TM0091 Rev A 15



Return the Blood (Rinseback) - Alternate• To be used in an Emergency • (i.e. prolonged troubleshooting or

unable to move arterial patient line)


• Open saline clamps on priming line (ensureflow), clamp the arterial patient line proximal tosaline "T", and allow saline to infuse and returnthe patient's blood.




TM0091 Rev A 16



Troubleshooting

TM0091 Rev A 17

• Press MUTE

• Identify condition and follow instructions to correct the problem

• Press STOP

• Press TREATMENT to continue



, .Commonly Encountered Alarms

Alarm # Cause How to Correct24 - Check Arterial Access:

Arterial line kinked or clamped Check arterial access orOR Access pressure pod error unkink or unclamp red line OR

Access Pressure at Low Limit See Alarm Chart (C-6) Followsteps for resetting accesspressure pod membrane.

2 5 - Access Pod Error:Access pressure pod connection See Alarm Chart (C-6)kinked, OR clamped, leaking, or Follow steps for resetting

Reset Access Pressure Pod not connected OR Access access pressure podpressure pod error membrane.

20 - Check Blood Circuit:Arterial line kinked or clamped Check arterial needle, unkinkOR venous line disconnected, or unclamp red line, check

Venous Pressure Low OR clotted filter blue line, check for clottedfilter with saline bolus.

21- Check Blood Circuit:Venous Pressure LowDecreasing



TM0091 Rev A 18

Commonly Encountered Alarms

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Alarm # Cause How to Correct

11 Air entering blood circuit, OR poor Follow steps for arterial air- Check for Arterial air flow through arterial access OR recovery on alarm chart (C-3)

Loose connection at arterial access

10 - Check for venous airAir entering blood circuit, OR Arterial Follow steps for venous airconnection loose OR Arterial access removal on alarm chart (C-7)dislodged or disconnected

37 ,38 - High balanceDrain line occluded, OR therapy line Check for closed clamps oroccluded, OR clotted filter cap on drain line, check for

chamber pressure closed clamps on therapy fluid

35 - Check Waste Lineline, check for kinked lines ondialyzer.

Pressure High

14 - Check Fluid LineEmpty Therapy Fluid Bags OR Gently pull on the inlet andLoose Therapy Fluid connection OR outlet lines of the Fluid warmer

Inlet: Air Detected in Fluid Warmer disposable air trap full of air bag.Line Inlet

TM0091 Rev A 19



, ,<l

NxStage Customer Service

1-866-NXSTAGE(1-866-697 -8243)

24/7 Technical/clinical support



TM0091 Rev A 20

NxStage Yellow Caution Alarm CodesDisplay Cause Action

000 End of Treatment / Rinseback None1 Infusing Fluid Bolus None2 Fluid Balance System Check None3 Parameter Limit Exceeded Set a Value Too Low or Too High4 Blood Pump Off Press Treatment/Add Fluid to Continue5 Target Volume Reached UF Volume Target Reached6 Blood Circulation Only Fluid Removal Rates Set to Zero7 Alarms Overridden Temporary Override of Alarms (Monitor until Green)8 Pressure Limits Not Locked Pump Rate Change (Monitor until Green)9 Auto High Pressure Recovery Alarm Reset After Red Alarm (None)12 Air Recovery Underway If No Air Noted Press Treatment to Continue/If Air Remove14 Air Detected in Fluid Line Inlel Empty Therapy Fluid Bags/Loose Connections/Warmer Full of Air/Air in Tubing20 Venous Pressure Low Arterial Flow Problem KCONenous Line Leak or Disconnection/Clotted Filter21 Venous Pressure Decreasing Arterial Flow Problem KCONenous Line Leak or Disconnection/Clotted Filter23 Effluent Pressure Decreasing Arterial Flow Problem KCO/Clotted Filter/Filtration Fraction Too High24 Access Pressure Decreasing to Low Limit Arterial KCO/Clotted Filter/Filtration Fraction Too High/Effluent Line KCO25 Access Pod Error/Rest Access Pressure Pod Access Pressure Connection KCO, Leaking or Not Connected27 Filter Pressure Error/Reset Filter Pressure Pod Filter Pressure Connection KCO, Leaking or Not Connected30 Venous Pressure Approaching High Alarm Limit Venous Flow Problem KCONenous Needle Infiltration31 Check Filter for Clotting Clotted Filter32 Venous Pressure Increasing Venous Flow Problem KCONenous Need Infiltration or Clotted40 Power Failure If Power Restored/Press Treatment/Add Fluid to Continue51 Fluid Cooldown Underway Red Alarm-50 Cleared52 Continue Treatment/Fluid Cooldown Complete Fluid <38.5 C after Red Alarm-50 Press Treatment to Resume70 Cartridge Life Exceeded Cartridge TimeNolume Limit Exceeded/End Tx Replace Cartridge71 Preventive Maintenance Due Complete Treatment and Schedule Maintenance72 Treatment Complete User Opened Door at End of Treatment80 Reconfigure Cartridge Line Operator Parameter #25 set to 1/Press Add Fluid to Continue81 Tap Filter to Remove Air (Optional) Filter May Be Checked For Air/Priming Procedure Underway88 Pressure Offset Rezeroing Needed Cycler was Powered Up with Door Closed and/or a Cartridge Installed93 Correct Settings Conflict Parameter Set to a Value Which Conflicts with Previous Value/Re-Enter Values999 Service Mode Activated DO NOT INITIATE TREATMENT/CALL NxSTAGE

©2009 DaVita Inc. All rights reserved. Handbook TabS Alarm Codes Page 2 of 2

Proprietary and Confidential - For internal use only. May not be copied or distributed without written permission from DaVita Inc.

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Description

Indicates Blood Leak Detector Malfunction/Fluid Has Interfered with Blood Leak

ActionAlarm Test Passed None Required

Venous Air Assess For Air (Pt to blood pump)Arterial Air Check Connections/Poor Flow

Check Fluid Line Inlet (Air Detected) Check Priming Fluid/Kinked TubingVenous Pressure Low (Blood Circuit) KCO in Pt Arterial Line/Poor Arterial Flow/Clotted Filter

Venous Pressure Decreasing (Blood Circuit) KCO in Pt Arterial Line/Poor Arterial Flow/Clotted FilterEffluent Pressure Low (Blood Circuit) Arterial Flow Low/KCO Effluent Line/Filtration Fraction Too High/Clotted Filter

Effluent Pressure Decreasing (Blood Circuit) Arterial Flow Low/KCO Effluent Line/Filtration Fraction Too High/Clotted Filter

Access Pressure at Low Limit Assess KCO in Pt line/Poor Arterial Flow/Arterial Pressure Pod error

Venous Pressure High Assess KCO in Venous LineNenous Line ClottedClotting Detected Check Filter for Clotting/Clotted Filter

High TMP: TMP >500mmHg Check Filter/KCO Venous Filter Line/Clotting Venous Header

Waste Line Pressure High Waste Line occluded/Waste Bag Full/Low effluent pressure-Low Arterial FlowFluid Balance System Failure TERMINATE TREATMENT

High Balance Chamber Pressure KCO in Circuit line/Clotted Filter/Air or Fluid in Balancing System

Therapy Inlet Occlusion Check Fluid Inlet/Air or Fluid in Balancing System

Failed Power Recovery Perform Manual Rinseback If System Not ClottedFluid Temperature High Warmer Set Too High/Therapy Fluid Bags too Warm

Blood Detected in Effluent Line Filter Membrane Leak/Air in Effluent/Filtration Fraction Too HighFailed Blood Leak Detector Blood Leak Detector Lens and/or Mirror Not CleanWaste Line Check Failure Cartridge Not Properly Loaded

Failed Alarm Test Improper Priming/Faulty Cartridge/Cycler MalfunctionUF Occlusion Test Failure Cartridge Not Properly Loaded

Pressure Offset Rezeroing Needed Blocked/Kinked Fluid Lines/Pressure Offset ErrorPressure Offset Rezeroing Failed Cycler Unable to Adjust Variable Pressure Offset on Start up

Fluid Circuit Test Failure Check Cartridge for Leaks/Malfunction of Fluid Balancing SystemCartridge Leak Probable Cartridge Integrity Compromised

System Alarms System Error/lnternal Communication ErrorBlood Leak High



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4.1




1TM0091 Rev A

.'J ,I

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,)

CAR-160Waste line(yellow clamp) Arterial

patient line(red clamp)

Tberapy fluidinl(green clamp) Venous

patient lin", ~(blue clamp) .~

(\~ .• ~ ~'.1- .;.:h-'" " ~"J.;,....... .,,-.,

'j! .., 1"-::' ~

'J I! _ I ~~ \ J

J,.:..::',a Saline lin(white clamp)

t Arterialpressure podPost-filter port

(blue clamp)



TM0091 Rev A 3

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Set-up

• Wash Hands

• Gather Supplies• Hang bags if needed

• Prepare the Cycler• Open door• Turn ON the power to both the cyclerand fluid warmer. Pure flow will be on.• Tighten patient lines on priming spike,then lift priming spike from cartridge• Insert cartridge (press tubing in to ~squares- air detectors)• Shut door

Cartridge, saline, syringes, fluid and accesssupplies

"Open the Door turn on the lights"

Pure flow never gets turned off.



TM0091 Rev A

\

4

Initiate Prime and Alarm Tests• Prime Cartridge:

• Spike saline bag• Hang saline bag from IV pole• Attach access pressure pod• Press ADD FLUID

This starts the 15 minute cycle

• Prime Fluid Warmer: For Bags Only• Insert warmer disposable into warmer and shut door• Connect Therapy Fluid MLA lines to DIALYSATE bags.• Break frangibles/cones• Prime and clamp unused MLA lines• Prime the warmer air trap and then clamp• Clamp warmer outlet• Put warmer knob to 12 o'clock position

Do not need to do this if using thePure Flow cabinet.6 lines

TopFront

(1:00) or what is comfortable

• Prepare drain line extension (Beginning of the weektie tube on IV pole on back) if using bags.

Do not need to do this if usingPureFlow cabinet.



TM0091 Rev A

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5

Initiate Prime and Alarms Test• Complete Alarms Test

• After 18 minutes see all "8's", then press MUTE• See display test (1-4, a-h, 9-1), then press MUTE• See 23.0/000 - Do not press STOP

• REMOVE AIR FROM THE BLOOD CIRCUIT:• See 23.0 and "000" display• Snap/tap arterial patient line to remove air• Invert filter (blue side up) AND venous filter line up,tap to remove air from filter• Put filter in filter holder with venous filter cap portupright, vent post-filter cap port and clamp• Snap/tap venous patient line to remove air• Recheck to be sure air is removed from patient lines• Press STOP


If you put needles in here, then primeVenous needle. Attach heparinsyringe. Inject heparin and clamp.Prime Arterial line and clamp.

This is the Red/ white/ blue to getair out of lines. Red line first, filtersecond, blue line third.


TM0091 Rev A

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6

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Manage Treatment Settings• Enter Treatment Parameters After 10 seconds, screen will go

back to the rate display.

• Press MEASURING CUP, for volume display (VOL)• Green -Verify target volume of DIALYSATE fluid• Yellow -Enter target volume of ultrafiltration (ex. 1.0L)• Red display will read: Vol.

How Much Screen 15~Green- Your Fluid prescription.Yellow -This is your weight youwant to remove.

• Press MEASURING CUP (if needed), for rate displayRed -Verify blood flow rate (ex. 250 ml/min)

, Yellow -Enter ultrafiltration rate (ex. 1.0Uhr)Green - Enter DIALYSATE flow rate (ex. 3.0 Llhr) (Will

do this step later when Blood Flow achieved)

How Fast ScreenRed -This is the starting Bloodflow. ZooYellow-This is how fast Fluid isremoved from you per hour.

f ,g



TM0091 Rev A

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7

Prepare for Patient Connections• Close all 8 clamps. (2 red, 2 blue, 2 yellow,1 green and white)

-. Prime saline "T" (~9-~tfamp) and clamp.Using pure flow, press GO and prime one port on thechicken foot. Clamp small green clamp on line.

• Attach saline line (white) to saline "T" (.a:eaclamp) DO NOT UNCLAMP Wh·l~

• Connect cartridge therapy fluid inlet (green) ~6D vn~to warmer outlet or Pure Flow cabinet (green)and unclamp.

• Clamp and disconnect drain line (yellow)and connect to drain line extension or PureFlow cabinet on front, then unclamp.

• Wash Hands

• Prepare the vascular access If already done, skip this step.Training/reference material. Not intended to replace User's Guide.


TM0091 Rev A 8

(

w~ U&~6upLaunch Treatment

• Connect to Patient Access:• Clamp and disconnect red and blue patient lines fromthe priming spike. Connect to patient access andunclamp

• Verify: Wh-,1-e...1. Saline line is double clamped ~and white clamps)2. Dialysate fluid lines (green clamps) are unclarnpedAnd if using bags:

The unused MLA lines are clampedThe warmer is turned to the 12 o'clock positionThe warmer air trap vent is clampedThe warmer outlet and fluid inlet line are unclamped

3. Patient lines (red and blue) are unclarnped4. The waste line and the drain line extension or to PureFlow cabinet are unclarnped.

• Start therapy• Press GO on pure flow control panel (If not done)• Press TREATMENT (see 7, then 8 in yellow cautionwindow). Increase to prescribed blood flow and thenDialysate.

Increase dialysate (GREEN arrow)until #3 in yellow display



TM0091 Rev A

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9

·Monitor Treatment• Document on flow sheet as directed

• Monitor:• Access pressure (i.e. 50 to 200) Access max: 260• Venous pressure (i.e. <250-300) Venous max: 300• Effluent pressure (close to venous pressure) Effluent: close to• Ultrafiltration volume (actual fluid removed) venous pressure• Rates: therapy fluid, ultrafiltration, blood flow• Ensure patient lines are visible• Vital signs and response to therapy.• DIALYSATE bags draining equally• Saline line is primed and double clamped (red and white clamps)• Warmer air trap full, vent if necessary• Arterial pressure pod full - pressures within range• Post-filter cap for air (if so, extract air with a syringe, hold thesyringe upright and inject any blood back through the post filter capport then clamp the post filter cap port securely).• Promptly respond to all Alarms and Cautions



TM0091 Rev A 10

I

Treatment: Common Procedures

• Saline Bolus:• Note volume of saline in bag• Open saline line (~'rrfu white clamps) and allowdesired amount of saline to infuse, then reclamp• Evaluate need to add saline bolus volume to fluidbalance calculations

• Bolus/Flush Filter to Check for Clotting: h'I{-e...• Note volume of saline, open saline line (~ and whiteclamps) and occlude arterial patient line proximal tosaline "T" . When complete, remove occlusion to arterialpatient line and reclamp saline line (j:et1 and whiteclamp) vJh~e...• Add saline bolus volume to fluid balance calculations ifnot previously added in to the total UF goal at thebeginning of treatment.

\



TM0091 Rev A 1 1

Temporary Disconnection• Recirculation of the Blood Circuit • i.e. difficulty with access

• Complete rinseback, ending with the arterialpatient line (red clamp) connected to the primingspike (red port).

• Clamp and disconnect venous patient line (blueclamp) from the access, attach it to the primingspike (blue port), then unclamp.

• Press TREATMENT and set therapy fluid at 0.1L/hr, ultrafiltration rate to zero and increase bloodflow rate to 250-350 ml/min to create venouspressure of 40 or higher.

• Low venous pressure alarms may occur. If so,reset alarm and increase blood flow rate to increasevenous pressure.



TM0091 Rev A 12

End of Treatment and Return Blood (Routine)• "000" will appear in yellow caution window

• Treatment targets have been met and blood pumpcontinues to run


• Press STOP to stop blood pump and move the cyclerinto rinseback mode then press STOP on Pure Flow topause batch.



• Clamp and disconnect the venous patient line (blueclamp) from the patient and reconnect to the blue port onthe priming spike. Close Green (non reopening) clamp onPure Flow line and clamp small green clamp.Training/reference material. Not intended to replace User's Guide.


TM0091 Rev A 13

End of Treatment and Return the Blood(Operator End)

• Press and hold STOP for 2 seconds to see "000" inyellow display (therapy fluid and UF rates go to zero, butblood pump stays on)


• Press STOP to stop blood pump. Press STOP on PureFlow to pause batch.






TM0091 Rev A 14

Return the Blood (Rinseback) - Alternate• To be used when the rinseback is unplanned • i.e. still in treatment mode and there is

time to move the arterial patient line.


• Press STOP

• Clamp and disconnect arterial patient line (redclamp) and reconnect to priming spike (red port),and unclamp.

• Press TREATMENT






TM0091 Rev A 15

Return the Blood (Rinseback) - Alternate• To be used in an Emergency • (i.e. prolonged troubleshooting or

unable to move arterial patient line)


• Open saline clamps on priming line (ensureflow), clamp the arterial patient line proximal tosaline "T", and allow saline to infuse and returnthe patient's blood.






TM0091 Rev A 16

Troubleshooting

• Press MUTE

• Identify condition and follow instructions to correct the problem

• Press STOP

• Press TREATMENT to continue



TM0091 Rev A 17

Commonly Encountered Alarms

Alarm # Cause How to Correct24 - Check Arterial Access:

Arterial line kinked or clamped Check arterial access orOR Access pressure pod error unkink or unclamp red line OR

Access Pressure at Low Limit See Alarm Chart (C-6) Followsteps for resetting accesspressure pod membrane.

2 5 - Access Pod Error:Access pressure pod connection See Alarm Chart (C-6)kinked, OR clamped, leaking, or Follow steps for resetting

Reset Access Pressure Pod not connected OR Access access pressure podpressure pod error membrane.

20 - Check Blood Circuit:Arterial line kinked or clamped Check arterial needle, unkinkOR venous line disconnected, or unclamp red line, check

Venous Pressure Low OR clotted filter blue line, check for clottedfilter with saline bolus.

21- Check Blood Circuit:Venous Pressure LowDecreasing



TM0091 Rev A 18

l.'

Commonly Encountered AlarmsAlarm # Cause How to Correct

11 Air entering blood circuit, OR poor Follow steps for arterial air- Check for Arterial air flow through arterial access OR recovery on alarm chart (C-3)

Loose connection at arterial access

10 - Check for venous airAir entering blood circuit, OR Arterial Follow steps for venous airconnection loose OR Arterial access removal on alarm chart (C-7)dislodged or disconnected

37 ,38 - High balanceDrain line occluded, OR therapy line Check for closed clamps oroccluded, OR clotted filter cap on drain line, check for

chamber pressure closed clamps on therapy fluid

35 - Check Waste Lineline, check for kinked lines ondialyzer.

Pressure High

14 - Check Fluid LineEmpty Therapy Fluid Bags OR Gently pull on the inlet andLoose Therapy Fluid connection OR outlet lines of the Fluid warmer

Inlet: Air Detected in Fluid Warmer disposable air trap full of air bag.Line Inlet



TM0091 Rev A 19

, ,<l

NxStage Customer Service

1-866-NXSTAGE(1-866-697 -8243)

24/7 Technical/clinical support



NxStage Yellow Caution Alarm CodesDisplay Cause Action

000 End of Treatment / Rinseback None1 Infusing Fluid Bolus None2 Fluid Balance System Check None3 Parameter Limit Exceeded Set a Value Too Low or Too High4 Blood Pump Off Press Treatment/Add Fluid to Continue5 Target Volume Reached UF Volume Target Reached6 Blood Circulation Only Fluid Removal Rates Set to Zero7 Alarms Overridden Temporary Override of Alarms (Monitor until Green)8 Pressure Limits Not Locked Pump Rate Change (Monitor until Green)9 Auto High Pressure Recovery Alarm Reset After Red Alarm (None)12 Air Recovery Underway If No Air Noted Press Treatment to Continue/If Air Remove14 Air Detected in Fluid Line Inlel Empty Therapy Fluid Bags/Loose ConnectionslWarmer Full of Air/Air in Tubing20 Venous Pressure Low Arterial Flow Problem KCONenous Line Leak or Disconnection/Clotted Filter21 Venous Pressure Decreasing Arterial Flow Problem KCONenous Line Leak or Disconnection/Clotted Filter23 Effluent Pressure Decreasing Arterial Flow Problem KCO/Clotted Filter/Filtration Fraction Too High24 Access Pressure Decreasing to Low Limit Arterial KCO/Clotted Filter/Filtration Fraction Too High/Effluent Line KCO25 Access Pod Error/Rest Access Pressure Pod Access Pressure Connection KCO, Leaking or Not Connected27 Filter Pressure Error/Reset Filter Pressure Pod Filter Pressure Connection KCO, Leaking or Not Connected30 Venous Pressure Approaching High Alarm Limit Venous Flow Problem KCONenous Needle Infiltration31 Check Filter for Clotting Clotted Filter32 Venous Pressure Increasing Venous Flow Problem KCONenous Need Infiltration or Clotted40 Power Failure If Power Restored/Press Treatment/Add Fluid to Continue51 Fluid Cooldown Underway Red Alarm-50 Cleared52 Continue Treatment/Fluid Cooldown Complete Fluid <38.5 C after Red Alarm-50 Press Treatment to Resume70 Cartridge Life Exceeded Cartridge TimeNolume Limit Exceeded/End Tx Replace Cartridge71 Preventive Maintenance Due Complete Treatment and Schedule Maintenance72 Treatment Complete User Opened Door at End of Treatment80 Reconfigure Cartridge Line Operator Parameter #25 set to 1/Press Add Fluid to Continue81 Tap Filter to Remove Air (Optional) Filter May Be Checked For Air/Priming Procedure Underway88 Pressure Offset Rezeroing Needed Cycler was Powered Up with Door Closed and/or a Cartridge Installed93 Correct Settings Conflict Parameter Set to a Value Which Conflicts with Previous Value/Re-Enter Values999 Service Mode Activated DO NOT INITIATE TREATMENT/CALL NxSTAGE

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Description ActionAlarm Test Passed None Required

Venous Air Assess For Air (Pt to blood pump)Arterial Air Check Connections/Poor Flow

Check Fluid Line Inlet (Air Detected) Check Priming Fluid/Kinked TubingVenous Pressure Low (Blood Circuit) KCO in Pt Arterial Line/Poor Arterial Flow/Clotted Filter

Venous Pressure Decreasing (Blood Circuit) KCO in Pt Arterial Line/Poor Arterial Flow/Clotted FilterEffluent Pressure Low (Blood Circuit) Arterial Flow Low/KCO Effluent Line/Filtration Fraction Too High/Clotted Filter

Effluent Pressure Decreasing (Blood Circuit) Arterial Flow Low/KCO Effluent Line/Filtration Fraction Too High/Clotted Filter

Access Pressure at Low Limit Assess KCO in Pt line/Poor Arterial Flow/Arterial Pressure Pod error

Venous Pressure HighClotting Detected

High TMP: TMP >500mmHgWaste Line Pressure High

Fluid Balance System FailureHigh Balance Chamber Pressure

Assess KCO in Venous LineNenous Line ClottedCheck Filter for Clotting/Clotted Filter

Check Filter/KCO Venous Filter Line/Clotting Venous Header

Waste Line occluded/Waste Bag Full/Low effluent pressure-Low Arterial Flow

TERMINATE TREATMENTKCO in Circuit line/Clotted Filter/Air or Fluid in Balancing System

Therapy Inlet Occlusion Check Fluid Inlet/Air or Fluid in Balancing System

Failed Power Recovery Perform Manual Rinseback If System Not ClottedFluid Temperature High Warmer Set Too High/Therapy Fluid Bags too Warm

Blood Detected in Effluent Line Filter Membrane Leak/Air in Effluent/Filtration Fraction Too HighFailed Blood Leak Detector Blood Leak Detector Lens and/or Mirror Not CleanWaste Line Check Failure Cartridge Not Properly Loaded

Failed Alarm TestUF Occlusion Test Failure

Pressure Offset Rezeroing NeededPressure Offset Rezeroing Failed

Fluid Circuit Test FailureCartridge Leak Probable

System AlarmsBlood Leak High

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Improper Priming/Faulty Cartridge/Cycler MalfunctionCartridge Not Properly Loaded

Blocked/Kinked Fluid Lines/Pressure Offset ErrorCycler Unable to Adjust Variable Pressure Offset on Start up

Check Cartridge for Leaks/Malfunction of Fluid Balancing SystemCartridge Integrity Compromised

System Error/lnternal Communication ErrorIndicates Blood Leak Detector Malfunction/Fluid Has Interfered with Blood Leak


Handbook TabS Alarm Codes Page 1 of 2

nx stage

Documents

detailed reference list

prescription use

users guide

prime arterial line

reference notes

venous filter line

clamp warmer outlet

treatment settings