NX stage install prep

[Garry]

Hi,
Lots of questions!

Currently updating our installation documentation for home dialysis and I'm trying to completed the NX one along with streamlining the process.  The majority of our home patients are now on the NX with Pureflow.

What timescale do you work to from being informed that a patient is suitable for NX home dialysis?

Could anybody assist by elaborating on the type of install that they provide for the NX equipment at home?   Taking the most basic installation being designed to be supplied with tap or under sink attachments with the option of running drain to a toilet or shower drain.  Currently we would try to accommodate patients' preferred equipment position, routing supplied hosing around the room in trunking or, where required, under flooring and through walls.  Extra 13A sockets would be installed if required.  Clearly this is limited by permitted feed/drain length requirements.

How do techs approach the installation of the LINX equipment?  With only a 6ft drain length recommendation it often makes installation difficult, especially for upstairs installs where positioning of the equipment within the bathroom is not permitted.  Though we obtain the relevant water quality information and treatment parameters to calculate if a LINX is required there is often some difficulty obtaining the LINX and/or installation kit to allow the installation to be completed in a timely manner.  If suitable location is not available do you just go ahead with install with understanding by patient/NX that filter pack changes will be more frequent?

This work is all completed by our plumbing/electrical contractor.  Once finished who completes your final connections to the equipment?  With appropriate training the NX programme is designed to give the patient the skills to complete this (as they will be doing this for component swap outs).  Is this what happens at your centres or do the techs still do final connection, or even maybe the home nursing staff?

…. or if somebody already has a department procedure covering the NX install I'd be grateful of a peek

Thanks

[Ian Wilde]

Hi Garry,

I'm off to the home haemo MDT this aft so will try and get some answers about timescales for you.

Our most basic installation is probably someone who lives on a canal boat believe it or not.  Water in and then drain into the canal!  (yes we got permission).

All our NxStage patients are using the Pureflow system and we don't have any LINX devices installed as we are blessed with good water.

We have our own buildings manager (available to do work for other trusts btw) who coordinates the plumber to fit a supply with isolating tap into the room for the machine and then the waste is routed to a saddled connection into a waste pipe somewhere.  We don't have any installations that just hang in a shower drain/toilet etc.  Patients are given some choice but we will always steer them in a certain direction that we're happy with.  

The Buildings Manager will also coordinate the electrician to assess the supply where the machine will be plugged in (we have found missing earths in the past) and we provide an RCD protected socket for them to use with their dialysis equipment.

We the techs will connect the machine up for the patient and make sure the prescription data is correct.

Our chap on the boat wanted to do the installation himself as he was very precious about his vessel (which was stunning btw).  He's an engineer and was deemed more than competent to do it.  He only uses the machine while moored so is connected to a "proper" power source which is checked by an electrician regularly so no worries about safety.

We had another patient who wanted a NxStage on her narrowboat but she would have been using a generator as she roams the waterways.  She had a transplant though the week before she was due to start training.

[Ian Wilde]

Sent you an email too Garry from when we visited Portsmouth's NxStage programme.

[John Ramsay]

Hi,

Further to the NX stage install prep.

Does anyone do regular water testing e.g.  TVC, Endotoxin, Full chemical Analysis of the NX Stage system that are supplied from a tap at home?

I know the patients are to use Chlorine test strips to test the dialysate batch prior to dialysis.

Regards

John

[Paul J McCarthy]

Hi
We have our plumbers bring a water supply plus drain into the dialysis room, plus dedicated sockets for the equipment.  We used to use Lynx as we are in a hard water area. But had too many big leaks from them. Even went as far as fitting them in a tray with a flood stopper. In the end gave up on them, they just change their packs more often. Hope this is of some help to you..  

[fraser gilmour]

Hi John,
We don't do TVC or Endo on the NXstage as it has integrated ultrafilter stages. ISO 23500 states micro testing isn't required when these filters are used as per manufacturers recommendations.
We don't sample for metals etc but check historical incoming water quality data as standard pre installation, nothing ongoing. The DI challenge test data they give for the Pureflow, along with cond. measurement  is enough to give me confidence in the system.
They still do it but I think the chlorine test strip is a waste of time, I'd be surprised if these are good enough to show a change at 0.1

Can't seem to get hold of a LINX unit anymore, it was difficult enough before FMC took over. We have had patients come off the system due to having to replace the PAK every 2-3 weeks in our hardest water areas.