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Question: On HHD and air in the lines!

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  • Question: On HHD and air in the lines!

    My son has now been on HHD for a total of two months. To be honest it has been a grueling two months. We had (my son and I ) a total of three weeks training. I feel as though the home training nurses (there were two) were very informative and willing to help but there were so many things that we did not cover. We have made several small mistakes (thankfully not life threatening) along the way ,but have spent hours worrying about unanswered questions. One of the questions ( and still no answer) is, every time I attach my sons needles to the arterial and venous lines there is obvious air bubbles in the lines. We don't worry so much about the arterial lines since the machine will catch it and alarm but there is always air released into the venous line when I detach the syringe from the line to connect the venous line to his needle line after cannulating. How much is too much? they are not large bubbles (bigger than a grape seed) but there are several, about 6 or 8 ,which are pushed directly into my son's access when the Nxstage is started, And he says at times he thinks he can feel or hear them going in. This is something he never noticed when in center. When I ask his home nurse she says, I don't know I haven't noticed them before. How is that possible! Does anyone have a suggestion?
    All and all the bottom line is, my son feels so much better after treatment than he did in-center. He is not weak or tired and is now going about his usual routine which was not possible before. He says he feel very close to his usual self again.

    Stumpr54, thanks so much for all of your informative post. My son is only 33 and he has had a hard time excepting this new way of life and many
    times your post was what kept us going.




    Worried Mom
    Last edited by jackielynn; 07-30-2015, 10:52 AM.

  • #2
    Hello jackielynn,

    Check out my latest post about choosing to continue to work.

    I get air bubbles in both arterial and venous lines at the time of draw back after cannulation. Sometimes an 11 alarm (air in the arterial line) is triggered. I stop the cycler and restart and restart through the 12 alarm without issue. The System1 Cycler is very sensitive - to protect the patient.

    I used to freak out with these alarms when I started HHD, and soon realized from experience that the bubbles are small and harmless. I have this confidence because I follow the same process each time without appreciable variation. I have had some instances where the draw back in the venous needle tube seemed to produce more than the usual number and size of air bubbles - usually the result of blood "flying" into the tube and getting past the air that is normally present. As a precaution, I will "purge" the needle tube into my trash bag (cartridge bag), creating a column of solid blood in the tube, just to be on the safe side. My wife hates the relatively small amount of blood in the trash bag, but it's an exception with good reason.

    I have come to believe that the amount and size of air bubbles needed to be introduced into the blood stream to cause a potential embolism is significant, e.g. you would really have to get a lot of air into the venous needle tube to experience symptoms. Don't forget that blood carries oxygen, e.g. air, though it is evenly distributed.

    This is all something that comes with experience and the trust of your own technique and the precision by which you do it. The early days are fraught with process variation and it is wise to proceed with caution. Once you've got things dialed in, and at 5X weekly treatments, it won't take long, you can use that experience to guide your decisions in all aspects of a treatment, not just how much air is too much air in the lines.
    Last edited by stumpr54; 08-01-2015, 08:48 AM.

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    • #3
      This is something that has been happening to me recently as well, I will attach a syringe to the venous line to suck them out and generally that works. It’s still a nerve wracking experience though.

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