Six years ago today I had my donated kidney removed based on a life-threatening arterial infection. I had my donated kidney and pancreas transplant for nine months. My pancreas transplant never worked, but the kidney was working great for me.

The arterial infection was preventing blood flow to the kidney, so I had to decide if I wanted to lose the kidney or my left leg. I remember telling the doctor a working kidney was great, but I would rather keep walking.

After opening me up they found so much abdominal infection, they told my wife they literally bathed my abdomen with bleach. The infection did so much damage, I also had to have a femoral artery bypass from my left right leg to my left leg.

Post-surgery I continued to have problems with infections, and had to learn to walk again. Three months later I returned to work, and dialyzed in-center three time per week.

What a life change. Severe limitations on how much I could drink, tired all the time, hardly able to climb a single flight of stairs, even more diet limitations with potassium and phosphorous.

After being in-center for about a year and a half, I discussed my life expectancy with my Nephrologist and was shocked to learn the average patient lives from six to eight years. I recall telling him “that’s not going to work for me, I have two kids in college and a home mortgage.”

We then discussed the health benefits of more frequent dialysis via home hemo and NxStage. Within a short time I had a button-hole fistula to make self-cannulation easier, and after another month I began training on the use of NxStage equipment.

Today I feel much better, I have much normal blood levels of potassium and phosphorus, I have more energy, and I feel much more in-control of my health and life because of NxStage home hemodialysis.

It has been a life-saving change for me, health-wise, physically and mentally. Friends and relatives always tell me how great I look for a man on hemodialysis. I still tire very easily because of low hemoglobin, but with frequent injections of Epogen, I have more energy than I did when dialyzing in-center.

I feel like the luckiest man alive, I survived the arterial infection that should have killed me, and now due to six-days-a-week home hemo via NxStage, I expect to celebrate many future home hemo anniversaries.

If you run on a NxStafe System you will become very familiar with the usual warnings and errors and how to resolve them.

A problem I have begun having more and more frequently is a recurring error 35. Error 35 – Check Waste Line: Waste Line Pressure High (Red Alarm). This error indicates the waste line is occluded (or blocked).

Sounds simple enough, either the effluent line has become clamped, blocked or crimped. Simply find and remove the problem.

Well, after using the NxStage for almost five years, more and more waste blockage forms in the line that runs from the back of the NxStage to disposal. When I first started using the NxStage it was recommend that I clean the effluent line once per month with a 10% bleach solution and water. Later I was told to reduce the number of days between cleanings to ten days. Since then I have reduced it to nine days, but that was still not enough.

Yesterday while running I got my first error 35 when I had 21 minutes left to dialyze. I checked that all clamps were open, I had my partner check the end of the effluent line to ensure it was not blocked and restarted. I ran for one more minute and got another error 35. This is a red alarm that shuts down the pump, so it takes two minutes to restart.

Argh –  the dreaded addition of time to when I get off. Following the directions in the NxStage book, simply press stop, then restart treatment. After doing this I multiple times I continued to get another error 35 after each minute of treatment. Now my 21 minutes of remaining treatment would take over an hour.

To clear the blockage in the effluent line I had my partner fill a 60ML syringe with tap water, and add a connector to the end of the syringe, then stop the NxStage, clamp both yellow clamps on the effluent line, separate the connections at the yellow clamps, screw on the syringe, Note: make sure to connect the syringe to the short effluent line that  goes into the Pureflow, NOT the longer line that goes back into the cartridge, and then push all 60 ML of water through the effluent line that enters the PureFlow. When complete, disconnect the syringe, reconnect the effluent line, open both  yellow clamps, and restart treatment.

This procedure corrected the blockage in the effluent line and allowed me to complete my entire treatment without another error 35. And, I also changed the time between cleaning the effluent line from nine days to seven days to further prevent this from recurring.

You may also find my blog entry on Do You Need to Shorten Your Effluent Line helpful with resolving recurring error 35s.

NxStage warning 24 is arterial pressure that’s too high, its reset by simply pressing the yellow alarm reset button. Error 25 is a hard machine stop for arterial pressure that’s too high and forces you to Stop and Restart the unit. In addition to halting the NxStage unit, high arterial pressure is dangerous for your fistula. Both of these errors require that you correct the problem that’s causing them, or reducing your run speed.

I’m lucky, I have a great button-hole fistula, and normally run at 500 speed with my NxStage dialyzer. I start at 350, advance to 470 with the first couple of minutes and most of the time I am running at 500 within the first 15 minutes.

Why run at the fastest speed? The faster the run speed, the higher the dialysate rate. These two factors determine how long you will be on the machine. If you’re like me, the last 30 minutes of dialysis seem like hours. Anything that reduces this time is GREAT.

Every now and then I have trouble getting much over 470, but why? The obvious issues are needle placement in your fistula. Sometime simply adjusting the arterial needle will allow faster speeds.

When I first started at home, I frequently had to “prop” my arterial needle. I used three 3”X3” cotton swabs rolled up to form a one inch round pad that I placed under the tabs of the needle to allow a faster run speed. Luckily I only needed this for a few weeks.

About a week ago I again had trouble getting to my usual 500 run speed. After reviewing both the arterial and venus lines, I discovered that if these lines were crossed one or more times, it slowed my run speed. Also I use two pieces of tape on the bicep of my fistula arm to hold the needles and lines in place, if these pieces of tape are too tight, it can reduce blood flow, and run speed.

I also check to make sure there aren’t any unusual kinks in the lines, anywhere between my arm, and their entry back into the NxState unit. I only takes a very slight kink or sharp turn to reduce blood flow, and run speed.

Lastly I carefully inspect my needle sets. If I find one that has unusual curves in the tubing portion of the line, I only use them on the venus line, and save the perfectly straight lines for use in my arterial side.

As I mentioned in one of my earlier posts Have Your Fistula Checked if trying these steps still won’t allow you to get to your normal run speed, it might be time to have your fistula checked by an Arterial Surgeon.  Clotting or narrowing of your fistula can also cause loser run speeds.

Over time, you will learn what minor issues can reduce run speed, and become very adept at correcting them and completing your dialysis run as fast as possible.