As part of home hemodialysis I have an annual home visit by the dialysis center to ensure I am following established procedures, and and recommendations for cleanliness and infection control.  
During my last visit I mentioned that it was almost time for me to refill my small liquid soap container from the bulk bottle I purchased. The dialysis nurse said that they now recommend that the small liquid soap bottles be replaced each time they are emptied, and not refilled, to reduce germs and contamination of the plastic container.

I thought about this and decided that I will continue to refill my soap container, not replace it each time it’s empty. Here’s my logic; during my decades of employment I worked as a technology consultant to manufacturing and distribution customers. I worked in many companies assisting with their implementation of technology for both manufacturing and distribution. I recall manufacturers making products similar to liquid soap.

When the products are completed a person loads 12 to 24 of the products into shipping container for shipment to a distribution center. The employees that do this task are sometimes paid both an hourly wage, and a piece wage to encourage quickly loading their products into boxes. The more they load, the greater their wage. They are very good at this, and do it very quickly. They also get very little time for restroom breaks or for lunch. I never asked any of them, but I fear many do not take the time to wash their hands after a restroom breaks. I also witnessed employees who were sick, who still came to work to earn their badly needed wages. If they are sick while working, their germs and bacteria end up on the products they are packing for shipment.

Eventually those products arrive at the retailer in boxes. The retailers pay contractors or employees to unload the boxes and place those products on the shelf. They have the same issues as the people loading the products into shipping boxes. Did they wash their hands after using the restroom, or do they also work when they are sick, inadvertently getting germs and bacteria on the products they are unloading and placing on the shelves of your favorite store?

If these new soap containers don’t yet have enough germs on them, what about the parent of a sick child who is at the store browsing for liquid soap after touching their sick child, picking up the soap container to read the labels or prices prior to making a final purchase decision?

I contend that the new soap containers from any retail store are potentially more contaminated than the one I have been using, refilling and had control over in my own home.

Every time I refill my soap container, I also thoroughly wipe all exposed surfaces with a Chlorox wipe. I have been doing home hemodialysis and refilling my soap container for over five and a half years, and have never had an infection with my fistula. That’s a good thing because a sepsis infection in an AVF fistula can be lethal.

I also get a lower price on bulk soap refills, and feel better about reducing the amount of plastic waste I put in my trash, that ends up in the local landfill. If you disagree with my thoughts here, please leave a comment and let me know why, maybe I’ll change my approach. But for now, I will continue to refill my liquid soap container, and not purchase a new one each time I empty one.

Over the last ten days I have had high Venus pressures and pain in the Venus portion of my fistula while dialyzing, and pain in my fistula after completing dialysis. Some days the pain would subside and my Venus pressures were lower, although still elevated. When I ran last Friday I had a higher level of pain than I had before, and pain in my fistula after I finished running.

I called the vascular care office and they were able to get me in this morning (Monday). After using a scope on my fistula the doctor told me there was some narrowing in my fistula, and that scar tissue was also contributing to my problems. He said the scar tissue was causing the pain I was having during dialysis.

I questioned how I was getting scar tissue in my fistula. He replied that when you run at pump speed 500, the blood sprays out of the two openings in the fistula a needle, and this hard spray inside your fistula can cause scar tissue. I have been running on this fistula for over five years and this is the first time I have had an issue with scar tissue.

I asked the doctor how the scar tissue can be dealt with, then I got the bad news, nothing can be done to repair damaged scar tissue. He advised dialyzing at a lower pump speed to lower the chances of causing more scar tissue and to protect my fistula from further damage.

The doctor performed an angioplasty, he made a small incision just below and to the right of my arterial button-hole, and used a balloon-shaped catheter to enlarge the Venus portion of my fistula. Since the surgery, my Venus pressure has been reduced while dialyzing this evening, and my pain during dialysis is gone.

My dialysis center has always advised using the highest pump speed possible, for me that was 500. The arterial doctor advised me to use a lower pump speed as long as I was getting adequate clearance. He advised using a pump speed of 350-400. I’m not sure that I can put up with the increased run time using this slow of run speed. When I started tonight, I set the pump speed at 400, and my total run time to remove 1.6L would have been 2 hours and 50 minutes. My normal run time were less than 2 hours and 15 minutes.

I plan to start reducing my run speed, but am cautious to reduce it from 500 to 400 without ensuring that I will continue to get adequate clearance at the lower pump speed. My plan is to use the lower pump speed of 400 the day I draw blood for my monthly labs, so I can find out what the reduced pump speed does to my clearance, before making the final decision on what run speed I will be using.

My next blood draw will be in another in two and a half weeks, in the mean time I plan to use a maximum pump speed of 450. I’ll post a follow-up blog entry to advise how this works for me, and how the lower pump speed affected my clearance value.

02/18/16 Update – I have been running with a pump speed of 450, and it has added about ten more minutes to my run time and my clearenace stayed the same.  My concern with reduced clearenace at the lower pump speed was unfounded.  The NxStage System One is automatically calculating your run time based on Dialysate Rate.  Dialysate Rate is based on a combination of UF Goal (amount of liquid to be removed) and pump speed.  When I run at a lower pump speed, the total time to remove the liquid actually stays the same, but the length of time to use all the Dialysate lenghthens by about 10 minutes.  The great new is that on a NxStage you can lower the pump speed and never affect your clearenace, the NxStage System One is always providing the same amount of cleareance by lengthening the run time.  The reason cleareance would be an issue based on lower run speed is only when you are dialyzing in-center, you are limited to a specific amount of time so they can the next dialysuis patient on and started.

I have been doing home hemodialysis for five and a half years and for the first time got this warning error when I first powered on the NxStage System One in preparation for setting up. 

The troubleshooting section of the NxStage manuals indicates – SCHEDULE PREVENTATIVE MAINTENANCE: PREVENTATIVE MAINTENANCE DUE (YELLOW CAUTION).     

I called NxStage Technical support and they indicated I needed to have my NxStage sent back to the factory for preventative maintenance. The good news – I could simply press the MUTE button to reset the warning error and continue with setup. This error will reoccur each time the NxStage System One is powered on until it is replaced.

NxStage sent me a new System One in about one week. Like usual, great service from NxStage. Even though I received the same warning error each time I powered the old one on, I simply pressed the MUTE button to continue setup.

The only caution I have about replacing your System One is the requirement to set the System Settings. See the NxStage User’s Guide to document all of the current System Settings on your current System One BEFORE replacing it with the new unit.

Appendix A in the User’s Guide indicates how to access the NxStage System One user settings, and documents each of those settings. While reviewing the settings on my current System One, I simply used a pencil to document the value of each setting in the User’s Manual. It made changing each of the settings on the new machine very easy.

Many of the settings did not need to be changed, but by documenting each setting from the old machine, and verifying each one on the new machine, I was confident my new machine would do exactly what the old one did during my hemodialysis treatments. 

I know it’s been a few years since I last replaced my System One due to a pump failure, but this particular error has been a very rare experience for me.