Tablo

H.E.R. · Jan 10, 2024

Diablo.. did u find the answer to your question from back in Oct.. and more importantly was your son, ER RN, made aware?

Tablo was designed for home Hemo Dialysis and designed to limit the manipulative ability of this machine for patient safety. Tablo HD machine limits the essential/ life saving rapid changing of machine settings ( by experienced Dialysis nurse/tech) that is absolutely needed in a hospital Acute hemodialysis setting to protect and literally save the life of a patient.. loved one, family member. I speak with 48 years of working with many different HD machines (& RO systems)and 34 years as in hospital/Acute nephrology RN (which includes hemo dialysis & peritoneal dialysis).. Hospital administrators DO have HD machine options that are safer for our patients and with less costs... try looking at these HD machine purchase costs and maintenance contracts: Fresenius, Brauns.. and very importantly SPEAK with people that "know". My expertise is always available.. with access to very knowledgeable people.

diabo, RN · Feb 23, 2024

Thank you

Urinegdhands · Feb 20

Howdy... I have been Tablo for two years now and can honestly say they are not for Acute HD. Many alarms! From blood pump errors, to Red Cap not seated which I have to soak caps and connections numerous times to reset. Cartridges come apart on back alot as well. It has been not the funnest and most time consuming. The patient experience has been OK when they function correctly but like some have stated you cannot do the same things with this machine.

Krissi MacInnis Kelley · Feb 21

Hey you are spot on and the more I am forced to work these machines, the more agitated and angry I get. I even read a posted comment from a home HD user whose Tablo machine gave so much difficulty from operation to breaking down that this home user finally went with a NextStage home HD machine and stated never had a problem. These machines are clearly not for acute use, and cannot be manipulated in a way that HD nurses and technicians know and need. These machines are specifically targeted and made for home use; ie, train the monkey to push the buttons and not harm themselves in the process. Again they are not appropriate for acute use in hospital settings - they are not built to be pushed, rolled on elevators, plugged and unplugged, run several treatments per day, the cassettes are cheap, they are not self loading, the Hansons "ports" connectors are cheap (plastic, not metal), flimsy materials, the screens are hard to read from any distance because they are made with a patient sitting right in front of them. If they stop working whilst you are in the middle of a treatment, God help you if you are on call by yourself and you need to leave the patient to retrieve a working machine and your patient has a AVF or AVG, what do you do? Pull the needles? Start over with cannulation after you get everything situated? What if the pt is a bleeder (we do have those prolonged bleeding times ( 1 hour) with certain patients, that will never change!). These machines, due to their unreliability and inappropriateness, actually make caring for the acute dialysis patient a safety risk. I read a review by one acute nurse who got really stressed because the Table was not working and she was on call with a stat treatment with a pt whose serum potassium was 9 something! Can you imagine? And yet, and yet, I truly believe this happened, has happened, and will happen again. The Company that markets these machines as appropriate for acute use is badly mistaken, is mis representing the machine and if I had purchased them for my unit, I would be taking legal action against the Company for misrepresenting the capabilities of these machine for a busy acute unit and I would have a long list of machine breakdowns to support my case. We do keep track of the breakdowns, which are numerous, continuous and stressful.

Further, please read about the "certain" recalls of Tablo machines "for risk of patient exposure to higher than allowable levels of toxic compound NDL-BCBAs" at FDA.GOV. A class I recall. And visit www.massdevice.com.

And get this, AI information states these machines cost around $47,000. I finally figured out the high cost vs the cheap quality of the machine components. Software! The cost is in the software that runs the machine completely - so a monkey can push the buttons - run the machine and not be harmed. But acute dialysis nurses are anything but! With years of experience with different machines, different clinical settings, different patients every day, all sorts of access issues and medical extenuating circumstances in every instance, we are anything but a monkey. You are also paying for the machine to WiFi data - like for a home patient being monitored for tx info, clearances, etc. We don't need that stuff. Again, acute setting - pt admitted , pt discharged.

No IV pole, no heparin pump. I noticed if I give a medication using the designated med line, it can affect the transducer negatively.

Let these machines be restricted to home use only and give us a "real" dialysis machine. Who ever purchases these machines for acute use is making a very bad and very expensive mistake in the form of machine costs, breakdowns, employee costs (my co worker just spent two hours down time trying to get a Tablo to work plus retrieve another Tablo (will it work?) and start over again. They have to rinse after a treatment which costs time. This happens every day every week at our unit. Gets expensive. Hey and if they thought the 300 Qd was going to save money, just adjust the Qd rate on the real dialysis machine - they can do that.

The best machines I ever used was the simplistic Baxter 500, all Fresenius and heck, I'd take the BBraun too! The Tablo machine is the ABSOLUTE worst dialysis machine in ALL WAYS I have ever had to use. Tablo is Taboo for us in acute dialysis settings.

Good Luck and realize you are not the only one frustrated - there is a huge number of disgruntled, stressed out dialysis staff forced to use these. :(

Urinegdhands · Feb 21

Yes all that and more. I believe the real reason they are going to these is money. They don't want to pay for specialty nurses and or they are too hard to find. So they can train their ICU staff to run these and take on the patient like CRRT. Money always wins.

Duncan6 · Feb 21

And this is part of the reason I'm heading back to FMC next month. If it wasn't an infection control issue I might just hug the 2008T,LOL.

Staffing is also a huge reason I'm going back. In the almost 2 years I've been here I've only had 1 other nurse for 6 months and she left in January. I'm staying long enough to train the new nurse and that's it.

I'm at a rehab hospital and they didn't have a dialysis program previously so there was no one here with dialysis experience to talk them out of Tablo.

Krissi MacInnis Kelley · Feb 21

Well I don't know; that's an interesting take on it. Where I work, and all the other hospitals, they use dedicated CRRT machines for critical care. It's not possible for the Tablo to replete a critical care patient with specific solutions like Prismasol (not sure spelling). The Fresenius had a module for something like CRRT, the module had to be purchased, you needed something like an F3 dialyzer, and different bloodlines if I recall. But it was never truly a true CRRT dedicated machine.

My employer makes a point of only hiring experienced HD nurses/techs, and very experienced ones at that!

I do puzzle why hospital upper management selects these machines. I cannot imagine to replace experienced staff, but I guess there is a shortage of dialysis nurses nationwide, both acute and chronic?

I think they were told they would save money. I don't what the "savings" would be or how, but I agree, it was definitely about money. But I only see loss and waste where it should not be.

I once worked in outpatient years ago and we were asked to "test use" a couple different HD machines, as nurses and techs. We all voted hands down for Fresenius after using it. It's the only employer I ever had that actually asked for staff input through live use. Nobody asks us squat anymore, yet we are the frontline getting it done.

I think their shoddy reputation and in acute settings will catch up to Outset. Give it some time. I don't think upper management has caught on entirely but I do know of one large hospital that refuses to use them.

Krissi MacInnis Kelley · Feb 21

😉 Duncan - I would hug anything Fresenius at this point!!

Urinegdhands · Feb 21

Yes I am the care coordinator and only nurse for my hospital. And they had 16 PRN nurses trying to orientate and they all quit. I am now getting some interest but sadly its so hard to get them. This was before I came on board

But yes chatting within my network its money and they figure once Tablo goes live with CRRT capabilities they will be using their staff nurses to save money. It is nice for them to have the added skills, but we will see.

We do a lot of SLED with Tablo and the patients do extremely well almost better than CRRT with some literature attesting to SLED doing as well as CRRT.

Times are changing.........

HDRN · Jul 24

Hello everyone, I'm new to this group. What brought me here was a representative from a company called .Outset approached my manager today at work. She asked my manager what machines we are currently using and pitched her sales about the Tablo. I work in a small hospital inpatient dialysis. We use the B Braun and we just ordered 3 new ones. My manager gave me the brochure the representative gave her. I was reading the information, and I got online and found this discussion group. I saw the last post was from 2024. Alot of good feedback from everyone and I so appreciate it, but I'm curious about how things are going today with Tablo?

H.E.R. · Jul 24

Hey there HDRN.... glad u reached out... the wisest seek knowledge, absorb what's needed and throw away the rest. So do what u need w/ this. The Tablo was made for in home HD.. and I feel is great for those folks. The Acute setting absolutely requires a machine we, Acute Nephrology Nurses, can adjust QUICKLY as a response and medical need to ACUTE pt's quickly changing critical status, life sustaining medical needs. The Tablo does NOT have that ability. Onset has programmed the Tablo to safe-guard home HD pt's w/ dbl checking & "are you sure?" machine setting questions .. which just doesn't work in the ACUTE care setting when every second counts.

Summarized: Tablo good for HOME HD pt..NOT medically (and could be) "every second counts" life threateningly dangerous in the ACUTE CARE setting. Oh and Tablo can spin a good sale! Stick with Braun OR Fresenius machines.. for the patient's.. isn't that who this is about? My opinion is from 35 yrs Acute Nephrology Nursing experience.. take it or not.

Gooooo ACUTE NEPHROLOGY NURSES!! You're great..!!

HDRN · Jul 25

Hello H.E.R! Wow! Thank you soooo much for the information. This is truly helpful and reaffirms the answer I gave my manager about not purchasing the Tablo. I value your input and so many others on the discussion. Alot of rich information and knowledge from so many who are seasoned in the area of dialysis. I've been an acute dialysis nurse for about 4 1/2 yrs now and it was the best decision I've made as a nurse. I love doing dialysis. My number goal is to take care of any patient that comes my way in safe and effective way while receiving a proper treatment. I'm learning more every time I come to work. I love the B Braun machine. Thank you again and take care of yourself as you care for others.