4008 ￑ᆰᅪ죠ᅦtech-basics

Comments

Transcription

4008 ￑ᆰᅪ죠ᅦtech-basics
Fresenius Medical Care
Technical Training
on
4008 Dialysis Machine
Shanghai, April 2002
Hotin
May 2001
Dialyzer Membrane
Fresenius Medical Care
May 2001
Fresenius Polysulfone - Structure
Fresenius Medical Care
May 2001
Fresenius Polysulfone - Structure
Fresenius Medical Care
HOLLOW FIBRE DIALYSER
PORE
PORESIZE
SIZEisisdependant
dependanton
onthe
thetype
type
ofofmembrane;
membrane;
HF Dialyser:
Pore size ~ 0.3nm
LF Dialyser:
Pore size ~ 0.1nm
May 2001
Venous Pressure
Measurement
P
Fresenius Medical Care
Blood out
Venous
Bubble Catcher
Dialysate in
Dialyzer
Dialysate out
Venous Clamp
Blood in
Blood Pump
P
Arterial Pressure
Measurement
HEMODIALYSIS
HD
The transport of uremic wastes by diffusion, i.e. the process in which
of particles move across a semipermeable membrane from the area
of higher concentration (blood) to the area of lower concentration
(dialysate).
May 2001
j:\sd\ch\folien\tpf_nma\hd_arm_e.cdr
SD / TRAINING CENTER SCHWEINFURT
Heater
Fresenius Medical Care
Hemofilter
Blood leak
detector
cleared blood
Filtr. pump
Blood
Sub. pump
Blood pump
Hemofiltration HF
Filtrate
Substituate
Removal of uremic wastes by convective transport. The driving force is provided
by the transmembrane pressure present at the hemofilter.
Due to the filtration of large volumes during hemofiltration, simultaneous reconstitution of blood with appropriate amounts of physiologic replacements solution
is required.
Fluid balance
May 2001
SD / TRAINING CENTER SCHWEINFURT
j:\sd\ch\folien\tpf_nma\hf_e.cdr
Heater
Fresenius Medical Care
Hemofilter
cleared blood
Blood leak
detector
Filtr. pump
Blood
Sub. pump
Blood pump
Hemodiafiltration HDF
Filtrate
Substituate
Hemodiafiltration is a combination of hemodialysis and hemofiltration to take advantage of the benefits of hemodialysis - high clearance of small-molecular substances
and hemofiltration - good clearance with middle-molecular substances.
Fluid balance
May 2001
SD / TRAINING CENTER SCHWEINFURT
j:\sd\ch\folien\tpf_nma\hdf_e.cdr
Display of the Clearance with the different Dialysis Treatment Procedures
Clearance
(ml/min)
Fresenius Medical Care
200
conventional Hemodialysis
Hemofiltration
Hemodiafiltration with Polysulfone membrane (Fresenius)
150
100
50
102
103
104
Inulin
Urea
Creatinin
Vit. B12
105
Albumin
Molecularweight
(Dalton)
ß2-Microglobulin
May 2001
SD / TRAINING CENTER SCHWEINFURT
FMC HD Machines - 4008B/S
Fresenius Medical Care
May 2001
FMC HD Machines - 4008E/H
Fresenius Medical Care
May 2001
FMC HD Machine - 4008S
Fresenius Medical Care
May 2001
FMC HD Machine - 4008H
Fresenius Medical Care
May 2001
Structure of Haemodialysis Machine
Fresenius Medical Care
Main Components
Monitor
- Control Unit
Modules
- Extracorporeal
Blood Circuit
Hydraulics - Preparation of
Dialysis Fluid
May 2001
Structure of Haemodialysis Machine
Fresenius Medical Care
Monitor
Extracorporeal
Blood Circuit
Hydraulics
May 2001
• Operating Elements
• Displays
• Alarms
• Blood Pump
• Heparin Pump
• Air Detector
•• Preparation
Preparation of
of Dialysis
Dialysis Fluid
Fluid
-- Mixing
Mixing
-- Heating
Heating
-- Degassing
Degassing
•• Transport
Transport of
of dialysis
dialysis Fluid
Fluid
•• Fluid
Fluid Balance
Balance &
& Ultrafiltration
Ultrafiltration
Electronic Compartment
Fresenius Medical Care
May 2001
Blood Pump
Fresenius Medical Care
• Arterial Pressure Connector
• Delivery Rate: 15 - 600 ml/min
• Automatic Stop in blood alarms
• Sensor to check the cover is open/closed
May 2001
Heparin Pump
Fresenius Medical Care
Anticoagulation:
To prevent blood clotting in the
extracorporeal blood circuit
May 2001
Air Detector
Fresenius Medical Care
• Ultrasonic Sensors
• Prevent air entering patient body
• Holder Size: 22 or 30 mm
• Venous Pressure Connector
• Venous Line Clamp (Optical Detector):
Closed in blood alarms
• Keys for fluid level adjustment
May 2001
bibag Module
Fresenius Medical Care
May 2001
bibag Module
Fresenius Medical Care
•
•
•
•
•
•
•
May 2001
Less Storage Space
Lightweight
Safe
Clean
Practical
Long Shelf Life
Environmentally Friendly
Tasks of Haemodialysis Machine
Fresenius Medical Care
1.
Produce fresh dialysate
2.
Provide correctly prepared dialysate to the dialyzer
3.
Remove fluid from the patient by ultrafiltration
4.
Handle and monitor effluent dialysate
5.
Operate and control the extracorporeal circuit
May 2001
Basic Haemodialysis Setup
Fresenius Medical Care
Monitor
Hydraulics
ECC
Dialyzer
Preparation
& handling
of fresh
dialysate
Handling of
used dialysate
and
ultrafiltrate
HD Machine
Ultrafiltrate
Blood
lines
Extracorporeal
Circuit
May 2001
General Features / Benefits
Fresenius Medical Care
•• High
High Safety
Safety Level
Level
-- 22 independent
independent microprocessor
microprocessor systems
systems
-- approved
approved hydraulic
hydraulic parts
parts
-- cyclic
cyclic pressure
pressure holding
holding tests
tests
•• Proven
Proven Volumetric
Volumetric Ultrafiltration
Ultrafiltration
•• Auto
Auto Self-test
Self-test
•• Auto
Auto Disinfection
Disinfection Programs
Programs
•• UF
UF // Na
Na Profiles
Profiles
•• Emergency
Emergency Battery
Battery Operation
Operation of
of Blood
Blood Systems
Systems (15
(15 …
… 20
20 min)
min) (Power
(Power Failure)
Failure)
•• Program
Program Heparinization
Heparinization Time
Time // Bolus
Bolus
May 2001
Features / Benefits in Operation / Handling
Fresenius Medical Care
• Simultaneous Display of Status & Alarms
• Additional Alphanumeric Display
• Direct Selection of UF-parameters
• Intelligent Setting of Pressure Limits
• Pressure-corrected Blood Flow & Blood Volume Calculation
• Service Programs
May 2001
Options in 4008 System
Fresenius Medical Care
Additional Status Display
BPM
SN-Double Pump
BTM
DIASAFE / DIASAFEplus Filter
BVM
4008 HDF
CDS
Online HDF / HF
OCM
ONLINEplus
IrDA
bibag
May 2001
Fresenius Medical Care
SCREEN
SCREEN11
Green
Greenindicates
indicatesthat
that
this
screen
can
be
this screen can be
viewed
viewedby
bypressing
pressing
confirm.
To
confirm. Tomove
move
the
cursor
press
the cursor pressthe
the
arrow
arrowacross
across May 2001
Here
Hereisisdisplayed
displayedthe;
the;
• •Machine
type
Machine type
• •Software
Softwareversion
version
Fresenius Medical Care
SCREEN
SCREEN22
T1
T1Test
Test
IfIfan
anerror
erroroccurs
occursaa
• •xx oror
• •number
numberappears
appears
totoinform
you
inform youofofthe
thefailure.
failure.
The
alarm
occurs
at
the
The alarm occurs at theEND
END
ofofthe
test
procedure
the test procedure
May 2001
The
Thevarious
varioussteps
stepsofofthe
the
T1
TEST
T1 TEST
• •green
greenhighlights
highlightsthe
thespecific
specific
part
of
the
test
sequence
part of the test sequence
Fresenius Medical Care
SCREEN
SCREEN 33
IfIfthe
theT1
T1Test
Testisissuccessful
successful
the
screen
will
be
the screen will becompleted
completed
with
with
May 2001
Fresenius Medical Care
Ultrafiltration
Menu
Dialysate
UF Values
UF Goal
UF Time Left
UF Rate
UF Profile
UF Volume
ISO Values
ÍSO Goal
ISO Time
ISO Rate
ISO Volume
MAIN
MAINSCREEN
SCREENDISPLAY
DISPLAY
Treatment
mode
• HDF
• SN Click Clack
May 2001
Menu
Alarm limits
menu
• Reinfusion
• Needle Adjustment
prog
• Arterial Limits
• Venous Limits
• TMP Limits
Mixing Ratio
Base Na+
Concentrate
Bicarbonate
Temperature
Flow
Na+ Profile
Start Na+
CDS
Conductivity window
System
parameters
• Reset treatment
parameters
• Brightness
• Auto-On programme
(cleaning modes)
• Date
• System Time
(actual time)
Dialysis
representations
Graphic displays for
the front screen
• UF / Na Profiles
• Arterial/Venous pressures
• BPM (syst/dias)
• BPM MAP
• BTM
• BVM
• BPM / BVM
• Cumulative bloodflow
• Effective Dialysis time
Fresenius Medical Care
UF
UFMENU
MENU11
Entering
Enteringthe
theUF
UFData
Data
GREEN
GREENcursor
cursorshows
showsyou
you
which
data
can
be
entered
which data can be entered
WHITE
WHITEhighlight
highlighttells
tellsyou
you
which
figure
you
can
enter
which figure you can enter
To
Tomove
movethrough
througheach
eachfield
field
press
the
arrow
press the arrow
• •up
up
• •down
down
May 2001
Isolated
Isolatedsequential
sequential
ultrafiltration
ultrafiltrationcan
canalso
also
be
performed.
be performed.
To
Toenter
enterthis
thisfield
fieldpress
press
arrow
across
arrow across Then
Thenfollow
followthe
thesame
same
process
as
for
entering
process as for entering
the
thedata
datafor
forUF.
UF.
Remember
to
Remember toenter
enterthe
the
Total
Goal
and
Time
Total Goal and Timeinin
the
theUF
UFvalues
valuesand
andthen
then
ONLY
the
values
for
ONLY the values for
the
theIsolated
Isolatedininthe
theISO
ISO
values
values
Fresenius Medical Care
UF
UFMENU
MENU22
When
Whenusing
usingaaUF
UFprofile
profile
select
the
profile
required
select the profile required
• •11- -66and
andthe
theappropriate
appropriate
graph
will
be
displayed
graph will be displayed
• •Max
MaxRate
Ratewill
willthen
thenbe
be
displayed.
This
is
the
displayed. This is thestart
start
value
of
the
ultrafiltration
value of the ultrafiltration
CHECK
CHECKtotoensure
ensurethat
thatthe
the
UF
Co-eff
of
the
dialyser
UF Co-eff of the dialyser
isissuitable
suitable!!!!
May 2001
Fresenius Medical Care
DIALYSATE
DIALYSATE MENU
MENU
Setting
Settingthe
theDialysate
Dialysate
concentration
concentration
Conductivity
Conductivitywindow
window
allows
us
to
move
allows us to move
ororcentre
centrethe
thealarm
alarm
guards
when
we
guards when we
change
changeany
anyofofthe
the
dialysate
parameters
dialysate parameters
May 2001
• •check
checkthe
themixing
mixingratio
ratio
• •concentration
of
the
concentration of thecanister
canister
• •concentration
required
concentration requiredfor
for
the
patient
the patient
• •bicarbonate
bicarbonatelevel
levelfor
forthe
the
patient
patient
• •dialysate
dialysatetemperature
temperature
• •dialysate
flow
dialysate flow
• •profile
profileififrequired
required++graphic
graphic
• •when
selected
a
start
value
when selected a start value
1mmol
1mmolgreater
greaterthan
thanthe
the
concentrate
level
will
concentrate level willbe
beshown
shown
This
can
then
be
increased
This can then be increased
according
according totothe
theDoctors
Doctors
prescription
prescription
Fresenius Medical Care
TREATMENT
TREATMENTMODE
MODESCREEN
SCREEN
Single
SingleNeedle
NeedleClick-Clack
Click-Clack
can
canbe
beused
usedininemergencies
emergencies
e.g.
when
one
of
e.g. when one ofthe
theneedles
needlesblows
blows
and
it
is
difficult
to
insert
a
second
and it is difficult to insert a second
• •upper
upperlimit
limitshould
shouldbe
belowered
lowered
totothe
desired
value
by
pressing
the desired value by pressingthe
the
- -minus
key
minus key
• •lower
lowerlimit
limitshould
shouldbe
beraised
raisedtotoaa
value
value20
20mmHg
mmHghigher
higherthan
thanthe
the
pressure
already
achieved
using
pressure already achieved usingthe
the
++key
key
• •then
thenmove
movethe
thecursor
cursortotothe
theOFF
OFF
and
switch
ON
again
by
using
and switch ON again by usingthe
the
++/ /- -key
key
May 2001
IfIfdesired
desiredyou
youcan
canalways
alwaysreturn
returntototwo
two
needle
dialysis
at
a
later
time.
needle dialysis at a later time.
Fresenius Medical Care
ALARM
ALARMLIMITS
LIMITSSCREEN
SCREEN
Here
Hereititisispossible
possibletoto
reposition
repositionand
andmake
makethe
the
alarm
guards
either
alarm guards either
wider
widerorornarrower
narrower
• •Arterial,
Arterial,
• •Venous
Venous
• •TMP
TMPLimits
Limits
Reinfusion
Reinfusion
allows
allowsusustotogive
givesaline
saline
during
or
at
the
end
during or at the endofof
the
thedialysis
dialysisby
by
OPENING
the
OPENING thealarm
alarm
guards
to
avoid
nuisance
guards to avoid nuisance
alarms
alarms
ItItisisactive
activefor
for3minutes
3minutes
ororititwill
automatically
will automatically
return
returntotonormal
normalstatus
statusifif
blood
bloodisisseen.
seen.
Needle
NeedleAdjustment
Adjustment
deactivates
deactivatesthe
thealarm
alarm
guards
for
arterial
guards for arterialand
and
venous
pressures
for
venous pressures for
33min.
min.totoallow
allowyou
youtoto
turn
turnorormanipulate
manipulatethe
the
needle
with
the
blood
needle with the blood
pump
pumprotating.
rotating.
May 2001
Fresenius Medical Care
SYSTEM
SYSTEMPARAMETERS
PARAMETERSSCREEN
SCREEN
Auto
Auto-On
-Onprogramme
programme
allows
you
allows youtotoselect
selectaa
cleaning
cleaningprogramme
programmeand
andthe
the
time
you
would
like
the
time you would like the
programme
programmetotocommence
commence
ininthe
morning,
the morning,sosothat
thatthe
the
machine
will
be
cleaned
machine will be cleanedand
and
ready
for
use
before
the
staff
ready for use before the staff
arrive
arriveininthe
theunit
unit
The
Thenumber
numberindicated
indicated
here
can
be
entered
here can be enteredusing
using
key
board
to
quickly
key board to quicklyenter
enter
the
data
for
the
Auto-On
the data for the Auto-On
programme
programme
Brightness
Brightnessallows
allowsyou
youtoto
dim
dimororbrighten
brightenthe
thelights
lights
on
the
machine
on the machine
Reset
Resetmeans
meanstotoerase
eraseall
allthe
the
data
you
have
in
the
UF
menu
data you have in the UF menu
during
duringthe
thetreatment.
treatment.
ALL
DATA
ALL DATAwill
willthen
thenbe
belost
lost
System
SystemTime
Timeand
andDate
Dateshould
shouldbe
bechanged
changedtotoyour
yourlocal
localtime
time
This
leaves
the
factory
with
the
Time
in
Germany
!!
This leaves the factory with the Time in Germany !!
May 2001
4008
116
111
73
75
87
63
109 7
24b
112
24
3
61
86
Fresenius Medical Care
30
97
41
76
8
29
92
54
31 32
43
33 34
5
2
66
b
a
114
150
6
9
c
68
89 88
151
a
b
26
c
115
77
35 36
37 38
85
78
21
65
84 115
74
125
94
98
95
10
12
a
90 b
91
22
23 94
May 2001
71
95 25
72
SD / TRAINING CENTER SCHWEINFURT
4008
111
73
87
116
7
109
112
24b
Fresenius Medical Care
63
3
75
61
86
24
A
30
97
76
8
29
41
43
114
33 34
31 32
92
54
150
6
5
2
9
68
a
66
b
89
c
26
88
a
b
c
35 36
77
78
37 38
115
21
65
B
99
10
149
125
95
94
12
148
25
100
123
119
P
P
137
124
104
134
135
138
23
136
131a
133
132
120 118
22
130
102
117
121
122
91
90
b
May 2001
131b
90
a
85
84
151
95
94
72
71
74
115
Theory of Operation of Balancing Chamber
Fresenius Medical Care
1st cycle:
31
32
33
34
BC2
BC1
from Patient
Balance Chamber
35
36
37
Fresh Dialysate
May 2001
38
21
Dialyser
to Patient
Theory of Operation of Balancing Chamber
Fresenius Medical Care
2nd cycle:
Spend Dialysate to Drain
31
32
33
34
BC2
BC1
from Patient
Balance Chamber
35
36
37
Fresh Dialysate
May 2001
38
21
Dialyser
to Patient
Closed System
Fresenius Medical Care
0 ml
10 ml
10 ml
May 2001
Closed System
Fresenius Medical Care
Spend Dialysate
to Drain
Balance Chamber
to Patient
Dialyser
from Patient
Fresh Dialysate
to Balance Chamber
May 2001
Closed System with UF
Fresenius Medical Care
Spend Dialysate
to Drain
Balance Chamber
Dialyser
to Patient
10 ml
from Patient
Fresh Dialysate
to Balance Chamber
UF Pump
10 ml
Ultrafiltrate to Drain
May 2001
Only the amount of fluid
removed by the UF pump
is removed from the patient.
Fill Program
Fresenius Medical Care
11st
st cycle:
May 2001
Fill Program
Fresenius Medical Care
22nd
nd cycle:
May 2001
Open System
Fresenius Medical Care
Pven
PDial
Dialysate Flow
Pump
TMP
electronic
TMP-Control
UFK = 4
ml
mmHg x h
Vacuum
Pump
[
W [kg] = TMP [mmHg] x UF K
Dialysate Flow
+ UF-Volume
TMP =
ml
mmHg x h
W
UFK x t
Dialysate
Preparation
System
May 2001
SD / TRAINING CENTER SCHWEINFURT
j:\sd\ch\folien\tpf_nma\ope_sy_e.cdr
[
x t [h]
Closed System
Fresenius Medical Care
Pven
PDial
1 6 0 0
TMP
timer
counter
UF-Pump
Drain
Dialysate
Flow
Flow- Pump
Fresh
1 ml
Old
UF Vol
fresh
Dialysate
from
Preparation
System
Advantage:
Very precise volumetric ultrafiltration control
Good for High-Flux Dialyzers
High effective & short time dialysis
May 2001
SD / TRAINING CENTER SCHWEINFURT
j:\sd\ch\folien\tpf_nma\clo_sy_e.cdr
Overview of Cleaning Programs
Fresenius Medical Care
End of Dialysis
Rinse
Rinse
PGM
RPGM 1:
1: --RPGM
R- endless
PGM 2:
2: --Rendless
Hot
Hot Rinsing
Rinsing
PGM
F-HR-CPGM 1:
1: --F-HR-CPGM
F-HR
PGM 2:
2: --F-HR
PGM
IHR
PGM 3:
3: --IHR
Dialysis
May 2001
Disinfection
Disinfection (Cleaning)
(Cleaning)
PGM
F-D-MPGM 1:
1: --F-D-MPGM
F-HDIS-MPGM 2:
2: --F-HDIS-MPGM
F-D-M-HRPGM 3:
3: --F-D-M-HRPGM
F-HDIS-M-HRPGM 4:
4: --F-HDIS-M-HRPGM
F-D(F)-MPGM 5:
5: --F-D(F)-M-
4008
116
111
73
75
87
63
109 7
24b
112
24
3
61
86
Fresenius Medical Care
30
97
41
76
8
29
92
54
31 32
43
33 34
5
2
66
b
a
114
150
6
9
c
68
89 88
151
a
b
26
c
115
77
35 36
37 38
85
78
21
65
84 115
74
125
94
98
95
10
12
a
90 b
91
22
23 94
May 2001
71
95 25
72
SD / TRAINING CENTER SCHWEINFURT
Valve Sequences in Cleaning Programs
Fresenius Medical Care
In cleaning programs V91 opens with each BC cycle for 0.5 sec.
in order to clean the rinse chambers (90).
The Con. & Bic. Pumps are doing 1 stroke per BC cycle.
RINSE: (F, R, C)
• Normal Cycles (18) : Flushing out
- V41 controlled by Float Switch
- BC cycled like in dialysate mode
- V24, V24b, V30, V87 open
- V26, V43, V84, V86 closed
May 2001
Valve Sequences in Cleaning Programs
Fresenius Medical Care
Fill Cycles (2) :
- BC cycled like in FILL PROGRAM
- V26, V43, V86 open
- V24, V24b, V30, V41, V84, V87 closed
- ASP runs
- UF
-Pump runs (max. frequency)
UF-Pump
• MANDATORY RINSE: (M)
- V43 permanent open
- UF
-Pump runs permanent (max. frequency)
UF-Pump
May 2001
Valve Sequences in Cleaning Programs
Fresenius Medical Care
• RECIRCULATED CLEANING PROGRAMS: (D, HDIS, HR)
GENERALLY:
-
V86 open
V87 closed
V43 open
UF-Pump runs (max. frequency)
NORMAL CYCLES (D:18 / HDIS,HR:13):
-
BC cycled like in dialysis mode
V24, V24b, V30 open
V26, V41, V84 closed
May 2001
Valve Sequences in Cleaning Programs
Fresenius Medical Care
FILL CYCLES (2):
-
May 2001
BC cycled like in FILL PROGRAM
V26 open
V24, V24b, V30, V41, V84 closed
ASP runs
4008
116
111
73
75
87
63
109 7
24b
112
24
3
61
86
Fresenius Medical Care
30
97
41
76
8
29
92
54
31 32
43
33 34
5
2
66
b
a
114
150
6
9
c
68
89 88
151
a
b
26
c
115
77
35 36
37 38
85
78
21
65
84 115
74
125
94
98
95
10
12
a
90 b
91
22
23 94
May 2001
71
95 25
72
SD / TRAINING CENTER SCHWEINFURT
Preparation for Chem. Disinfection Programs 1…4
Fresenius Medical Care
Prior Aspiration of Disinfectant
The given values are based on a standard machine. For machines
including Diasafe or On-Line-HDF the vol. of disinfectant are increased!
• After Rinsing Clean (F) is finished:
1. Closing of the BC valves with the current increase pulse
2. Waiting for the floater to reach “up”-position
3. V41-control disabled. V26, V43, V87 & BC fresh fluid valves open,
degassing pump delivers fluid with reduced speed from the heater block,
until the lower switch point of the floater is reached.
May 2001
Preparation for Chem. Disinfection Programs 1…4
Fresenius Medical Care
4. 1 BC cycle → level in 66 c: 30ml below lower switch point
5. V26, V87 & BC fresh fluid valves open, V43 closed,
degassing pump off, UF-Pump: 4 strokes
→ Level: 34ml below lower switch point
6. V84, V86 open, UF-Pump: 50 strokes = 50ml disinfectant
(Dilution 1:25), the conductivity is monitored by the sensors 115:
If there is no conductivity detected after 24 strokes, the process
is stopped: alpha display “DISINFECTANT EMPTY ?”
After 50 strokes of the UF-Pump the floater must be in “up” position.
May 2001
Preparation for Chem. Disinfection Program 5
Fresenius Medical Care
Prior Aspiration of Disinfectant
The given values are based on a standard machine. For machines
including Diasafe or On-Line-HDF the vol. of disinfectant are increased!
• After Rinsing Clean (F) is finished:
1. Closing of the BC valves with the current increase pulse
2. Waiting for the floater to reach “up”-position
3. V41-control disabled. V26, V43, V87 & BC fresh fluid valves open,
degassing pump delivers fluid with reduced speed from the heater block,
until the lower switch point of the floater is reached.
May 2001
Preparation for Chem. Disinfection Program 5
Fresenius Medical Care
4. V26, V87 & BC fresh fluid valves open, V43 closed,
degassing pump off, UF-Pump: 23 strokes = 23ml
5. After the disinfectant is connected the aspiration is done by use of
the acid pump.
32 strokes of acid pump = 37ml disinfectant (Dilution 1:34)
6. After aspiration the floater must be in “up”-position.
May 2001
4008 Hydraulic Functions in Cleaning Programs
Fresenius Medical Care
With
With Diasafe
Diasafe (in
(in round
round brackets)
brackets)
&
& On-Line-HDF
On-Line-HDF (in
(in square
square brackets)
brackets)
Rinse
HR/HDIS 2 & 4
DIS 1 & 3
DIS 5
Flow [ml/min]
600
450
600
600
Flow Pump [ml/min]
600
600
720
720
BC Switch Delay [s]
-
1
0.5
0.5
250
250
250
250
18x normal /
2x Fill + ASP on
13x normal /
2x Fill + ASP on
18x normal /
2x Fill + ASP on
18x normal /
2x Fill + ASP on
-
X
X
X
In Fill Cycle
Mandatory Rinse:
continuous
continuous
continuous
continuous
Dead Time [ms]
BC Cycles
Recirculation
UF-Pump 4000ml/h
May 2001
4008 Hydraulic Functions in Cleaning Programs
Fresenius Medical Care
Vol. of Disinfectant [ml]
Disinfection Dilution
Degassing Pump Speed Reduct.
Temp. [°C]
Temp. Limit [°C]
End of prg.
Rinse Chamber Evac.
Conc. P. + Bic. P.
May 2001
Rinse
HR/HDIS 2 & 4
DIS 1 & 3
DIS 5
-
- /50
(66)
[82]
50
(66)
[82]
UF-Pump
UF-Pump
37
(49) [61]
Conc. Pump
32 strokes
(42) [52]
-
- / 1:25
by 6V
1:25
-
1:34
-
37
84
87
at NTC 3
37
37
33.5 / 41
78.5 / 90
Timer start ≥ 80
33.5 / 41
33.5 / 41
10 strokes
10 strokes
10 strokes
10 strokes
4008
116
111
73
75
87
63
109 7
24b
112
24
3
61
86
Fresenius Medical Care
30
97
41
76
8
29
92
54
31 32
43
33 34
5
2
66
b
a
114
150
6
9
c
68
89 88
151
a
b
26
c
115
77
35 36
37 38
85
78
21
65
84 115
74
125
94
98
95
10
12
a
90 b
91
22
23 94
May 2001
71
95 25
72
SD / TRAINING CENTER SCHWEINFURT
Dialysate Alarms: Conductivity & Temperature
Fresenius Medical Care
• Optical Alarm (continuous)
• Audible Alarm
• Bypass (no external flow: V24 closed, V26 open)
• No Storage (self resetting)
May 2001
Upper Temperature Alarm
Fresenius Medical Care
• All consequences like the other
“Dialysate Alarms” as before
• Additional the heater is controlled OFF (40° C)
• By actual display value exceeding the display range:
Heater Relay opens (41° C)
May 2001
Flow Problems - Water Alarm
Fresenius Medical Care
2 conditions:
1.
The floater stays in position “DOWN ”
(No water available)
Reactions: After 6 seconds:
• Alpha display shows: “WATER ALARM”
• Heater OFF
• Balancing Chamber cyclings stop
• Alarm
May 2001
Flow Problems - Water Alarm
Fresenius Medical Care
2.
The floater stays in position “UP” for more than
30 seconds
Reactions:
• Heater OFF
• Balancing chamber cyclings continue
• Alarm
May 2001
Flow Problems - Flow Alarm
Fresenius Medical Care
Condition: No current increase impulse within 12 seconds
Reactions:
• Balancing chamber cyclings done by “EIGENTAKT”
• Heater OFF
• Alarm
May 2001
During a cleaning program - Upper Flow Alarm
Fresenius Medical Care
Condition: The flow increased to more than 1000ml/min
Reactions:
• Program stops
• Alarm
May 2001
Flow - Troubleshooting Recommendations
Fresenius Medical Care
• Check the pressures in the hydraulics
• Watch the drain line (fluid amount per BC cycling)
• Observe the valve sequences with the test box
May 2001
Blood Alarms
Fresenius Medical Care
• Optical Alarm (1st alarm flashing,
following alarm continuous)
• Audible Alarm
• Blood Pump Stop
• Venous Line Clamp Closed
• UF-Pump Stop
• Alarm Storage (reset by DIALYSIS START)
May 2001
TMP Alarm
Fresenius Medical Care
• All consequences like the other Blood Alarms as before
• Additional the Closed System opens to atmosphere
(V43 opens during DEAD TIME)
May 2001
LP631 (CPU1) DIP Switch Array 1
Fresenius Medical Care
May 2001
LP631 (CPU1) DIP Switch Array 2
Fresenius Medical Care
May 2001
LP632 (CPU2) DIP Switch Array 1
Fresenius Medical Care
Must
Must be
be OFF
OFF
May 2001
Must
Must be
be OFF
OFF
LP632 (CPU2) DIP Switch Array 2
Fresenius Medical Care
May 2001
Miscellaneous
Fresenius Medical Care
May 2001
4008
Filling
Filling Procedures
Procedures
•• BC
BC off
off
•• V91
V91 opens
opens
•• Pump
Pump 29
29
⇒
1300-1800ml/min
⇒1300-1800ml/min
•• Pressure
Pressure (134)
(134)
>> +130mbar
+130mbar
⇒
⇒ V91
V91 closed
closed
•• BC
BC starts;
starts;
Pump
Pump 25
25 starts
starts
•• Pressure
Pressure (134)
(134)
<< +100mbar
+100mbar
⇒
⇒ V91
V91 opens
opens at
at
dead
-time of
dead-time
of BC
BC
3
24
A
30
97
76
43
54
150
6
5
2
9
68
a
66
b
89
c
26
88
a
b
121
122
35 36
78
37 38
115
21
65
125
95
12
148
124
22
130
137
134
135
138
23
136
131a
133
132
120 118
91
90
b
104
May 2001
85
84
77
102
P
P
c
151
biBag
biBag
131b
123
114
33 34
31 32
92
100
117
8
29
41
25
119
Medical Care
75
61
86
10
90
a
7
112Fresenius
24b
63
94
149
116
109
B
99
111
73
87
95
94
72
71
74
115
Last 3-min Rinse Test
Fresenius Medical Care
•• During
During the
the last
last 33 min
min of
of
the
the mandatory
mandatory rinse
rinse program
program
•• DIP
DIP switch
switch 77 of
of DIP
DIP array
array 22 of
of LP631
LP631
set
set to
to ON
ON
May 2001
4008
111
73
87
116
7
109
112
24b
Fresenius Medical Care
63
3
75
61
86
24
A
30
97
76
8
29
41
43
114
33 34
31 32
92
54
150
6
5
2
9
68
a
66
b
89
c
26
88
a
b
c
35 36
77
78
37 38
115
21
65
B
99
10
149
125
95
94
12
148
25
100
123
119
P
P
137
124
104
134
135
138
23
136
131a
133
132
120 118
22
130
102
117
121
122
91
90
b
May 2001
131b
90
a
85
84
151
95
94
72
71
74
115
Last 3-min Rinse Test - 2
Fresenius Medical Care
May 2001
Diagnostics - Applications
Fresenius Medical Care
Prerequistes:
• Water Supply present
• Test Box connected
1.
Clean V84 (disinfectant deposits, crystals)
Caution! In this application there’ll be outflow from the
disinfectant connector
May 2001
Enable FLOAT SWITCH “FL_SWITCH_EN”
Open V35, V31, V26, V84
Run degassing pump “STOP_EP”
Diagnostics - Applications
Fresenius Medical Care
2.
Check the Closed System for tightness:
2.1
With Negative Pressure
- Connect an external dialysate pressure gauge
- Eliminate air from the hydraulic unit by selecting
menu point CALIBRATION / UF-Pump (Ver 1):
machine performs FILL PROGRAM (flow must be on)
- Open V24, V24b, V30, V87
May 2001
Diagnostics - Applications
Fresenius Medical Care
- Create a dialysate pressure of app. -500mmHg by
the ASP
- Observe the dialysate pressure
to be stable for 3 min.
- Max. pressure change: +40mmHg
- If pressure stable, the closed system is tight
May 2001
Diagnostics - Applications
Fresenius Medical Care
2.2
With Positive Pressure
- Connect hydraulic pressure gauge to measure
point C (Flow Pump outlet)
- Eliminate air from the hydraulic unit by selecting
menu point CALIBRATION / UF-Pump (Ver 1):
machine performs FILL PROGRAM (flow must be on)
- Enable float switch
May 2001
Diagnostics - Applications
Fresenius Medical Care
- Open V35, V31, V24, V24b, V87
- Run degassing pump
- Close V35, V31
- If pressure on the hydraulic pressure gauge is stable,
the closed system is tight
May 2001
Diagnostics - Applications
Fresenius Medical Care
- Check heater exchanger, V86, V87
- Close V87
- Open V43
- Pressure stable ?
May 2001
Diagnostics - Applications
Fresenius Medical Care
3.
Check Balancing Chamber Valves for tightness:
- Connect an external dialysate pressure gauge
- Eliminate air from the hydraulic unit by selecting
menu point CALIBRATION / UF-Pump (Ver 1)
3.1
Check the fresh dialysate valves:
- Open float switch
- Open V24, V24b, V30, V87
May 2001
Diagnostics - Applications
Fresenius Medical Care
- Run degassing pump
- Create a dislysate pressure of app. -500mmHg by
the ASP
- Test of V35:
- Open V31
- Observe the dialysate pressure to be stable for 3 min.
- Max. pressure change: +40mmHg
- If pressure is stable, V35 is tight
- Close V31
May 2001
Diagnostics - Applications
Fresenius Medical Care
- Test of V37:
- Open V33 ...
- Test of V31:
- Open V35 ...
- Test of V33:
- Open V37 ...
May 2001
Diagnostics - Applications
Fresenius Medical Care
3.2
Check the spent dialysate valves:
- Connect an external dialysate pressure gauge
- Open V24, V24b, V30, V87
- Run flow pump
- Open V43 to reduce dialysate pressure
- Close V43
May 2001
Diagnostics - Applications
Fresenius Medical Care
- Test of V36:
- Open V32
-
Observe the dialysate pressure to be stable for 3 min.
Max. pressure change: -40mmHg
If pressure is stable, V36 is tight
- Close V32
May 2001
Diagnostics - Applications
Fresenius Medical Care
- Test of V38:
- Open V34 …
- Test of V32:
- Open V36 …
- Test of V34:
- Open V38 ...
May 2001
TSC & Maintenance Checklist
Fresenius Medical Care
May 2001
TSC & Maintenance Checklist
Fresenius Medical Care
May 2001
TSC & Maintenance Checklist
Fresenius Medical Care
May 2001
TSC & Maintenance Checklist
Fresenius Medical Care
May 2001