4008 ᆰᅪ죠ᅦtech-basics
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