Troubleshooting Guide Aquarius

Transcription

1 Low Access Pressure Access pressure has dropped below the lower alarm limit of 0 to - 250mmHg Blood pump is off Blood flow is too low Turn blood pump on Check blood flow rate. Consider increasing the blood pump speed Access line is kinked/clamped. Remove the kink/unclamp the line. Utilise the line tidies to prevent kinking of the lines. Vascular catheter contains occlusions/clots Check patient access. Reposition the patient. Access is against the vessel wall. Reposition the catheter and/or line. Consider aspirating the lumens. Consider pulling the catheter back. Review anti-coagulation. Rotate the blood pump ¼ anti-clockwise. Consider swapping the lines over. Consider a new catheter. Check access line, including access and pre-filter sensors, for kinks or occlusions. Prepare to end the therapy. Faulty access or pre-filter pressure sensors. High Access Pressure Access pressure has exceeded the upper alarm limit of -50 and +200mmHg Coagulation in the return drip chamber. Vascular catheter contains occlusions/clots Consider increasing the post-dilution rate. Review anti-coagulation. Ensure adequate blood level in the drip chamber. Check patient access. Reposition the patient. Access is against the vessel wall. Reposition the catheter and/or line. Consider aspirating the lumens. Consider pulling the catheter back. Consider a new catheter. Review anti-coagulation. Rotate the blood pump ¼ anti-clockwise. Swap the lumens over. Remove the kink/unclamp the line. Utilise the line tidies to prevent kinking of the lines. Access line is kinked/clamped.

2 High Return Pressure Return pressure has exceeded the upper alarm limit of 120 to 300mmHg Return line is kinked or clamped. Remove the kink/unclamp the line. Utilise the line tidies to prevent the lines from kinking. Return line is occluded or clotted. Reposition the line. Consider swapping the lumens. Drip chamber is clotting. Consider increasing the post-dilution rate Review anti-coagulation Ensure adequate blood level in the drip chamber. Prepare to end the therapy. Faulty return pressure transducer. Ensure return pressure pod is securely on. Suspected faulty transducer Stop the treatment and report the breakdown via the 24hr CRRT pager. Low return pressure Return pressure has dropped below the lower alarm limit of 20 to 200mmHg Blood flow rate is too low. The blood pump has stopped Consider increasing the blood pump speed. Rotate blood pump ¼ anti-clockwise pump Return line is disconnected. Re-attach the return line. High pre filter pressure The pre filter pressure exceeds the upper alarm limit of 400mmHg Check filter for signs of clotting. Access line is kicking. Visible clots in the filter. Visible clots in return chamber. Check clotting. Consider increasing pre-dilution. 3 consecutive high pre filter pressure alarms within 20 minutes, consider ending the treatment. Restart the therapy. Blood flow is too low Ensure adequate blood flow. (Maintain FR <25%) Line is occluded Check line set for narrow sections. Clamps left on Check access line for kinks or clamps.

3 Faulty pre filter pressure sensor. Avoid touching the pressure sensor during lining of the machine. Check pressure sensor. If the pressure sensor was touched during lining, removed the set, switch the machine off. Start again. Air detected Air or microfoam visible in the drip chamber or Return line. The return line is not properly positioned in the air detector. The blood level is too low in the drip chamber. Remove air from the drip chamber and Return line. Ensure Return line is not pinched within the air detector. Raise the blood level in the drip chamber. To remove air from the line: Step1. Attach syringe to the top of the return chamber after carefully releasing the pressure from the line. Step 2. Press the clamp key to open the return line clamp. Air detector sensors are dirty. Marks on the return line. Clean the sensors. The air detector is faulty Ensure line is not pinched within the air detector. Ensure all connections are securely on. Check all connections, including access, filter and Heparin connections for sources of air leaks. Ensure that all seals on the Accusol bag/s are broken, bag/s is spiked, all clamps are unclamped and lines are not trapped under the heater door. Step 3. Remove all air from the return chamber with the syringe. Step 4. Place the tubing back into the air detector and put it back in place. Step 5. If level in the drip chamber is correct and the bubbles are out of the tubing, press the clamp key to close the return line clamp. Step 6. Resume treatment High TMP Working range -50 to +450mmHg CVVH/HD/HDF +30 and +400mmHg TPE +30 and +100mHg TMP has risen slowly filter is clogging. TMP has raised rapidly filtrate line or bags clamped or kinked. Reduce post-dilution flow rate and increase pre-dilution flow rate. Review anti-coagulation. Check blood flow / exchange ratio. Increase blood flow rate accordingly. Ensure all the pressure domes are securely on. Unclamp or remove kink from line. Ensure all the pressure domes are securely on..

4 High TMP from the start. Check blood flow / exchange ratio. Increase blood flow rate accordingly. Ensure all the pressure domes are securely on. Low TMP -30mmHg Filtrate pump runs slower than the treatment pumps. The filtrate line is closed between the filter/kidney and waste/effluent bag/s. Modify blood flow rate and/or fluid exchange. (Maintain FR <25%) Check filtrate line is not kinked, clamped or twisted. Line is not pinched within the pump housing. No visible air lock in the filtrate line. Ensure all the pressure domes are securely on.. Blood Flow Failure The number of revolutions of the pump exceeds or falls below the alarm limits by ± 5%. Check the blood flow rate. Check blood pump tubing is not twisted/pinched within the pump housing. Check the tubing for narrow sections/clamps. Press the blood pump to restart the treatment.

5 Balance alarm/ Check substitution/dialysate line OR Balance alarm/ Check filtration/effluent line Counted balance alarms: The patient s fluid balance deviates more than 50 g in adult treatment or 20 g in paediatric treatment for more than 15s. The deviation is less than 120 g The deviation could not be compensated during TFL Review UF variation in the More screen. All clamps are open. Lines and bags are hanging freely. Lines and bags are not kinked, clamped or blocked. Bag connections are correct. Bags and lines are not resting on the cart frame. Bags are not swinging. Lines on the manifold are all unclamped. Accusol bags are spiked. Long and short seals are broken on the Accusol bags. Ensure connections are secure and fluid is not leaking from the bags Avoid touching the filtrate or substitution bags while the treatment is running. Avoid adding or removing bags while the therapy is running. Avoid moving the system while the Balance system is active. Consider using one bag per scale. Restart the balance pumps by pressing the Balance Start/Stop key Note: If 5 counted balance alarms occurred during the 20 minute window period it will not be possible to resume the treatment. Follow the onscreen instructions to end the treatment. Non counted balance alarms: The patient s fluid balance deviates more than 120 g for more than 15 seconds. Bags are swinging on scales or touching the cart frame of the. When multiple bags are hung on the scale, if the bags are touching each other or the tubing lines are resting on the cart frame, the draining of the bags can cause them to shift position, resulting in a temporary weight change A bag is detached from the scale. Adding or removing a bag without stopping the Balance system. Moving the system while the balance system is active. Restart the balance pumps by pressing the Balance Start/Stop key

6 Blood Leak Blood leak chamber not filled with fluid. During lining: Go to reprime and select ultrafiltrate line. Ensure filtrate line is securely connected. Ensure there are no kinks/narrow sections on the line. Check lining within pump housing Ensure there are no scratches/marks on the chamber. During set up/treatment the blood leak chamber has been removed from its housing. Dust on the mirror. Mirror is cracked or missing. Filter membrane is damaged / ruptured. Reposition the blood leak chamber. Remove mirror. Clean and replace as found. (Ensure silver mark/notch is pointing up or down according to how it was positioned.) It is not recommended to clean the infrared light. It is not recommended to use a mirror from another device. Report breakdown to the 24 hour pager. Filtrate / plasma contain blood. (Ultra filtrate is a rose colour) Check BLD % reading in MORE screen. Consider doing a urine dipstick to confirm the presence of blood. Discontinue treatment and change circuit. Select Options and End treatment, follow the on-screen instructions to wash back and end the treatment. Check Degassing Chamber The ADU worked for more than 25s without detecting fluid in the chamber. Check all clamps on the substitution/dialysate line are unclamped. Check the substitution/dialysate line is not kinked. The system detects a positive pressure higher than +30 mmhg. If using a manifold ensure lines are not clamped or kinked. Check if the frangible pins on the bags are broken. Ensure both seals on the Accusol bag are broken. Restart the treatment Ensure lines are not trapped under the heater door. (Ensure heater coil is positioned with the smooth side against the heater plate and the lines are in a horizontal position.) Utilise the line tidies to prevent kinking of the lines.

7 Check Degassing Chamber (cont) The hydrophobic filter on the ADU sensor line is wet. (Measured pressure < ve 300 mmhg). To remove fluid from the sensor line (long line with green clamp): Step1: Clamp the line. Step2: Disconnect line from the sensor and hold the line up. Step3: Attach a 10ml syringe, unclamp the green clamp and push air into the line until the line is clear of any water. Step4: Clamp the line again, remove the syringe and attach line to the sensor. Step5: Lift the chamber up from the pressure switch and push the chamber down again. Ensure the fixation plate is pushed down around the short tubing. No fluid chamber detected The degassing chamber (ADU) is not inserted. Ensure the ADU chamber is sitting on the pressure switch. (Black and red switch at the bottom of the ADU unit) Ensure the fixation clip is in a horizontal position and closed around the short tubing of the ADU. Ensure the magnet is not missing. Ensure the magnet is not dirty. Pressure test disabled Air detection system does not detect free air in the tubing. (The clamp and pressure test is disabled.) Make sure that the return line does not contain air. Make sure that the return line is properly installed in the air detector and that the air detector is pushed in. Ensure that the return line is not scratched. Re-prime the blood line.. Change substitution/dialysate bag OR The substitution / dialysate bag/s are nearly empty (approx. 150mls left per bag) Change the bag/s. (Ensure treatment has stopped.) Change filtrate/effluent bag The filtrate bag has reached maximum permissible weight (5kg) Change the bag/s

8 Check transducer connections The pressure domes have not detected any pressure change for 15 seconds. Ensure the domes are securely connected. IMPORTANT: do not remove any pressure sensors during treatment. If domes are in place increase blood pump speed if return pressure is low. Turnover Failure Balance pump speeds are consistently higher or lower than the programmed speed for more than 20 consecutive minutes to ensure accurate fluid delivery. Fluid leaking from bags. Incorrect line installation Incorrect bag installation. Ensure all connections are securely on. Ensure lines are not kinked, clamps are unclamped, and lines are not twisted. Bag/s is not spiked, spike or frangible pin is blocking the flow of fluid, bag/s is not hanging freely, or bags are swinging. Contact CRRT 24hr pager to report the breakdown. Consider using a different size filter.. Pump calibration out of range Filter inappropriate for fluid delivery rates. Heater cools down Balance system has stopped for more than 15 s and the heater plate temperature is above 43 C. Ensure the balance system is active. The treatment is paused until the temperature is below 42 C or above 35 C Substitution pumps will run at a slow rate to help cooling (Except during TFL). Heater cool down management may take up to 10 minutes. The treatment will restart automatically. Machine fails System Test/Self test on start up. Pump doors are open. Machine was lined before it was switched on. Close the door/s. Remove the line set, switch the machine off. Switch machine back on. Press the blood pump to restart the self test. If machine fails test again, switch the machine off and unplug from the wall. Leave the machine for 15 minutes and put the machine through self test again. If it still fails note the message on the screen and report device on the 24 hour pager. Bags are hanging on the scales. Remove bag/s from the scales

9 Heparin Pump Actual values of control and protective systems are outside of their limits. The syringe is incorrectly positioned. Heparin driver is making a grinding sound Whistling sound coming from the Heparin line. During Self test/start up: Ensure the machine is not lined. During treatment: 1. Check the heparin line is not clamped. 2. Go to "Options" and "Change Syringe", following the on-screen text. Note: It is NOT necessary to remove the syringe during this process 3. If problem persists, program the pump to 0, clamp the line and remove the syringe. Ensure Heparin line is not clamped. Ensure Heparin line is clamped and capped off. If the error cannot be reset, put system out of operation and notify technical support. No Bag Less than 45g are detected per scale. No bag/s on the waste/filtrate scale. Bag weighs less than 45g. Place bag/s on the scale. It is not recommended to re-use used/empty Accusol bags. Lines or the manifold is touching the frame of the machine Lines are twisted. Filtrate line is clamped Self test was performed with bag/s hanging on the scales. Number of bags programmed is different from number of bag/s actually hanging on the scales Ensure lines and the manifold is not touching the frame of the machine. Straighten/un-twist the line. Unclamp the line. Remove bag/s from the scales and repeat the self test Use an additional bag on each scale: Go to Programming window. Program 2 bags. Ensure that 2 empty effluent bags are hanging on the filtration scale and connect both filtration bags to the filtrate line. Ensure that 2 substitution bags are hanging on the substitution scale and connect both substitution bags to the Programme correct number of bags as per scale. pumps

10 Master key transfer/keyboard Failure/Operation Mode The alarm is to notify the user that an issue occurred A key press longer than 60 s detected by master CPU. Short disturbances in the communication between the master and the controller CPU. Clear the alarm by pressing the mute key followed by the blood pump key. If the alarm does not clear, contact the CRRT 24hour pager to report the breakdown.