Fresenius Medical Care
Technical Training on 4008 Dialysis Machine Shanghai, April 2002 Hotin
May 2001
Dialyzer Membrane Fresenius Medical Care
May 2001
Fresen Fres eniu iuss Po Poly lysu sulf lfon onee - St Stru ruct ctur uree Fresenius Medical Care
May 2001
Fresenius Polysulfone - Structure Fresenius Medical Care
HOLLOW FIBRE DIALYSER
PORE PORESIZE SIZEisisdependant dependanton onthe thetype type of membrane; of membrane; HF Dialyser: Pore size ~ 0.3nm
LF Dialyser: Pore size ~ 0.1nm
May 2001
Venous Pressure Measurement
P
Fresenius Medical Care
Blood o ut
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
Heater
Fresenius Medical Care
Hemofilter
Blood leak detector
cleared blood
Filtr. pump
Blood
Sub. pump
Blood pump
Hemofiltration HF Removal of uremic wastes by convective transport. The driving force is provided by the transmembrane pressure present at the hemofilter.
Filtrate
Substituate
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 / TRAININGCENTER SCHWEINFURT
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
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
10
2
10
3
10
4
Inulin
Urea Creatinin
Vit. B12
10 Albumin
5
Molecularweight (Dalton)
ß2-Microglobulin
May 2001 SD / TRAINING CENTERSCHWEINFURT
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 Com ponents 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
• Operating Elements • Displays • Alarms • Blood Pump • Heparin Pump • Air Detector • Preparation Preparation of of Dialysis Dialysis Fluid Fluid
Hydraulics
May 2001
-- 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 Clamp (Optical (Optical Detector): Detector): Closed in blood alarms
• Keys for fluid level adjustment May 2001
bibag Module Fresenius Medical Care
May 2001
bibag Module Fresenius Medical Care
• Less Storage Space • Lightweight • Safe • Clean • Practical • Long Shelf Life • Environmentally Friendly
May 2001
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 SN-Double Pump DIASAFE / DIASAFEplus Filter
BPM
BTM
BVM
4008 HDF
CDS
Online HDF / HF
OCM
ONLINEplus
bibag
May 2001
IrDA
Fresenius Medical Care
SCREEN SCREEN11
Green indicatesthat that Greenindicates
this thisscreen screencan canbebe viewed by pressing viewed by pressing confirm. Tomove move confirm.To the thecursor cursorpress 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 IfIfananerror erroroccurs occursaa • •xx or or • •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 T1 TEST 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
Isolated Isolatedsequential sequential ultrafiltration ultrafiltrationcan canalso also be performed. be performed.
GREEN cursorshows showsyou you GREENcursor
To Toenter enterthis thisfield fieldpress press arrow across arrow across
To Tomove movethrough througheach eachfield field press the arrow press the arrow • •up up • •down down
Then Thenfollow followthe thesame same process as for entering process as for entering the thedata datafor forUF. UF. Remember Remembertotoenter 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
which whichdata datacan canbebeentered entered WHITE highlight tells you WHITE highlight tellsyou which figure you can enter which figure you can enter
May 2001
Fresenius Medical Care
UF UFMENU MENU22
When Whenusing usingaaUF UFprofile profile select selectthe theprofile profilerequired required • •11- -66and andthe theappropriate appropriate graph will be displayed graph will be displayed • •Max MaxRate Ratewill willthen thenbebe displayed. displayed.This Thisisisthe 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 concentrationrequired 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 whenselected selectedaastart startvalue value 1mmol greater than the 1mmol greater than the concentrate concentratelevel levelwill willbebeshown 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 canbebeused 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 shouldbebelowered lowered totothe desired value by pressing the desired value by pressingthe the - -minus minuskey key • •lower lowerlimit limitshould shouldbeberaised raisedtotoaa value 20 mmHg higher value 20 mmHg higherthan thanthe the pressure pressurealready alreadyachieved achievedusing usingthe the ++key key • •then thenmove movethe thecursor cursortotothe theOFF OFF and andswitch switchON ONagain againby byusing usingthe the ++/ /- -key key
May 2001
IfIfdesired desiredyou youcan canalways alwaysreturn returntototwo two needle needledialysis dialysisatataalater latertime. time.
Fresenius Medical Care
ALARM ALARMLIMITS LIMITSSCREEN SCREEN
Here Hereititisispossible possibletoto reposition and reposition andmake makethe the alarm alarmguards guardseither 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 endof of the dialysis by the dialysis by OPENING OPENINGthe thealarm alarm guards to avoid nuisance guards to avoid nuisance alarms alarms ItItisisactive activefor for3minutes 3minutes ororititwill automatically will automatically return returntotonormal normalstatus statusif if blood bloodisisseen. seen. Needle NeedleAdjustment Adjustment deactivates deactivatesthe thealarm alarm guards guardsfor forarterial arterialand and venous pressures for venous pressures for 33min. min.totoallow allowyou youtoto turn or manipulate turn or manipulatethe the needle needlewith withthe theblood blood pump pumprotating. rotating.
May 2001
Fresenius Medical Care
SYSTEM SYSTEMPARAMETERS PARAMETERSSCREEN SCREEN Auto Auto-On -Onprogramme programme allows you allows youtotoselect selectaa cleaning programme cleaning programmeand andthe the time timeyou youwould wouldlike likethe the programme programmetotocommence commence ininthe morning, the morning,sosothat thatthe the machine will be cleaned machine will be cleanedand and ready readyfor foruse usebefore beforethe thestaff 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 eraseall Resetmeans meanstotoerase 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 thenbebelost lost System SystemTime Timeand andDate Dateshould shouldbebechanged 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 63
75
87 109
86
Fresenius Medical Care
7
24b
112
24
3
61
30
97
41
76 29
92
54
31 32
43
33 34
5
2
114
150
6
66
a
b
9
c
68
89
151
88
a
b
26 c 115
77 35 36
37 38
78 21
65 125 94
98
95
10
12 a
90
b
91
22 23
May 2001
94
95
71
72
25
74
84 115
85
4008 111
73
87
116 7
109
112
24b
Fresenius Medical Care
63 3
86
75
61
24 30 97 76
8 29
41 43 31
92
33
32
114
34
54
150
6
5
2
9 68
a
66
b
89
c
26 88
a
b
c
84
151 35
77
36
78
37 38
115 21
65 125 99
94
95 10
149
12
148
25 100 90 a
91
22
90
130
123 119 121
P
122
P
120
137
102
117
104
134
135
138
23
118 124
136
131a 3 2 3 3 1 1
May 2001
b 1 3 1
95
94
72
71
74
85 115
Theory of Operation of Balancing Chamber Fresenius Medical Care
1 st 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
Fresh Dialysate to Balance Chamber
May 2001
from Patient
Closed System with UF Fresenius Medical Care
Spend Dialysate to Drain
Balance Chamber
Dialyser to Patient
10 ml Fresh Dialysate to Balance Chamber
UF Pump 10 ml Ultrafiltrate to Drain
May 2001
from Patient
Only the amount of fluid removed by the UF pump is removed from the patient.
Fill Program Fresenius Medical Care
11st st cycle: ccycle: ycle:
May 2001
Fill Program Fresenius Medical Care
22nd nd cycle: ccycle: ycle:
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
[
x t [h]
Closed System Fresenius Medical Care
Pven
PDial
1 6 0 0
TMP UF-Pump
Drain
timer counter
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
Overview of Cleaning Programs Fresenius Medical Care
End of Dialysis
Rinse Rinse
PGM R PGM 1: 1: --RPGM R - endless PGM 2: 2: --Rendless
Hot Hot Rinsing Rinsing PGM F-HR -CPGM 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: --F-HDIS-MPGM F-D-M-HR PGM 3: 3: --F-D-M-HRPGM F-HDIS-M-HR PGM 4: 4: --F-HDIS-M-HRPGM F-D(F)-MPGM 5: --F-D(F)-M-
4008 116 111
73 63
75
87 109
86
Fresenius Medical Care
7
24b
112
24
3
61
30
97
41
76 29
92
54
31 32
43
33 34
5
2
114
150
6
66
a
b
9
c
68
89
151
88
a
b
26 c 115
77 35 36
37 38
78 21
65 125 94
98
95
10
12 a
90
b
91
22 23
May 2001
94
95
71
72
25
74
84 115
85
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 Switch - BC cycled like in dialysate mode - V24, V24b, V30, V87 open - V26, V43, V84, V86 closed closed May 2001
Valve Sequences in Cleaning Programs Fresenius Medical Care
Fill Cycles (2) : - BC BC cycled cycled like like in in FILL FILL PROGRAM PROGRAM - V26, V43, V43, V86 V86 open open - V24, V24, V24b, V24b, V30, V30, V41, V41, V84, V84, V87 V87 closed closed - ASP ASP runs runs - UF - Pump runs UF-Pump runs (max. (max. frequency) frequency)
• MANDATORY RINSE: (M) (M) - V43 permanent permanent open open - UF - Pump runs UF-Pump runs permanent permanent (max. (max. frequency) frequency) 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 in dialysis mode V24, V24b, V30 open V26, V26, V41, V41, V84 closed closed
May 2001
Valve Sequences in Cleaning Programs Fresenius Medical Care
FILL CYCLES (2): -
May 2001
BC cycled cycled like like in in FILL FILL PROGRAM PROGRAM V26 open V24, V24b, V24b, V30, V41, V41, V84 closed closed ASP runs
4008 116 111
73 63
75
87 109
86
Fresenius Medical Care
7
24b
112
24
3
61
30
97
41
76 29
92
54
31 32
43
33 34
5
2
114
150
6
66
a
b
9
c
68
89
151
88
a
b
26 c 115
77 35 36
37 38
78 21
65 125 94
98
95
10
12 a
90
b
91
22 23
May 2001
94
95
71
72
25
74
84 115
85
Preparation for Chem. Disinfection Programs 1…4 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 pulse 2. Waiting for the the floater to 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 1…4 Fresenius Medical Care
4. 1 BC cycle → → level in 66 c: 30ml below lower switch point 5. V26, V87 V87 & BC fresh fluid valves valves open, V43 V43 closed, degassing pump off, UF-Pump: 4 strokes → → Level: 34ml below lower switch point 6. V84, V86 V86 open, UF-Pump: 50 strokes = = 50ml disinfectant 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 must be be in in “up” “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 pulse 2. Waiting for the the floater to 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 V87 & BC BC fresh fluid valves valves open, V43 V43 closed, degassing pump off, UF-Pump: 23 strokes = 23ml 5. After the disinfectant is connected the the aspiration is is done by by use of of the acid pump. 32 strokes of acid pump = 37ml disinfectant (Dilution 1:34) 6. After aspiration aspiration the floater floater must be be in 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 Mandator 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]
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]
Disinfection Dilution
-
- / 1:25
1:25
1:34
Degassing Pump Speed Reduct.
-
by 6V
-
-
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
Temp. [°C]
Temp. Limit [°C] End of prg. Rinse Chamber Evac. Conc. P. + Bic. P. May 2001
4008 116 111
73 63
75
87 109
86
Fresenius Medical Care
7
24b
112
24
3
61
30
97
41
76 29
92
54
31 32
43
33 34
5
2
114
150
6
66
a
b
9
c
68
89
151
88
a
b
26 c 115
77 35 36
37 38
78 21
65 125 94
98
95
10
12 a
90
b
91
22 23
May 2001
94
95
71
72
25
74
84 115
85
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: “W ATER ALARM” ALAR M” • Alpha display shows: “WATER • 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
Condit Cond itio ion: n: No cur curre rent nt in incr crea ease see imp impul ulse se wit withi hin n 12 sec secon onds ds inc incre reas ase Reactions:
• Balancing chamber cyclings done by “EIGENTAKT” “EIGENT AKT” • 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 ⇒ -1800ml/min 1300 1300-1800ml/min ⇒1300Pressure Pressure (134) (134) >> +130mbar +130mbar ⇒ V91 closed closed ⇒ V91 BC BC starts; starts; Pump Pump 25 25 starts starts Pressure Pressure (134) (134) << +100mbar +100mbar ⇒ V91 opens opens at at ⇒ V91 dead-time of dead dead-time of BC BC
116
3
86
24 97 76 43 31
92
33
32
150
6
5
2
9 68
a
66
b
89
c
26 88
a
b
122
P
120
84 35
77
36
78
37 38
115 21
65
95 12
148
91
22
90
130 137
104
134
135
138
23
118 124
136
131a 3 2 3 3 1 1
May 2001
c
151
102 P
114
34
54
123 121
8 29
41
100
117
75
61
25
119
Medical Care
30
10
90 a
112 Fresenius
24b
63
94
149
7
109
125 99
111
73
87
biBag biBag
b 1 3 1
95
94
72
71
74
85 115
Last 3-min Rinse Test Fresenius Medical Care
• During During the the last last 33 min min 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
86
75
61
24 30 97 76
8 29
41 43 31
92
33
32
114
34
54
150
6
5
2
9 68
a
66
b
89
c
26 88
a
b
c
84
151 35
77
36
78
37 38
115 21
65 125 99
94
95 10
149
12
148
25 100 90 a
91
22
90
130
123 119 121
P
122
P
120
137
102
117
104
134
135
138
23
118 124
136
131a 3 2 3 3 1 1
May 2001
b 1 3 1
95
94
72
71
74
85 115
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, V26, V84 V84 Run degassing pump “STOP_EP”
Diagnostics - Applications Fresenius Medical Care
2.
Check the Closed SSystem ystem for tightness:
2.1
With Negative Pressure - Connect an an external external dialysate pressure gauge gauge - Eliminate air from the hydraulic unit by selecting menu point CALIBRATION / UF-Pump (Ver 1): machine performs FILL PROGRAM (flow must must be be on) on) - Open V24, V24b, V24b, V30, V87 V87
May 2001
Diagnostics - Applications Fresenius Medical Care
- Create Create a dialysate pressure 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 the closed system is tight tight
May 2001
Diagnostics - Applications Fresenius Medical Care
2.2
With Positive Pressure - Connect hydraulic hydraulic pressure gauge to measure point C (Flow Pump outlet) - Eliminate air from the hydraulic unit by selecting menu point CALIBRATION 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 V87 - Run degassing pump - Close V35, V31 - If pressure on the hydraulic pressure gauge 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 for tightness: - Connect an external dialysate pressure gauge gauge - Eliminate air from the hydraulic 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 V87
May 2001
Diagnostics - Applications Fresenius Medical Care
- Run de dega gas pump gassing pu - Crea Cr eate disl slys ysat atee pr pres essu sure ree of app. p. -5 -500 00mm mmHg Hg Cre eate attee a di pre essur ss ure of ap mmH Hg by the ASP - Test of V35: - Open V31 - Ob Obse serv rve e the tth hee ddial ialy lys sat atee pr pre eessu ssur ss ure e to to be be sta stabl blee fo ffor oor r 3 mi m iin. n.. Obser bs erve ve diia alys ysat pres sure re min - Ma Max. x. pr pres essu sure re ch chan ange ge:: +4 +40m 0mmH mHg g - If pr pres essu sure re is st stab able le,, V35 V35 is ti tigh ght t - Close V31 May 2001
Diagnostics - Applications Fresenius Medical Care
- Test of V3 V377:: - Open V33 ... - Test of V3 V311:: - Open V35 ... - Test of V33: - Open V37 ... May 2001
Diagnostics - Applications Fresenius Medical Care
3 .2
Check the spent dialysate valves: - Connne nec ne extern rnal aly ate ress re gga aug e nn ect an an ex rnal al ddia diial alysat ate ppre pr essu ssure gau ugge - Ope pen V24,, V24 V 24b b, V30 V 30, V 887 7 pen V24 V2 24b, 4b V3 30, V8 V87 - Run flow pump - Open V4 V 443 3 to to re reduce dialysate pressure V43 - Close V43
May 2001
Diagnostics - Applications Fresenius Medical Care
- Test of V36: V36: - Open V32 -
Observe the dialysate 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 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
