multiFiltrate System Troubleshooting Guide May 2008

Contents

Introduction Balancing error on scales Arterial pressure too low Arterial pressure too high Venous pressure too low Venous pressure too high TMP pressure too low TMP pressure too high Blood leak detected Air detected in venous return chamber Pressure before filter too low Pressure before filter too high Non-opaque/opaque fluid detector Balancing error – UF rate or substituation rate too high Heater unable to achieve set temperature Heater over temperature Scales reverse alarm Drop Counter Rate Citrate/Calcium too low Drop Counter Rate Citrate/Calcium too high Recommended filter size and blood flow rates Useful contact numbers

Balancing error on scales

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

Check the message box for the affected scale (I, ll, lll, lV). Are the cones broken and the clamps open from the bag to the circuit connection for the affected scale?

NO

Break cones (open clamps) press start/reset key to recommence treatment.

YES YES

Enter bag change menu, tighten connections, press start/reset key to recommence treatment.

Is there a fluid leak from the bags? NO YES

Is there an object (inc. curtains etc) on or touching the affected scale?

Remove the objects, press start/ reset key to recommence treatment.

NO YES

Is the machine in a draft or under the outlet of the air conditioning?

Move machine or close window (stop air conditioning flow). Press start/reset key to recommence treatment.

NO NO

Are scales III and IV affected? YES

Are the blood lines or other objects in contact with the filtrate bag?

YES

Remove the objects and press start/ reset key to recommence treatment.

NO

This Guide has been produced by Fresenius Medical Care to help you get the best out of the multiFiltrate machine. This Guide is intended as a support tool and will not replace the operating manual or the judgement and experience of the nurse and the attending physician. Please read this Guide and familiarise yourself with the content. This Guide contains information on how to resolve some of the most common machine alarms. This Guide is intended to be kept with the multiFiltrate machine so it is always to hand. Decisions concerning specific treatments for patients are within the sole responsibility of the attending physician and nurse.

Is the filtrate outflow line clamped?

YES

Unclamp it and press start/reset key to recommence treatment.

NO

Enter bag change menu. Is the effluent scale value negative after a bag change? Are scales I and ll affected?

YES

NO

YES Was a bag with fluid on the scale during

self test? If yes, the TARE weight has been set to include the volume contained in the bag during set-up. This cannot be corrected. End treatment and re-start with new circuit.

Examine the scale pans, are they seated NO Access bag change menu, manually correctly on the scale plates (are the remove and replace scale pans to plates recessed and flat or are they tilted)? have them seated correctly on the scale plates. Press start/reset key to YES recommence treatment. There might be a technical fault with the machine. Please contact the Technical Services Department.

1

Arterial pressure too low

Is the patient catheter kinked at the patient end?

YES

Arterial pressure too high

Unkink catheter, press start/reset to recommence treatment.

NO

Is the access catheter in the correct position to allow adequate flow?

YES

Consider the patient's condition. Are there patient factors that are creating a positive pressure at the access site?

NO Manipulate catheter. Press start/reset key until

flow is re-established. Consider swapping over lines if difficult to re-establish flows.

YES NO

Internal failure of arterial pressure sensor. Stop treatment. Washback patient blood. Remove machine from service and contact the Technical Services Department.

Press start/reset key. Clamp and disconnect arterial transducer line. Does arterial pressure drop to zero?

NO YES

Are there any infusions being administered before the blood pump (To the two additive ports)? NO

YES Replace transducer line with appropriate spare.

(Clamp off existing line, disconnect, attach new line to transducer port, and connect to additive port near to arterial transducer site). Press start/reset key to recommence treatment.

Check the arterial transducer line (red). Has fluid advanced all the way to the hydrophyllic filter?

Observe arterial transducer line (red). Are there clots in the line or at the line junction with the blood circuit?

Clamp transducer line and cap off. Attach replacement line to one of the two prefilter ports. Attach to arterial transducer and unclamp line. Arterial pressure should now be monitoring normally.

NO YES Replace transducer line with appropriate spare.

NO YES

Replace line as detailed above.

Clamp arterial transducer line (red). Remove transducer line from transducer port. Does arterial pressure drop to zero?

NO

Establish if there are clots in the catheter. Are there clots in the access catheter?

Stop infusions, or YES reduce infusion rate. Press start/reset Continue treatment. key. Observe effect on arterial pressure. Has it reduced? NO

YES

YES

Is there a clot at the base of the arterial transducer line (red)?

Take necessary action.

YES Remove clots manually, following unit policy.

Flush catheter once clots removed, recommence treatment with start/reset key.

NO YES

Reconnect arterial transducer line (red). Blood pump rate may be too high for patient’s condition. Reduce blood pump speed. Does this reduce the negative pressure?

Consider patient’s hydration – have they become underfilled? Consult medical staff for fluid assessment. Consider reducing goal for fluid removal.

(Clamp off existing line, disconnect, attach new line to transducer port, and connect to additive port near to arterial transducer site). Press start/reset key to recommence treatment.

NO

Internal failure of arterial transducer system. Stop treatment. Return blood to patient. Remove machine from operation and contact the Technical Services Department.

NO YES

Has the circuit been up for a significant period, do they have a high platelet count?

Consider general circuit clotting. It may be time to change the circuit before failure due to clotting.

NO

There might be a technical fault with the machine. Please contact the Technical Services Department.

Please refer to Page 20 for useful contact telephone numbers.

2

3

Venous pressure too low

Venous pressure too high

YES

Consider the patient's condition. Have they become hypovolaemic etc? Check for a systemic factor leading to the low return pressure.

Check the patient’s access catheter. Is it kinked at the access site? Take necessary action.

Is the venous (return) access line kinked or occluded before reaching the patient? NO

Check return connection to the access catheter.

Is the blood pump rate too high? Reduce blood pump rate by 20%. Press start/reset key. Observe effect on venous pressure. Does this solve venous pressure issue?

YES Manipulate catheter. Press start/reset key until

flow is re-established. Consider swapping over lines if difficult to re-establish flows. YES

YES

Tighten connection to eliminate leak.

Run circuit at reduced pump speed. If pump speed needs to be less than 150 - 180 mls per minute, consider the circuit to be clotting. Consider circuit washback and recommence treatment.

NO YES

Clamp and cap existing transducer line. Attach replacement line to one of the two ports on the venous chamber and to the venous transducer port. Unclamp line. Venous pressure monitoring should be re-established.

NO

Is the catheter still correctly placed?

Unkink catheter, press start/reset key to recommence treatment.

NO

NO

Is the catheter connection loose or leaking?

YES

NO

Emergency halt of treatment. Summon assistance for maintenance of haemostasis and patient's condition.

Examine venous transducer line (blue). Is it wet or contaminated with blood?

YES

Press start/reset key. Clamp NO venous transducer line (blue). Internal transducer monitoring failure. Stop treatment. Return blood to patient. Remove machine from operation and contact Remove from connection the Technical Services Department. port. Does venous pressure return to zero?

NO NO

Clamp venous transducer line (blue). Disconnect from transducer port. Does pressure drop to zero?

Potential internal monitoring failure. Washback circuit, remove machine from operation and contact the Technical Services Department.

YES

Replace venous transducer line YES (blue). Attach replacement transducer line to one of the outlet ports on the venous chamber. Unclamp line. Does this alter the monitored pressure? NO

YES

Is the pressure now within the normal limits?

NO NO Increase blood pump rate by YES

Is the blood flow rate adequate to generate a 'normal' venous pressure?

20% (if patient’s condition allows). Does this produce an increase in the venous pressure?

YES

NO

YES

Continue treatment.

Aim to achieve a target blood flow appropriate to the therapy you are utilising (normally a minimum of 150mls/min).

Examine venous bubble chamber for clots YES (observe visually for dark patches externally first, shining a light through the chamber may make these more visible. Consider dropping the level of blood in the chamber temporarily to check for clots below the surface). Are clots present?

Consider clotting as the potential cause of venous pressure increase. Consider circuit washback if venous pressure is excessive. Reducing pump speed will reduce venous pressure in the short term.

NO

There might be a technical fault with the machine. Please contact the Technical Services Department.

Consider blood clot in the filter. Return blood to the patient if possible.

There might be a technical fault with the machine. Please contact the Technical Services Department.

Please refer to Page 20 for useful contact telephone numbers.

4

5

TMP pressure too low

Increase the replacement fluid rate by 20%. Press start/reset key. Does this increase the TMP pressure?

YES

TMP pressure too high

YES

Ensure replacement rate is kept at a suitable level for the patient’s body mass and the size of the filter being used.

Is there evidence that the filter is clotting? (Associated rise in the pre-filter pressure, visibly clotted areas at the top surface of the filter etc).

NO Is the blood pump rate high enough? Increase the blood pump rate by 20% (if tolerated by the patient). Does this increase the TMP pressure?

YES

Aim for a blood pump speed that is adequate for the therapy chosen, the replacement fluid volume selected and the filter size used.

NO Is there a leakage in the tubing system from the filter to the waste bag?

YES

Can the connections be tightened to stop the fluid leak (and re-establish correct pressure)?

YES

NO

Press start/reset key and recommence treatment. YES Is there a pre-filter infusion running?

NO

NO Is the effluent outlet line clamped?

Reduce infusion rate, or change YES infusion site. A change in blood viscosity can artificially reduce the TMP. Has this altered the TMP pressure?

Press start/reset key and recommence treatment.

replaced. Accurate TMP pressure monitoring will no longer be possible. It is advised that the patient’s blood be washed back and treatment be recommenced with a new circuit.

Reduce blood pump rate to within acceptable operating limits. Press start/reset key. Has this altered the monitored TMP pressure?

NO

NO

Press start/reset key. Check the YES Either reduce the rate of ultrafiltrate YES removal, or increase the blood blood pump rate to ultrafiltration pump rate to compensate. Press rate ratio (BPR/UFR). Is this too start/reset key. Has this altered the high (above 20%)? monitored TMP pressure? NO

6

NO

Continue treatment.

Continue treatment.

NO YES

The TMP pressure transducer cannot be replaced. Accurate TMP pressure monitoring will no longer be possible. It is advised that the patient’s blood be washed back and treatment be recommenced with a new circuit.

Check the white pre-filter transducer. Is it wet?

YES Clamp line and remove from the YES white pressure transducer port. Attach replacement transducer line to the port on the top of the arterial chamber, and then to the pressure monitoring port. Unclamp the line. Has this altered the monitored TMP pressure?

NO

NO

YES Clamp line and remove from the white YES

NO

YES

YES Check the blood pump rate, is it too high for the filter size? (Check reference ranges of maximum blood flow rates for AV 600 and AV 1000 filters).

NO

NO

Check the white pre-filter transducer line. Is it wet?

Unclamp line and press start/reset key to recommence treatment.

Check the yellow pressure transducer. Is it wet?

NO

pressure transducer port. Attach replacement transducer line to the port on the top of the arterial chamber, and then to the pressure monitoring port. Unclamp the line. Has this altered the monitored TMP pressure?

YES

NO Discontinue treatment, recommence when able. If the leak may be due to a NO manufacturing error, retain kit for examination in a yellow plastic bag. Contact the Quality Helpline to report incident and arrange collection of kit in question. Observe for further failures of same batch in short term.

YES The TMP pressure transducer cannot be Check the yellow pressure transducer. Is it wet?

Consider that the circuit has reached its lifespan. Wash back blood to the patient and recommence treatment. If circuit lifespan has been low, consider the dose of anticoagulant, exchange rate, blood pump rate etc.

Press start/reset key and recommence treatment.

Is the venous return line kinked YES or occluded?

Press start/reset key to recommence treatment.

Unkink or clear return line to re-establish unimpeded flow. Press start/reset key to recommence treatment.

Consider undiagnosed issue with YES Return machine to patient use. the fluid lines or machine. Retain used kit for examination, Discontinue treatment. Wash blood place in yellow bag. Contact the back to patient. Once circuit is Quality Helpline to report incident unloaded, switch machine off and and arrange collection of kit in then switch on. Perform prequestion. Observe for further failures treatment self test. Is test passed? of same batch in short term.

NO Consider undiagnosed issue with the YES Return machine to patient use. fluid lines or machine. Discontinue Retain used kit for examination, treatment. Wash blood back to place in yellow bag. Contact Quality patient. Once circuit is unloaded, Helpline to report incident and switch machine off and then switch arrange collection of the kit in on. Perform pre-treatment self test. Is question. Observe for further test passed? failures of same batch in short term.

NO There might be a technical fault with the machine. Please contact the Technical Services Department.

NO There might be a technical fault with the machine. Please contact the Technical Services Department.

7

Blood leak detected

Air/microbubbles detected in venous return chamber

YES

Check filtrate line for the presence of 'frank' (visible) blood. Can you see blood in the line?

NO

NO

Visible blood suggests a significant membrane failure. Were TMP pressures high before blood leak detected, or has it failed very early in treatment?

NO

YES

Microscopic blood leak. Consider unit policy on microscopic blood leak (washback or continue as advised by local policy). Clotting will occur within filter once the membrane has ruptured, circuit lifespan is likely to be greatly reduced.

Discontinue treatment. Washback circuit blood and recommence treatment.

Consider filter production issues. Retain filter in yellow bag for collection by Fresenius staff. Take filter reference number if possible. Contact Quality Helpline to report incident and arrange collection of filter in question. Observe for further failures of same batch in short term.

Has the treatment begun – is blood in the venous chamber?

Lower venous chamber using down arrow until chamber is clear of air. Raise using up arrow. Press start/reset key to recommence treatment.

YES Is the level of blood above the air detector (within 2 cm of the top of the venous chamber)?

NO

Use up arrow to raise the level of the venous chamber to within 2cm of the top. Press start/reset key.

YES

Raise the level of the bubble chamber above the inflow port of the replacement line. Check for any remaining air in the replacement line. Continue treatment, observing for any drop in the level of blood in the chamber.

YES Press start/reset key. Has the replacement fluid flow become turbulent following a bag change (small amounts of air entering via the replacement line)? NO YES Is a large amount of air entering the bubble chamber?

NO

YES Does the source appear to be the replacement fluid line?

Check connections on fluid replacement bags. Tighten if necessary. Check connection of line to the venous bubble chamber. Tighten if required.

NO

Does the source appear to be the filter outlet line (blue)?

YES Check outlet connection to the filter. Tighten if necessary. Check the 2 pre-filter fluid additive ports are clamped. Check that access line is not kinked.

NO Are the two additive ports on NO the top of the venous chamber firmly clamped?

Clamp port lines.

YES If a large amount of air is entering the circuit from an unidentified source, attempt to wash the blood back. It may not be possible to achieve safely. Disconnect patient. Consider circuit flaw. Retain circuit for examination in yellow bag. Contact Quality Helpline to report incident and arrange collection of circuit in question. Observe for further failures of same batch in short term.

Is the replacement flow turbulent due to a low level in the venous chamber?

Please refer to Page 20 for useful contact telephone numbers.

8

YES Raise the level of the chamber using the up arrow to above the inlet port.

NO If a cause of the air detector alarm cannot be identified, the blood should be returned to the patient if possible and treatment discontinued. (Note, it may not be safe to return the blood if it appears to be frankly airated). Please contact the Technical Services Department.

9

Pressure before filter too low

Pressure before filter too high

Press start/reset key. Is there YES any visible leakage in the Tighten loose connections, ensure pre-filter additive ports are tubing system? (Consider clamped. from the patient access to the filter blood circuit connector).

Is there evidence that the YES filter is clotting? (Associated rise in the pre-filter pressure, visibly clotted areas at the top surface of the filter etc).

NO

NO NO

Is the pre-filter pressure transducer (white) connected firmly and correctly?

Tighten transducer into connector port. If accidently cross threaded and a tight fit is no longer possible replace pre-filter pressure transducer with a replacement line attached to the top of the arterial bubble chamber.

YES YES Clamp line and remove from YES

the white pressure transducer port. Attach replacement transducer line to the port on the top of the arterial chamber, and then to the pressure monitoring port. Unclamp the line. Has this altered the monitored TMP pressure?

Check the white pre-filter transducer line. Is it wet?

NO

YES Check the blood pump rate. YES Reduce blood pump rate to Is it too high for the filter within acceptable operating size? (Check reference limits. Press start/reset key. ranges of maximum blood Has this altered the pre-filter flow rates for AV 600 and AV pressure? 1000 filters). YES Clamp line and remove from YES

Press start/reset key to recommence treatment.

the white pressure transducer port. Attach replacement transducer line to the port on the top of the arterial chamber, and then to the pressure monitoring port. Unclamp the line. Has this altered the monitored prefilter pressure?

Check the white pre-filter transducer line. Is it wet?

NO YES

Is the venous return line kinked or occluded?

YES YES

Return machine to patient use. Retain used kit for examination, place in yellow bag. Contact Quality Helpline to report incident and arrange collection of the kit in question. Observe for further failures of same batch in short term.

Press start/reset key to recommence treatment.

NO

NO

Stop blood pump temporarily. Open blood pump door. Manipulate pump segment until blood tubing lies correctly in its housing. Close door and restart blood pump.

Check blood pump segment. Is it correctly positioned within its housing?

Continue treatment.

NO

NO

NO

Consider undiagnosed issue with the fluid lines or machine. Discontinue treatment. Wash blood back to patient. Once circuit is unloaded, switch machine off and then switch on. Perform pre-treatment self test. Is test passed?

Consider that the circuit has reached its lifespan. Press start/reset key. Wash back blood to the patient and recommence treatment. If circuit lifespan has been low, consider the dose of anticoagulant, exchange rate, blood pump rate etc.

Unkink or clear return line to re-establish unimpeded flow. Press start/reset key to recommence treatment.

NO YES

Consider undiagnosed issue with the fluid lines or machine. Discontinue treatment. Wash blood back to patient. Once circuit is unloaded, switch machine off and then switch on. Perform pre-treatment self test. Is test passed?

Return machine to patient use. Retain used kit for examination, place in yellow bag. Contact Quality Helpline to report incident and arrange collection of the kit in question. Observe for further failures of same batch in short term.

NO

There might be a technical fault with the machine. Please contact the Technical Services Department.

NO

There might be a technical fault with the machine. Please contact the Technical Services Department.

Please refer to Page 20 for useful contact telephone numbers.

10

11

Non-opaque/opaque fluid detector

NO

Is the venous chamber filled with blood ?

Override alarm. Press start/reset key. Allow priming with blood to continue. Consider starting treatment with blood pump speed increased by 20%.

YES YES

Is there an infusion of clear fluids in progress via the venous chamber?

Stop infusion. Press start/reset key. Allow circuit to re-establish flow. Restart infusion at a reduced rate. Rate can be incrementally increased if blood return appears sufficiently opaque.

Balancing error – UF rate or substituation rate too high

YES

Has the message appeared during the transition into 'treatment' mode?

Unkink line, or re-establish unimpeded flow from access. Press start/reset key to recommence treatment.

Is there an unimpeded flow from the access? (If not the replacement flow may over-dilute the blood within the venous chamber) YES YES

Press start/reset key. Is the blood flow lower than anticipated (less than 150mls/min) with normal to high post-dilution replacement?

Consider a reduction in post-dilution replacement until blood pump rate can be increased.

Has there been a change in blood pump rate, replacement fluid rate or the quantity of ultrafiltrate that is being removed from the patient?

NO NO

Open the door to the detector, re-insert line so that it lies correctly within the return clamp and the detector.

Is the return line correctly routed through the opaque/non-opaque detector?

YES

There might be a technical fault with the machine. Please contact the Technical Services Department.

To accommodate very high fluid removal rate or replacment fluid rates, there must be adequate blood flow. Check the current BPR/UFR figure. If it is above 20%, increase blood pump speed incrementally until it is 20% or below.

Please note: If maximum tolerated blood pump rate has been achieved or the blood pump is set at the maximum for the filter, it will be necessary to reduce either the replacement fluid rate, or the volume of patient fluid being removed as ultrafiltrate.

YES

Return machine to patient use. Retain used kit for examination, place in yellow bag. Contact Quality Helpline to report incident and arrange collection of the kit in question. Observe for further failures of same batch in short term.

If alarm persists, override alarm. If blood pump rate cannot be increased due to the patient’s condition, then reduce the rate of replacement fluid until BPR/UFR is less than 20%. Does alarm persist? YES

YES

NO

NO

If alarm persists after target rate is achieved, examine BPR/UFR, if this figure is above 20%, increase BPR further.

NO

NO

Consider undiagnosed issue with the fluid lines or machine. Discontinue treatment. Wash blood back to patient. Once circuit is unloaded, switch machine off and then switch on. Perform pre-treatment self test. Is test passed?

Override alarm, increase blood pump rate to target as tolerated by the patient (ideally over the next 3 minutes). If identical alarm occurs during this time, override until target rate achieved.

NO

Press start/reset key to recommence treatment.

NO YES Consider Return machine to undiagnosed issue patient use. Retain with the fluid lines or used kit for machine. examination, place Discontinue in yellow bag. treatment. Wash Contact Quality blood back to Helpline to report patient. Once circuit incident and is unloaded, switch arrange collection of machine off and the kit in question. then switch on. Observe for further Perform prefailures of same treatment self test. batch in short term. Is test passed? NO

There might be a technical fault with the machine. Please contact the Technical Services Department.

Please refer to Page 20 for useful contact telephone numbers.

12

13

Heater unable to achieve set temperature

Heater over temperature

YES

Initially allow alarm to occur, reset 2-3 times, particularly if replacement flows are very low.

Override alarm, allow further fluids to warm to room temperature before they are used.

Are the replacement fluids colder than standard room temperature?

NO

Press start/reset key to recommence treatment.

Does the alarm persist?

NO

YES NO

Is the heater bag fully housed within the heater chamber?

NO

Enter bag change menu. Attempt to reseat bag to a position fully within housing.

Please note: It may be necessary to clamp the fluid line to the venous bubble catcher, disconnect the fluid replacement line (as asceptic technique) and expel some of the fluid in the heater bag in order to manipulate it into the correct position.

YES

Is the door to the heater chamber fully closed?

Change heater bag to the corresponding colour heater chamber. Press start/reset key to recommence treatment.

Please note: It may be necessary to clamp the fluid line to the venous bubble catcher, disconnect the fluid replacement line (as asceptic technique) and expel some of the fluid in the heater bag in order to manipulate it into the correct position.

YES NO

NO

Is the heater bag in the correct heater chamber (ie green line in corresponding green heater etc)?

Reposition heater bag until door closes fully. Press start/reset key to recommence treatment.

Please note: It may be necessary to clamp the fluid line to the venous bubble catcher, disconnect the fluid replacement line (as asceptic technique) and expel some of the fluid in the heater bag in order to manipulate it into the correct position.

Change heater bag to the corresponding colour heater chamber.

YES

There might be a technical fault with the machine. Please contact the Technical Services Department.

Please note: It may be necessary to clamp the fluid line to the venous bubble catcher, disconnect the fluid replacement line (as asceptic technique) and expel some of the fluid in the heater bag in order to manipulate it into the correct position.

Is the heater bag in the correct heater chamber (ie green line in corresponding green heater etc)?

YES YES

Is there air in the heater bag?

Check if the clamps in the replacement fluid bag are open. If not, open the clamps. Then enter bag change menu. Select deaeration of corresponding line. Carry out deaeration procedure. Continue treatment.

NO

There might be a technical fault with the machine. Please contact the Technical Services Department.

Please refer to Page 20 for useful contact telephone numbers.

14

15

Scales reverse alarm

Drop Counter Rate Citrate/Calcium too low

NO

YES

Are the bags sat on the wrong scale for corresponding pump?

Enter bag change menu. Swap bags to the opposite scales. Press start/reset key to recommence treatment.

Manipulate until seated correctly in chamber holder. Press start/reset key to recommence treatment.

Is the drip chamber correctly seated in its holder?

YES YES

Is the line from solution bag kinked or are the clamps on?

Free line / undo clamps. Press start/reset key to recommence treatment.

NO

There might be a technical fault with the machine. Please contact the Technical Services Department.

NO NO

Is the cone in citrate bag broken? Is the calcium bag punctured fully with the access spike?

Break cone on citrate bag / fully pierce calcium bag. Press start/reset key to recommence treatment.

YES YES Kink line below the chamber outflow. Remove

chamber from holder. Move solution bag to below chamber and invert. Manually expel excess fluid bag into the solution bag. Press start/reset key to recommence treatment.

Is the drip chamber overfilled?

NO NO

Is the blood pump activated?

Press start/reset key to recommence treatment.

YES

There might be a technical fault with the machine. Please contact the Technical Services Department.

Please refer to Page 20 for useful contact telephone numbers.

16

17

Drop Counter Rate Citrate/Calcium too high

Recommended filter size and blood flow rates

Recommended Ultraflux®-Filter usage in CVVH (Post-dilution)

YES

Has the machine been moved / knocked immediately before the alarm?

Press start/reset key. Observe for alarm recurrence.

6 5

NO

Is the drip chamber too low (producing double drops from splashing)?

4

Remove chamber from holder. Manually fill chamber slightly by squeezing. Return chamber to holder. Press start/reset key to recommence.

NO YES

Is there any droplet accumulation on the wall of the drip chamber?

QF [l/h]

YES

3 2 1

Remove chamber from holder. Hold on side and rotate until all droplets are removed. Return to holder. Press start/reset key to recommence treatment.

0 0

100

200 300 Blood flow QB [ml/min]

400

500

NO

There might be a technical fault with the machine. Please contact the Technical Services Department.

Please refer to Page 20 for useful contact telephone numbers.

18

19

Useful contact numbers

If you have followed all the advice in this guide, and you are still experiencing problems, please refer to the table below to help you decide how to proceed.

Day of week

8.30am - 5.00pm

Telephone

Monday to Friday

Fresenius Medical Care (Switchboard)

Monday to Friday

Technical Services Department

01623 445197

Monday to Friday

Quality Helpline

01623 445215

Acute Operational Helpline*

08704 587971

24/7

01623 445100

* All calls are put through to a call centre in the UK. The call centre will bleep the on-call person who in turn will respond to the customer within 15 minutes.

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