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Nov 07, 2022 •239 likes •672 views

Maintenance of Dialysis Machines. Myself K.Devaraj Zonal Service Manager E-mail:devaraj@browndove.com Browndove Healthcare Pvt Ltd Equipment Maintenance A Necessity. (Where does we Stand?) Types of Equipments used in Hospitals 320

  1. Maintenance of Dialysis Machines. Myself K.Devaraj Zonal Service Manager E-mail:devaraj@browndove.com Browndove Healthcare Pvt Ltd

  2. Equipment Maintenance A Necessity. (Where does we Stand?)  Types of Equipment’s used in Hospitals  320 Different types.  Categorizing these Equipments on the basis of  Treatment to Patient  Diagnostic  Therapeutic  Life Saving  There structure  Stationary Electronic Parts  Moving Mechanical Parts  Combination of both  There usage  Limited Usage  Moderate Usage  Heavy Usage

  3. EQUIPMENT MAINTENANCE, A NECESSITY .  For Dialysis Machines Maintenance is a must.  You can delay but you just cant Avoid Maintenance of Dialysis Machines.  OUTCOME  In any center where they buy Dialysis Machines it is Important to allocate fund for Maintenance.

  4. Routine maintenance :-  Mainly consists of WTS & HD machines  Improve quality & survival of patients  Reduces the incidence of complication on dialysis  Routine Maintenance should pay attention to the problems  Interrelated to dialysis adequacy and patient outcome.

  5. Machine Monitors  Arterial pressure  Venous pressure  High or low Art/venous pressure Blood pump stops, time stops   TMP  Transducer Blood pump stops, clock stops   Air detector  Venous chamber Blood pump stops, clock stops   Conductivity  Low conductivity or high clock stops, bypass starts   Temperature  Heater malfunction or water temp variances  Dialysate flow  Low water pressure, pump failure, obstruction, power failure  Blood leak  Blood pump stops, clock stops

  6. Priority / Reality to Equipment Maintenance  Being a paramedical staff what level of Maintaining a equipment you are looking for?  Is your priority “Patient” or “Machine”?  Are you looking for a practical approach or just a knowledge gain?

  7. Prevention is better than Cure  Your “Equipment” is Your “Baby”.  First Step towards Maintaining a Equipment is its correct usage (Operation)  Go through Manual Carefully.  Maintaining  External Things  Internal Things.

  8. Record of Equipment Maintenance • Machine Log Register • Breakdown / PM done on machines • Service report file • Record of preventive Maintenance. • Periodical calibration certificate.

  9. MAINTENANCE YOU CAN DO.  External Things  Surrounding Temperature (AC Functioning)  Correct Voltage Supply (220V +/- 5%)  Water Supply Pressure (1 to 6 Bar)  Drainage Height (Max 1 Meter)  Correct Plug & Socket 15 Amp”.  Good Water Quality (AAMI or EU)  Supply of Good Quality Concentrate  Use of Correct Surface Disinfectant  Replacement of Filters  Internal Things  Checking of Dialyate Sample at regular Intervals  Daily (At least Once) Disinfection of Machine with correct Disinfectant.  Record of Equipment Maintenance .

  10. MAINTENANCE YOU CAN DO. Power failure :-  Is it plugged in ?  Is there an outlet problem?  Did you turn it off?  Machine or power cord failure  Call technical support.

  11. Structure of a Haemodialysis Machine Main Components A) Monitor - Control Unit & Electronics B) Modules - Extracorporeal Blood Circuit C) Hydraulics - Preparation of Dialysis Fluid

  12. Tasks of a Haemodialysis Machine 1) Produce fresh dialysate 2) Provide correctly prepared dialysate to the dialyser 3) Remove fluid from the patient by ultrafiltration 4) Handle & monitor spent dialysate 5) Operate & control the extracorporeal circuit

  13. HYDRAULICS  Preparation of Dialysis Fluid - Mixing  - Heating  - Degassing   Transport of dialysis Fluid  Fluid Balance & Ultrafiltration

  14. Fluid Delivery System The Machine

  15. Two Fluid Circuits Membrane interface Blood Back of Dialysis Machine Dialysate Dialyzer Patient

  16. Dialysate Delivery System  Water and dialysate concentrate prepared in machine  Mixed  Heated to a uniform temperature  Deaerated  Monitored by machine for:  Composition  Temperature  Flow  Delivered to dialyzer  Dialysate used only once

  17. Dialysate is Deaerated  Negative pressure created by a pump  Causes dissolved air to form bigger bubbles  Removes bubbles  Faulty deaeration causes :  False blood-leak alarms Vacuum pump  Rapid fluctuations in conductivity  Interference with volumetric control function  Air trap in dialyzer membrane  Air may cross dialyzer membrane & enter blood stream  Air embolism  Clot formation

  18. TYPES OF ALARMS AND ITS FUNCTIONS

  19. 2 major types of Hemodialysis Machine Alarms: Blood alarms Dialysate alarms Machine Response Common causes Appropriate staff response

  20. Conductivity Alarm Continuously monitors conductivity of dialysate solution  Out of acid and/or bicarbonate concentrate solution  Improperly connected acid and/or bicarb tubing  Malfunctioning machine  Poor quality water supply  Improperly mixing acid and/or bicarbonate solution  Obstructed dialysate flow - e.g. kink in dialysate line, clogged dialysate line filter(s)

  21. Low Conductivity  Lower concentration  Most common conductivity alarm  Air in acid or bicarbonate line  Proportioning pump running too slow  Hypotonic dialysate mixed 11 12 13 14 15 16 + -

  22.  Higher concentration  Interruption in water supply High Conductivity  Untreated incoming water  Proportioning pump running too fast  Acid or bicarbonate not mixed well enough. 11 12 13 14 15 16 + -

  23. Dialysate Temperature  Water heated prior to mixing with concentrate  Heater controlled by thermostat  Internal temperature sensor  Internal high/low limits  If temperature exceeds limits  Audible & visual alarms 37.0C  Bypass mode activated  Causes:  Malfunctioning heater  Obstruction in incoming water

  24. Water/Flow Alarms Water Alarm – No water supply, kink supply line Flow/Upper Flow Alarm – kink supply/dialysate line Call Service

  25. Machine Response To Blood Alarms Visual alarm/light flashes Audible alarm sounds Blood pump stops Venous line clamp closes Ultrafiltration stops Dialysis clock stops

  26. Integrity of the Dialyzer Membrane • Blood leak detector • Photo-optical sensor • Measures change in optical transmission • Blood circuit alarm located in dialysate compartment Dialysate in Dialysate Out Photo electric cell Light source Alarm Activated = blood • Membrane tear interrupts light transmission

  27. Blood Leak Detector Machine Response  Audible alarm  Visual alarm  Blood pump stops to prevent continued blood loss

  28. Transmembrane Pressure Alarm Measures the pressure on the dialyzer membrane  Wet or mal-positioned arterial and/or venous transducer(s) protector  Kink in the bloodline - especially between the dialyzer and the venous transducer protector  Improper flow of dialysate - e.g. kink in dialysate line, clogged dialysate line filter(s)  High UF rate <-> small dialyzer  Clotting in the dialyzer

  29. UF Control System  Valves located above & below balancing chambers  Alternately open and close to direct flow of fresh and used dialysate  Air is removed from used dialysate to ensure accurate measurement  Online PHT tests appropriate sealing of valves  Tests integrity of diaphragms  Bad valve seals cause:  Inaccurate ultrafiltration control

  30. Air Detector with line clamp Detects air in the venous drip chamber and engages clamp on line (failure to put line through clamp can result in an air embolism)  Arterial transducer protector not secure  Arterial chamber subsituate port not capped securely  Improperly priming set-up  Loose connections on arterial side

  31. Staff Response to HD Machine Alarms After ensuring patient safety, the staff response could follow these steps in order: Mute alarm; Reassure the patient 1. Identify the alarm. 2. Identify the problem 3. Fix the problem 4. Press “Reset” 5. Resume dialysis 6.

  32. Machine Test Pre-Treatment  Tests to be sure that all machine alarms are functioning properly Test  Must be done on each machine before each patient is dialyzed  Do not use the machine if it does not pass the test

  33. In the Event of Machine Breakdown.  Give Each & Every Detail to Service Engineer  Note down any error message.  Give your full Co-operation.  Take out time to be with Engineer to understand the problem fixed.  Log the Breakdown Chart after job completion.

  34. MAINTENANCE YOU CAN DO.  Daily:  Rinsing the machine before start up.  Hot & Chemical Disinfection.  External cleaning.  Monthly:  Change of Sub micron filters.  Change of Diasafe filter (recommended)

  35. Precautions you can taken care:  Do not place the tray on the machine.  Do not keep the saline bottles on the machine.  Keep the machine surrounding clean.  Do not pull /push machine if the power card is plugged.  Do not clean the surface of machine with any chemical which is not recommended.

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