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Troubleshooting (Integra)

Section 1 Power Failure
Section 2 Water Failure
Section 3 General Safe State
Section 4 Venous Pressure
Section 5 Arterial Pressure
Section 6 Recirculation
Section 7 Air & Foam
Section 8 Needle Falling out
Section 9 Clotted Circuit/Filter Change
Section 10 Dealing With A Medical Emergency

Power Failure

When there is a loss of power the machine will make a long acoustic noise and a yellow flashing light will appear. With loss of power the blood pump will not operate. 

  • Open arterial blood pump door. 
  • Remove blood pump handle from pump. 
  • Turn the pump anti clockwise doing half turns with the pump at a slow steady speed, watching for air and watching the access to ensure that the needle isn’t blowing.  
  • Once power has been restored place pump handle back into the machine close blood pump door and dialysis will resume. 
  • If power is down for longer than 15 minutes the patient should be taken off the machine and dialysis concluded till power has resumed.   

Water Failure 

  • The machine will go into restart and NO WATER will alarm.
  • You should check that the water is connected to the machine and no kinks are in the pipes. If problem persists then contact the renal technicians. If water is down for longer than 15 minutes the patient should be taken off the machine and dialysis concluded till water has resumed.  

General Safe State 

As part of the machines protection system the machine has to perform tests to ensure its safe to use, if the machine fails any of these tests (T1 test failed) will appear, the machine will then sound a continuous loud alarm and the red light on the machine will flash. 

The machine should be turned off and wait for 5 seconds then turn the machine on and re test the machine, unless the machine is in dialysis. 

A code will be present with the alarm the most common causes are PI PO test failed which is the pressure in and pressure out, this is regulated on the dialysate connectors on the dialysis machine. 

The other likely test is the venous pressure test if this happens it is advised to clamp off the isolators and turn the machine off and restart the machine. 

  • Machine alarms General Safe State 
  • Take note of the failed test. 
  • Take note of the time and weight loss on the machine if in dialysis. 
  • Turn off the machine wait for 5 seconds. 
  • Turn on the machine if in run up re run the machine, if in dialysis press the +/- keys   

Venous Pressure (High) 

  • When the venous pressure is higher than the blood flow this is deemed a high pressure. You should check the position of the needle if at the start of dialysis, if towards the end of treatment you should check the filter for clotting also checking for kinks and clamps on. If clotting might be an issue then run about 150 mls of saline into the dialysis circuit to check for clots. 
  • If clotting is the problem it might be the needle. Stop the machine and recirculate as instructed in this booklet. 
  • Attach a 5ml syringe to the needle and try to aspirate if no flow try to change the position. ( do not push blood back into the needle if no flow can be pulled out as this will cause the needle to blow). Once problem is resolved stop recirculation and continue with dialysis.     

Venous Pressure (Low)

If the venous pressure is low (i.e. reading 0) there is a good chance the isolator is wet, to remedy this you need to: 

  • Clamp off the isolator with a blue clamp. 
  • Attach 1 x 5ml syringe to isolator and gently push back any fluid in the isolator. 
  • Then attach isolator back onto the machine and release the blue clamp, the venous pressure should return to a more acceptable range.  

If the arterial pressure is low the possible issues could be: 

  • A clamp is still on. 
  • The needle has moved position. 
  • The fistula may not be functioning as it should.  

Arterial Pressure (High)  

  • If the arterial pressure is high the normal cause for this is that one of the isolators has got wet with either saline or blood. To remedy this problem.
  • Using a blue clamp attach to line where isolator is wet. Remove isolator from the machine attach a 5ml syringe and fill with a little air, then release clamp and gently push the air in to move the saline away from the isolator.   

Recirculation 

Equipment Required: 

  • 1 BL30 (Recirculation tube) 
  • 2 x 5ml syringes (For Needles)
  • 1 Take Off Pack   

Do the Following: 

  • Prepare pack and place 2 x 5ml syringes and recirculation tube onto the pack. 
  • Stop blood pump and clamp red and blue lines on needles and blood lines.   
  • Place recirculation tube on red and blue lines , unclamp lines and open 500ml saline start blood pump at 150mls /min. press BYPASS on dialysis machine.  Place syringes on the needles.  
     
  • When ready to reconnect patient place blue clamp on recirculater. 
  • Clamp red and blue lines remove syringes and connect blood lines back to needles (RED TO RED AND BLUE TO BLUE) clamp giving set of 500ml saline off. 
  • Recirculation can be done for a maximum 15mins. 
  • Press BYPASS and return to normal blood flow.  

Air & Foam 

The Air & Foam alarm happens when there is: 

  • No fluid present in the venous chamber.
  • A lot of foam at the top of the chamber.
  • Clotting in the circuit.   

When this happens just use the up arrow next to the venous chamber and raise the level.  

If there seems to be lots of foam ensure the clamp is on above the venous chamber & attach a 10 ml syringe to the top of the line, remove the cap & open the white clamp and remove the foam  

When Air & Foam alarm appears and the venous chamber is hard to squeeze and the blood is dark /Cold to touch the circuit has/is clotting. Washback should be performed is possible then filter change should be done.  

Needle Falling Out 

If a needle falls out on dialysis 

  • Stop blood pump and clamp lines. 
  • Put pressure on the needle site where needle has fallen out 
  • Recirculate blood as per recirculation guide 
  • Once the access has stop bleeding re-site needle stop recirculation and continue with the dialysis. 

 Clotted Circuit 

  • When the circuit is dark and venous pressure is high i.e. between 300-470 if the circuit is cold the lines have clotted. If possible and safe to do so the blood should be washed back if this is impossible then the needles and the lines should be clamped off & the machine should be put into filter change, the blood lines should be stripped off  and new lines put on the machine.
  • Attach a 5ml syringe to each needle so the needles can be flushed when the machine is preparing (this is to ensure the needles do not clot off). 
  • Make a note of how long you have been on the machine & how much fluid you have taken off
  • Inform the unit or your community nurse about this. 

Clotted Circuit/Filter Change  

To put the machine into filter change 

  • Press BYPASS 
  • Press Washback 
  • Wash blood back if possible if not clamp lines (also clamp needles and remove lines from machine leaving needles in the patient. 
  • Press Filter change. The machine will ask for you to confirm this by pressing the button again 
  • Reline machine with new lines and prime as per lining and priming guide. 
  • When primed Press patient connect and bleed out as normal the machine will remember all parameters from the dialysis but check these are correct from the note you made earlier. 

Dealing with a medical emergency  

Depending upon the emergency will depend on how to deal with it.

  • If the blood pressure drops on dialysis then the patient should be laid back and put into weight loss minimum (WLM), do blood pressure and if necessary give saline but in small amounts. Once blood pressure improves the patient can sit up and be taken out of WLM.
  • If any other medical emergency dial 999 immediately and tell them that the patient is on dialysis.