Myself K.Devaraj Zonal Service Manager - - PowerPoint PPT Presentation

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 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

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.

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.

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

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?

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.

Record of Equipment Maintenance

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

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.

Power failure:-

 Is it plugged in ?  Is there an outlet problem?  Did you turn it off?  Machine or power cord failure  Call technical support.

MAINTENANCE YOU CAN DO.

Structure of a Haemodialysis Machine

Main Components A) Monitor - Control Unit & Electronics B) Modules - Extracorporeal Blood Circuit C) Hydraulics - Preparation of Dialysis Fluid

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

HYDRAULICS

Preparation of Dialysis Fluid 

• Mixing



• Heating



• Degassing

 Transport of dialysis Fluid  Fluid Balance & Ultrafiltration

Fluid Delivery System

The Machine

Two Fluid Circuits

Patient

Back of Dialysis Machine Dialyzer

Blood Dialysate

Membrane interface

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

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  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

Vacuum pump

TYPES OF ALARMS AND ITS FUNCTIONS

2 major types of Hemodialysis Machine Alarms:

Blood alarms Dialysate alarms

Machine Response Common causes Appropriate staff response

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)

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

+ -

High Conductivity

 Higher concentration

 Interruption in water supply  Untreated incoming water  Proportioning pump running too fast  Acid or bicarbonate not mixed well enough.

11 12 13 14 15 16

+ -

Dialysate Temperature

37.0C

 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  Bypass mode activated

 Causes:

 Malfunctioning heater  Obstruction in incoming water

Water/Flow Alarms

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

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

Integrity of the Dialyzer Membrane

Dialysate in Dialysate Out Alarm Activated = blood Photo electric cell Light source

• Blood leak detector
• Photo-optical sensor
• Measures change in optical transmission
• Blood circuit alarm located in dialysate compartment
• Membrane tear interrupts light transmission

Blood Leak Detector

Machine Response

 Audible alarm  Visual alarm  Blood pump stops to prevent continued blood

loss

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

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

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

After ensuring patient safety, the staff response could follow these steps in order:

1.

Mute alarm; Reassure the patient

2.

Identify the alarm.

3.

Identify the problem

4.

Fix the problem

5.

Press “Reset”

6.

Resume dialysis

Staff Response to HD Machine Alarms

Machine Test Pre-Treatment

 Tests to be sure that all machine

alarms are functioning properly

 Must be done on each machine

before each patient is dialyzed

 Do not use the machine if it does not

pass the test

Test

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.

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)

 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.

Precautions you can taken care:

Preventive Maintenance

 All manufacturers write preventive maintenance

(PM) schedules for their machines.

 “Every 2,000-2500 hours or 6 months is the first

level, the O-rings and some rubber parts.

 Sometimes the O-rings go bad on the fluid side.  pressure-sensitive systems, magnetic valves.

 The only time we have a problem is when we

have a high patient census.

 Service engineers like to service the machines

well within the manufacturer’s schedule just to be extra safe.

Maintenance Kit

Kit containing various Parts that are to be replaced during P.M.

 - “O” Rings  - Filters.  - Seals. - Segments

MAINTENANCE & REPAIR

 MAINTENANCE

 Is taking care of a equipment in its routine day to day

working activity and the AIM is to “Avoid Breakdown”

 To be done Daily /Weekly /Monthly /Yearly.

 REPAIR

 Is a work carried out in the case of machine

breakdown and the AIM is to put it back in “Working Condition”

WE BELIVES IN

CONDUCT EDUCATION PROGRAM

QUALITY DIALYSIS QUALITY PRODUCTS

MAINTENANCE IT’S IMPORTANCE

Well Maintained Equipments are

 Less Prone to Failure  Gives you Quality  Gives Value for Money  Provide You Piece of Mind, Reliability & Confidence.  Brings to You & Your Center the “Name & Fame”

THANK YOU