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Objective:To construct a double-closed-loop management model for medical equipment and explore its application value in hemodialysis machine maintenance and fault management.Methods:Based on the closed-loop management of clinical operation of medical equipment and the closed-loop management of technical support,a dual closed-loop management model of equipment was constructed.65 hemodialysis machines in clinical use in Huashan Hospital Fudan University from January 2021 to January 2023 were selected and divided into a conventional mode and double-closed-loop mode according to different management modes.The conventional mode adopted conventional equipment management methods,and the double-closed-loop mode adopted a double-closed-loop management model.The cost-effectiveness,social benefit,failure occurrence,effective management quality matters,disinfection status,average patient waiting time and satisfaction were compared between the two groups.Results:The hemodialysis machine operating profit growth rate,diagnosis and treatment cost growth rate,service life index,scientific research service growth rate,diagnosis and treatment service growth rate,startup rate and operation rate of the double-closed-loop mode were(3.95±1.04)%,(3.80±0.58)%,(1.58±0.31)%,(4.30±0.95)%,(7.91±1.58)%,(96.58±2.76)%and(89.90±5.58)%,which were higher than those of the Conventional mode,the difference was statistically significant(t=5.418,10.070,7.490,17.570,11.820,8.849,6.840,P<0.05).The technical support expenses growth rate,bacterial colony count,bacterial endotoxin content and average patient waiting time of patients in the Double-closed-loop mode were(2.60±0.33)%,(0.370±0.008)cfu/ml,(0.0063±0.0011)EU/ml and(0.76±0.13)h,which were less than those of the conventional mode,the difference was statistically significant(t=23.040,82.985,14.482,19.530,P<0.05).The incidence rate of hemodialysis machine failure in the double-closed-loop mode was 9.23%(6/65),which was lower than that in the conventional mode,the difference was statistically significant(x2=6.392,P<0.05);among the 120 items of management data collected,quality control testing,maintenance and repair,clinical operation,information data,and scrap processing effectiveness rates were 95.83%(115/120),89.17%(107/120),96.67%(116/120),95.00%(114/120),and 97.50%(117/120),respectively,which were higher than those of the conventional mode,the difference was statistically significant(x2=15.238,16.596,9.808,15.585,16.119,P<0.05).Conclusion:The application of closed-loop management model to hemodialysis machine maintenance and fault management can effectively improve equipment cost-effectiveness,social benefits,management quality and patient satisfaction,and reduce the incidence of faults.
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The Fresenius 4008 S hemodialysis machine is one of the main hemodialysis machines in our hospital. Because of its longer service life, the probability of malfunction is larger. For flow alarm is the typical fault of this model, we combined with practical maintenance experience and theoretical technology, then briefly analyzed and summarized the malfunction. On the principle of easy to difficult, we check in order from five aspects, they are pipeline blockage, aging of the degassing pump or flow pump, the float switch malfunction, valve abnormality and the control circuit problem. Through this one-by-one and systematic troubleshooting, the flow alarm can usually be solved, also we can save the maintenance time and the cost.
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Maintenance , Renal DialysisABSTRACT
OBJECTIVE@#To analyze the causes leading to hemodialysis machine & accessories faults and to give preventive measures.@*METHODS@#The causes of 34 hemodialysis machine & accessories faults during hemodialysis process were studied through retrospective analysis from January 2017 to June 2018 in our hemodialysis center.@*RESULTS@#The main factors were hemodialysis machine failure, water & electricity failure, dialytic pipeline failure, unstandardized using. The members in hemodialysis center benefited a lot from the faults, The engineers strengthened the preventive repair & quality control of hemodialysis machine, the monitoring of water & electricity. The nursing staff strengthened the quality control of the pipeline and the study of the principle & standard use of hemodialysis machine.@*CONCLUSIONS@#The study on hemodialysis machine & accessories faults improved the professional level of nurses & engineers, helped them to solve and prevent faults more precisely and improved the quality of hemodialysis.
Subject(s)
Quality Control , Renal Dialysis , Retrospective StudiesABSTRACT
Objective:To investigate various risk factors that influence the safety of using hemodialysis equipment, and carry out risk control and reduce risk of using equipment through analyzed the statistical result of failure data of equipment.Methods:Based on all kinds of fault messages record in 2016, the failure data of 390 cases were carried out classified statistic analysis by using Microsoft Excel.Results: Through the statistic analysis of failure rate of 2016 year, there were four main factors were obtained. Aimed at the three higher percent factors that were equipment fault(85.1%), material(11.2%) and human reason(3.7%), respectively., the current management system of hemodialysis equipment was optimized and operation process was standardized from three aspects that included equipment management, material management, and the training and check for staff.Conclusion: Based on the analysis and research for the failure types of hemodialysis equipment purchased from different years, and the analysis of relevant reasons, the corresponding countermeasure of quality management is established, and the main body of responsibility is clarified, and the operative risk of hemodialysis equipment is effectively reduced.
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Objective:To design an intelligent system of leak detection for AK200Shemodialysis machine so as to fast troubleshoot the range of leaked point for helpingengineer. Methods: The likely leaked part of flow paths of hemodialysis were simplified basedon routine detection experiment and the statistical record and data of faults. And then, testmode of pressure when hemodailysis implemented self-inspection for leakage was imitated. There was a air pumpwas connected with aimed flow paths, and the positive and negative pressure generated by controlling an externalair pump and the connected magnetic valve were applied at different time and different section, respectively. Afterincreased pressure, depended on the comparison of intra pressures from pressure sensors for one part of pipelinebetween pre- and post of one spell to analyze and decide whether this section exist leak. And the judgment standardwas if the difference of pressure was less than 5mmHg, there was not leak in this flow path, otherwise, the likely leakpoint should be troubleshot in further detection. Results: 183 detections were implemented at AK200S/AK200USwhich once happened alarm of leakage. And in the 183 detections, the detection system for leakage has found theranges of leaked point in 171 detection. The distribution of leaked points was: 73 times were from filter to DRVAsection, 19 times were from DRVA section to DIVA section, 79 times were from DIVA section to champ of flexiblepipe at terminal of EVVA. On the other hand, in the leaked points, 162 points were at seal ring, 1 point was at filmof valve, 8 points were at connector, and the success rate of detection for leaked fault was more than 90%. Besides,the success rate of detection for leakage on flow paths of prepare troubleshooting under normal temperature was100%. Conclusion: The detection system of self-dependant development for leakage can help engineer to save timeof troubleshooting for leaked point and enhance the work efficiency.
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Objective To find out the problems in quality control of the hemodialysis machine to ensure its safety.Methods MESA 90XL meter and Austrian RIGFL 288 electrical safety tester were used to detect the hemodialysis machines according to military and national standards on dialysate temperature,dialysate conductivity,venous pressure,arterial pressure,dialysate flow,dialysate pH value,heparin pump flow,blood pump flow,dehydration flow,electrical safety and etc.Results Most of the hemodialysis met the clinical requirements while unqualified machines underwent maintenance,and some measures were proposed to solve the problems during the detection.Conclusion Periodical detection and quality control are of greát significance for the hemodialysis machine.
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Objective:In order to improve operator’s cognitive level for standardized disinfection, this paper will focus on analyzing and interpreting the disinfection procedures for some common dialysis machines.Methods: This paper will interpret and compare the disinfection procedures for three brands of dialysis machines in the following aspects: the choice of the disinfectant, the disinfection method, the concentration of the disinfectant and the injected volume of the disinfectant, etc.Results: The procedures of hot disinfection with citric acid were used completely in those three brands of dialysis machine, and the procedure of sodium hypochlorite need been used periodically to remove the proteins and other organic matter.Conclusion:Although the dialysis machines provide almost complete and efficient disinfection procedures, but the operator should need to select the most suitable procedures according to their practical situation. If the operators cannot master the disinfection procedures and have not noticed the importance of it, the wrong operator will lead to incomplete disinfection, affect the normal operation of the dialysis machines and increase the risk of cross-infection.
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Objective: To keep the ultrafiltration control systems running effectively, we take different maintenance methods. Methods:According to the different working principles, different ultrafiltration control systems need different ways to maintenance. Results:It is confirmed that maintenance can keep machine running in its best mode. Conclusion:Maintenance can provide the safe operation of hemodialysis machines, and ensure the medical quality.
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Objective:This paper analyzes different dialysate proportioning systems, when facing various types of system, we take different methods of maintenance to make the right proportion of dialysate. Methods: According to the different working principles, different dialysate proportioning systems need different ways to maintenance. Results:During the dialysis sessions, it makes proportioning of concentrations more stable. Conclusion:Maintenance can provide the safe operation of hemodialysis machines, and ensure high quality dialysis for patients.
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Objective:To investigate the feasibility of hemodialysis machine preventive maintenance model of based on quality control detection.Methods: Selected sample of 32 hemodialysis machines of two major imported brands, 16 of them using the traditional preventive maintenance mode for maintenance, and the other 16 sets of quality control detection based preventive maintenance hemodialysis machine maintenance mode. That: by use of HDM99XP detector instrument for testing the five hemodialysis machine main indicators, maintenance cycle is 16 weeks, and then the equipment failure rate indicators of two modes of preventive maintenance were compared.Results: The hemodialysis machine preventive maintenance model of based on quality control detection rise superior to the traditional maintenance mode in lower failure rate, quantitative, objective, and less affected by human factors.Conclusion: The hemodialysis machine preventive maintenance model of based on quality control detection was better than the traditional preventive maintenance mode,also a promising preventive maintenance mode.
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The test procedure and content of valves pressure test of AK95 hemodialysis machine are mainly introduced.The valves pressure test are the key of the self test procedure in hemsdialysis machine.It is necessary to find the accurate process where problems occur.[Chinese Medical Equipment Journal,2008,29(2):94]
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The BM self-test of GAMBRO AK95 hemodialysis machine is introduced, including venous pressure test, arterial pressure test, priming detector test, blood pump test, venous clamp test, arterial clamp test, air detector test, high venous pressure test, etc. The detail introduction of high venous pressure test is of great benefit to solve some faults of hemodialysis machine.
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The structure and function of the dialysate circuit of the hemodialysis machine are analyzed with the discussion on the relationship between dialysis quality,safety and compliations with the dialysate circuit,including dialysate temperature control,ultrafiltration control and dialysis hypotension,dialysate mixing and electrolytes homeostasis,disinfections of the machine and chronic inflammation of the patients,in order to improve the understanding on the related problems for both technicians and medical personnel,thus enhancing the prevention,monitoring and appropriate intervention of the potential failures,aiming to ensure the dialysis safety and optimal dialysis quality.
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Objective To get rid of the toxins from the blood when the blood pass through the hemoperfusion apparatus. Methods The circuit of the rejected hemodialysis machine was modified to make its monitoring unit and blood pump available. The blood was drawn from the body, and then the hemoperfution apparatus substituted as the dialyser. Results The application to 130 cases proved that the apparatus behaved well. Conclusion The modified machine can meet the desired requirements.