Flow balance optimization and fluid removal accuracy with the Quanta SC+ hemodialysis system.

BACKGROUND: Fluid management is integral to hemodialysis, both to correct abnormalities in a patient's plasma composition and to maintain fluid balance. Consequently, accurate net fluid removal during treatment is a critical design element of hemodialysis machines. As dialyzers have evolved, with increased ranges of ultrafiltration coefficients available, it has become more challenging for dialysis machines to minimize errors in flow balance and net fluid removal. RESEARCH DESIGN AND METHODS: This paper describes the design, evaluation and experimental performance of the flow balance and ultrafiltration module of the SC+ system to deliver clinically specified fluid removal with both passive and active control measures, in laboratory conditions designed to simulate a wide range of therapies. RESULTS: The use of passive and active control allows the errors to be minimized across a wider dynamic range of conditions. For the SC+ system, the average flow balance error was 1 mL/hr with an SD of 19 mL/hr and with ultrafiltration it was 13 mL/hr and an SD of 20 ml/hr across all conditions. CONCLUSIONS: This paper demonstrates that the SC+ hemodialysis system, a small, simple and versatile CE marked device, operates within the limits required by international standards across a wide range of experimental conditions.

[Analysis and Processing of Flow Alarm about Fresenius 4008 S Hemodialysis Machine].

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.

Analysis and Processing of Flow Alarm about Fresenius 4008 S Hemodialysis Machine / 中国医疗器械杂志

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.

[Analysis and Solution to Hemodialysis Machine & Accessories Faults].

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.

Analysis and Solution to Hemodialysis Machine & Accessories Faults / 中国医疗器械杂志

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.

The Effect of Increasing Blood Flow Rate on Severity of Uremic Pruritus in Hemodialysis Patients: A Single Clinical Trial.

BACKGROUND: Although the prevalence of uremic pruritus has decreased compared to the past, the problem still remains as a matter of health and a major challenge of research in medical field, and has no effective treatment at present. This study aimed to investigate the effect of increasing blood flow rate on severity of uremic pruritus in hemodialysis patients in Iran. METHODS: This clinical trial was performed on 60 hemodialysis patients that referred to hospitals affiliated to Tehran University of Medical Sciences and these patients were selected through the convenience method and were treated for four weeks. They were divided into two groups of experimental and control as random allocation block, and studied for 4 weeks. Information on pruritus severity was collected using a researcher-made questionnaire in three steps of before intervention and two and four weeks after start of intervention. The rate of blood flow was increased in the first two weeks and the second two weeks by 25 and 50 rounds per minute (rpm) compared to the mean rate of blood flow of hemodialysis device in the last two sessions before intervention. Data were analyzed using the tests Mann-Whitney, Fisher, and t-test. RESULTS: Analysis of data from 50 persons in both groups who completed the study revealed a significant difference between the groups in the severity of pruritus between the two sessions of hemodialysis (pruritus at home) at the end of the first two weeks of the intervention (<0.05) and the number of cases of pruritus (<0.05) at the end of the study. CONCLUSIONS: Increasing blood flow for hemodialysis machine can induce significant statistical and clinical reduction in the severity and the frequency of pruritus in hemodialysis patients and can be help to be improve the quality of life of these persons by increased the blood flow rate.

Research on risk control of hematodialysis equipment based on statistical data of failure / 中国医学装备

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.

In vivo and in vitro performance of a China-made hemodialysis machine: a multi-center prospective controlled study.

OBJECTIVE: To evaluate the in vivo and in vitro performance of a China-made dialysis machine (SWS-4000). METHODS: This was a multi-center prospective controlled study consisting of both long-term in vitro evaluations and cross-over in vivo tests in 132 patients. The China-made SWS-4000 dialysis machine was compared with a German-made dialysis machine (Fresenius 4008) with regard to Kt/V values, URR values, and dialysis-related adverse reactions in patients on maintenance hemodialysis, as well as the ultrafiltration rate, the concentration of electrolytes in the proportioned dialysate, the rate of heparin injection, the flow rate of the blood pump, and the rate of malfunction. RESULTS: The Kt/V and URR values at the 1st and 4th weeks of dialysis as well as the incidence of adverse effects did not differ between the two groups in cross-over in vivo tests (P > 0.05). There were no significant differences between the two groups in the error values of the ultrafiltration rate, the rate of heparin injection or the concentrations of electrolytes in the proportioned dialysate at different time points under different parameter settings. At weeks 2 and 24, with the flow rate of the blood pump set at 300 mL/min, the actual error of the SWS-4000 dialysis machine was significantly higher than that of the Fresenius 4008 dialysis machine (P < 0.05), but there was no significant difference at other time points or under other settings (P > 0.05). The malfunction rate was higher in the SWS-4000 group than in the Fresenius 4008 group (P < 0.05). CONCLUSIONS: The in vivo performance of the SWS-4000 dialysis machine is roughly comparable to that of the Fresenius 4008 dialysis machine; however, the malfunction rate of the former is higher than that of the latter in in vitro tests. The stability and long-term accuracy of the SWS-4000 dialysis machine remain to be improved.

Problems in quality control of hemodialysis machine / 医疗卫生装备

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.

Interpretation of disinfection procedures based on common hemodialysis machines / 中国医学装备

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.

A design about the system of leak detection of hemodialysis machine / 中国医学装备

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.

Working principles and application of different ultrafiltration control systems / 中国医学装备

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.

Explore the feasibility of preventive maintenance model of hemodialysis machine based on quality control detection / 中国医学装备

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.

Working principles and maintenance of different dialysate proportioning systems / 中国医学装备

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.

Efficacy of Heat Disinfection With the Aksys Personal Hemodialysis System.

The first objective of this study was to validate the use of water at 85°C ± 5°C to achieve high-level disinfection of a clean-in-place extracorporeal dialysis circuit. The second objective was to demonstrate that applying this hot water method to the entire fluid pathways of a newly designed dialysis instrument, including an integral reverse-osmosis membrane, routinely allowed the production of back-filtered dialysate meeting the U.S. Pharmacopeia (USP) standard for the water for injection (WFI). In a first study, six dialyzers were inoculated with P. aeruginosa, incubated, and subjected to 75°C water for 30 minutes. No organisms could be recovered from the experimental dialyzers nor from three negative controls, but they were recovered from three positive controls. In a second study, the carbon tanks in the water inlet line and the dialysate tank were both inoculated with massive amounts of dialysis water-adapted Gram-negative organisms, followed by seven dialysis treatments using bovine blood, where the fifth and sixth procedures were separated by 2 idle days and the sixth and seventh procedures were separated by 3 idle days. In addition, the bovine blood used in each treatment was highly contaminated. In every case, the back-filtered dialysate met the WFI standard. From the above results we conclude that a hot water disinfection process is efficacious in reducing even grossly exaggerated contamination in the Aksys personal hemodialysis system to the point where it can produce water and dialysate that greatly exceed the Association for the Advancement of Medical Instrumentation (AAMI) standards and priming and rinse-back solution (back-filtered dialysate) that meets the USP standard for WFI.

Transformation of hemodialysis machine into bedside hemofiltration apparatus / 医疗卫生装备

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.

Relationship Between Hemodialysis Dialysate Circuit Functions and Dialysis Quality / 医疗卫生装备

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.

BM Self-test of GAMBRO AK95 Hemodialysis Machine / 医疗卫生装备

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.

Analysis on Valves Pressure Test of GAMBRO AK95 Hemodialysis Machine / 医疗卫生装备

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]