Training 4008 PDF

Fresenius Medical Care
Technical Training
on
4008 Dialysis Machine
Shanghai, April 2002
Hotin
May 2001
Dialyzer Membrane
May 2001
Fresenius Polysulfone - Structure
May 2001
Fresenius Polysulfone - Structure
HOLLOW FIBRE DIALYSER
PORE
PORESIZE
SIZEisisdependant
dependanton
onthe
thetype
type
ofofmembrane;
membrane;
HF Dialyser:
Pore size ~ 0.3nm
LF Dialyser:
Pore size ~ 0.1nm
May 2001
Venous Pressure
Measurement
P
Blood out
Venous
Bubble Catcher
Dialysate in
Dialyzer
Dialysate out
Venous Clamp
Blood in
Blood Pump
Arterial Pressure
Measurement
HEMODIALYSIS HD
The transport of uremic wastes by diffusion, i.e. the process in which

of particles move across a semipermeable membrane from the area
of higher concentration (blood) to the area of lower concentration
(dialysate).
May 2001
j:\sd\ch\folien\tpf_nma\hd_arm_e.cdr
SD / TRAINING CENTER SCHWEINFURT
Heater
Hemofilter
Blood leak
cleared blood detector
Filtr. pump Sub. pump
Blood Blood pump
Hemofiltration HF
Filtrate Substituate
Removal of uremic wastes by convective transport. The driving force is provided
by the transmembrane pressure present at the hemofilter.
Due to the filtration of large volumes during hemofiltration, simultaneous recon-

stitution of blood with appropriate amounts of physiologic replacements solution Fluid balance
is required.
May 2001
j:\sd\ch\folien\tpf_nma\hf_e.cdr
Heater
Hemofilter
cleared blood
Blood leak
detector
Filtr. pump Sub. pump
Blood Blood pump
Hemodiafiltration HDF Filtrate Substituate
Hemodiafiltration is a combination of hemodialysis and hemofiltration to take advan-

tage of the benefits of hemodialysis - high clearance of small-molecular substances
and hemofiltration - good clearance with middle-molecular substances.
Fluid balance
May 2001
j:\sd\ch\folien\tpf_nma\hdf_e.cdr
Display of the Clearance with the different Dialysis Treatment Procedures
Clearance
(ml/min) Fresenius Medical Care
200 conventional Hemodialysis
Hemofiltration
Hemodiafiltration with Polysulfone membrane (Fresenius)

150
100
50
Molecular-
102 103 104 105 weight
(Dalton)
Urea Inulin Albumin
Creatinin Vit. B12 ß2-Microglobulin
May 2001
FMC HD Machines - 4008B/S
May 2001
FMC HD Machines - 4008E/H
May 2001
FMC HD Machine - 4008S
May 2001
FMC HD Machine - 4008H
May 2001
Structure of Haemodialysis Machine
Main Components
Monitor - Control Unit

Modules - Extracorporeal
Blood Circuit
Hydraulics - Preparation of
Dialysis Fluid
May 2001
Structure of Haemodialysis Machine
• Operating Elements
Monitor • Displays
• Alarms
• Blood Pump
Extracorporeal • Heparin Pump
Blood Circuit • Air Detector
•• Preparation
Preparation ofof Dialysis
Dialysis Fluid
Fluid
-- Mixing
Mixing
Hydraulics -- Heating
Heating
-- Degassing
Degassing
•• Transport
Transport of
of dialysis
dialysis Fluid
Fluid
•• Fluid
Fluid Balance
Balance && Ultrafiltration
Ultrafiltration
May 2001
Electronic Compartment
May 2001
Blood Pump
• Arterial Pressure Connector

• Delivery Rate: 15 - 600 ml/min
• Automatic Stop in blood alarms
• Sensor to check the cover is open/closed
May 2001
Heparin Pump
Anticoagulation:
To prevent blood clotting in the

extracorporeal blood circuit
May 2001
Air Detector
• Ultrasonic Sensors
• Prevent air entering patient body
• Holder Size: 22 or 30 mm
• Venous Pressure Connector
• Venous Line Clamp (Optical Detector):

Closed in blood alarms
• Keys for fluid level adjustment
May 2001
bibag Module
May 2001
bibag Module
• Less Storage Space

• Lightweight
• Safe
• Clean
• Practical
• Long Shelf Life
• Environmentally Friendly
May 2001
Tasks of Haemodialysis Machine
1. Produce fresh dialysate
2. Provide correctly prepared dialysate to the dialyzer
3. Remove fluid from the patient by ultrafiltration
4. Handle and monitor effluent dialysate
5. Operate and control the extracorporeal circuit
May 2001
Basic Haemodialysis Setup
Monitor
Hydraulics
ECC Dialyzer
Preparation
& handling
of fresh
dialysate
Handling of Blood
used dialysate Ultrafiltrate lines
and
ultrafiltrate
HD Machine Extracorporeal
Circuit
May 2001
General Features / Benefits
•• High
High Safety
Safety Level
Level
-- 22 independent
independent microprocessor
microprocessor systems
systems
-- approved
approved hydraulic
hydraulic parts
parts
-- cyclic
cyclic pressure
pressure holding
holding tests
tests
•• Proven
Proven Volumetric
Volumetric Ultrafiltration
Ultrafiltration
•• Auto
Auto Self-test
Self-test
•• Auto
Auto Disinfection
Disinfection Programs
Programs
•• UF
UF // Na
Na Profiles
Profiles
•• Emergency
Emergency Battery
Battery Operation
Operation of
of Blood
Blood Systems
Systems (15
(15 …
… 20
20 min)
min) (Power
(Power Failure)
Failure)
•• Program
Program Heparinization
Heparinization Time
Time // Bolus
Bolus
May 2001
Features / Benefits in Operation / Handling
• Simultaneous Display of Status & Alarms

• Additional Alphanumeric Display
• Direct Selection of UF-parameters
• Intelligent Setting of Pressure Limits
• Pressure-corrected Blood Flow & Blood Volume Calculation
• Service Programs
May 2001
Options in 4008 System
Additional Status Display BPM

SN-Double Pump BTM
DIASAFE / DIASAFEplus Filter BVM
4008 HDF CDS
Online HDF / HF OCM
ONLINEplus IrDA
bibag
May 2001
SCREEN
SCREEN11
Here
Hereisisdisplayed
displayedthe;
the;
• •Machine type
Machine type
Greenindicates
Green indicatesthat
that • •Software
Softwareversion
version
this screen can be
this screen can be
viewed
viewedby bypressing
pressing
confirm. Tomove
confirm. To move
the
the cursor pressthe
cursor press the
arrow across
arrowacross
May 2001
SCREEN
SCREEN22
T1
T1Test
Test
IfIfan
anerror
erroroccurs
occursaa
• •xx oror
• •number
numberappears
appears
totoinform
inform youofofthe
you thefailure.
failure.
The
The alarm occurs at theEND
alarm occurs at the END
ofofthe test procedure
the test procedure
The
Thevarious
varioussteps
stepsofofthe
the
T1 TEST
T1 TEST
• •green
greenhighlights
highlightsthethespecific
specific
part of the test sequence
part of the test sequence
May 2001
SCREEN
SCREEN 33
IfIfthe
theT1
T1Test
Testisissuccessful
successful
the
the screen will becompleted
screen will be completed
with
with
May 2001
Ultrafiltration Dialysate
UF Values UF Goal Mixing Ratio
Menu UF Time Left Menu Base Na+
UF Rate Concentrate
UF Profile Bicarbonate
UF Volume Temperature
Flow
ISO Values ÍSO Goal Na+ Profile
ISO Time Start Na+
ISO Rate CDS
ISO Volume Conductivity window
Treatment Alarm limits System Dialysis

MAIN
MAINSCREEN
SCREENDISPLAY
DISPLAY parameters representations
mode menu
• Reset treatment
• HDF • Reinfusion Graphic displays for
parameters
• SN Click Clack • Needle Adjustment the front screen
• Brightness
prog
• Auto-On programme
• Arterial Limits • UF / Na Profiles
(cleaning modes)
• Venous Limits • Arterial/Venous pressures
• Date
• TMP Limits • BPM (syst/dias)
• System Time
• BPM MAP
(actual time)
• BTM
• BVM
• BPM / BVM
May 2001 • Cumulative bloodflow
• Effective Dialysis time
UF
UFMENU
MENU11
Isolated
Isolatedsequential
sequential
ultrafiltration
ultrafiltrationcan
canalso
also
Entering be performed.
Enteringthe
theUF
UFData
Data be performed.
To
Toenter
enterthis
thisfield
fieldpress
GREENcursor
GREEN cursorshows
showsyouyou press
which data can be entered arrow across
arrow across
which data can be entered
WHITEhighlight
WHITE highlighttells
tellsyou
you
which figure you can enter Then
Thenfollow
followthethesame
same
which figure you can enter
process as for entering
process as for entering
To the
thedata
datafor
forUF.
Tomove
movethrough
througheach
eachfield
field UF.
press the arrow Remember
Remember toenter
to enterthe
the
press the arrow
Total
Total Goal and Timeinin
Goal and Time
up
• •up
the
theUF
UFvalues
valuesandandthen
down
• •down then
ONLY the values
ONLY the values for for
the
theIsolated
Isolatedininthe
theISO
ISO
values
values
May 2001
UF
UFMENU
MENU22
When
Whenusing usingaaUF
UFprofile
profile
select the profile required
select the profile required
• •11- -66and
andthe
theappropriate
appropriate
graph will be displayed
graph will be displayed
• •Max
MaxRate Ratewill
willthen
thenbe
be
displayed.
displayed. This is thestart
This is the start
value of the ultrafiltration
value of the ultrafiltration
CHECK
CHECKtotoensure
ensurethat
thatthe
the
UF Co-eff of the dialyser
UF Co-eff of the dialyser
isissuitable
suitable!!!!
May 2001
DIALYSATE
DIALYSATE MENU
MENU
Setting
Settingthe
theDialysate
Dialysate
concentration
concentration
• •check
checkthe
themixing
mixingratio ratio
• •concentration
concentration of thecanister
of the canister
Conductivity
Conductivitywindow • •concentration
allows us to
window
move concentration requiredfor
required for
allows us to move the patient
the patient
ororcentre
centrethe
thealarm • •bicarbonate
guards when
alarm
we bicarbonatelevellevelfor forthe
the
guards when we patient
patient
change
changeanyanyofofthe • •dialysate
dialysate
the
parameters dialysatetemperature
temperature
dialysate parameters • •dialysate flow
dialysate flow
• •profile
profileififrequired
required++graphicgraphic
• •when selected a start
when selected a start value value
1mmol
1mmolgreater
greaterthan thanthethe
concentrate
concentrate level willbe
level will beshown
shown
This can then be increased
This can then be increased
according
according totothe theDoctors
Doctors
prescription
prescription
May 2001
TREATMENT
TREATMENTMODE
MODESCREEN
SCREEN
Single
SingleNeedle
NeedleClick-Clack
Click-Clack
can
canbebeused
usedininemergencies
emergencies
e.g.
e.g. when one ofthe
when one of theneedles
needlesblows
blows
and it is difficult to insert a second
and it is difficult to insert a second
• •upper
upperlimit
limitshould
shouldbe
belowered
lowered
totothe
the desired value by pressingthe
desired value by pressing the
- -minus key
minus key
• •lower
lowerlimit
limitshould
shouldbe
beraised
raisedtotoaa
value
value20
20mmHg
mmHghigher
higherthan
thanthe
the
pressure
pressure already achieved usingthe
already achieved using the
++key
key
• •then
thenmove
movethe
thecursor
cursortotothe
theOFF
OFF
and
and switch ON again by usingthe
switch ON again by using the
++/ /- -key
key
IfIfdesired
desiredyou
youcan
canalways
alwaysreturn
returntototwo
two
needle dialysis at a later time.
needle dialysis at a later time.
May 2001
ALARM
ALARMLIMITS
LIMITSSCREEN
SCREEN
Reinfusion
Reinfusion
allows
allowsusustotogive
givesaline
saline
during
during or at the endofof
or at the end
Here
Hereititisispossible
possibletoto the
thedialysis
dialysisby by
reposition
repositionand andmake
makethe OPENING
the OPENING thealarm
the alarm
alarm guards either
alarm guards either guards to avoid nuisance
guards to avoid nuisance
wider
widerorornarrower
narrower alarms
alarms
• •Arterial,
Arterial,
• •Venous ItItisisactive
Venous activefor
for3minutes
3minutes
• •TMP
TMPLimits
Limits ororititwill automatically
will automatically
return
returntotonormal
normalstatus
statusifif
blood
bloodisisseen.
seen.
Needle
NeedleAdjustment
Adjustment
deactivates
deactivatesthe thealarm
alarm
guards
guards for arterialand
for arterial and
venous pressures
venous pressures forfor
33min.
min.totoallow
allowyou
youtoto
turn
turnorormanipulate
manipulatethethe
needle with the blood
needle with the blood
pump
pumprotating.
rotating.
May 2001
SYSTEM
SYSTEMPARAMETERS
PARAMETERSSCREEN
SCREEN
Auto
Auto-On-Onprogramme
programme
allows
allows youtotoselect
you selectaa
cleaning
cleaningprogramme
programmeand andthe
the
time you would like the The
Thenumber
numberindicated
indicated
time you would like the here
programme
programmetotocommence
commence here can be enteredusing
can be entered using
ininthe key
key board to quicklyenter
board to quickly
the morning,sosothat
morning, thatthe
the the data for the
enter
Auto-On
machine
machine will be cleanedand
will be cleaned and the data for the Auto-On
ready for use before the staff programme
programme
ready for use before the staff
arrive
arriveininthe
theunit
unit
Brightness
Brightnessallows
allowsyou
youtoto Reset
Resetmeans
meanstotoerase
eraseall
allthe
the
dim
dimororbrighten
brightenthe
thelights
lights data you have in the UF menu
data you have in the UF menu
on the machine
on the machine during
duringthe
thetreatment.
treatment.
ALL DATAwill
ALL DATA willthen
thenbe
belost
lost
System
SystemTime
Timeand
andDate
Dateshould
shouldbebechanged
changedtotoyour
yourlocal
localtime
time
This leaves the factory with the Time in Germany
This leaves the factory with the Time in Germany !!!!
May 2001
4008
116
111
73
75
63 87
24b 112 24
109 7
86 61 3
30
97
41 76 8
29
92 54 43
31 32 33 34 114
2 5 150
6
9
66 a b c 26
68 89 88
151 a b c
77 115 84 115 85
35 36 37 38 78
65 21 74
125
94 98 95
10 12
a 90 b 91
22
23 94 95 25
71 72
May 2001

4008
73 111
87 116
24b 112
109 7 Fresenius Medical Care
63
3 75
86 61
24
A 30
97
76 8
41 29
43 114
31 32 33 34
92 54 150
5 6
2
9
26
68 89 88
66 a b c a b c
84 85
151
35 36 37 38 78
77 115 115
21 74
65
B 125
99
94 95
10 12
149 148
25
100 91 22
90 90
a b 130
123
119 117 102 137
121 P 104 134 135
138
122 P 23
120 118
124 136
131b
131a
133
132
May 2001 95 94
72 71
Theory of Operation of Balancing Chamber
1st cycle:
31 32 33 34
BC1 BC2
from Patient
Balance Chamber Dialyser to Patient
21
35 36 37 38
Fresh Dialysate
May 2001
Theory of Operation of Balancing Chamber
2nd cycle:
Spend Dialysate to Drain
31 32 33 34
BC1 BC2
from Patient
Balance Chamber Dialyser to Patient
35 36 37 38 21
Fresh Dialysate
May 2001
Closed System
0 ml 10 ml
10 ml
May 2001
Closed System
Spend Dialysate
to Drain
Balance Chamber
to Patient
Dialyser
from Patient
Fresh Dialysate
to Balance Chamber
May 2001
Closed System with UF
Spend Dialysate
to Drain Balance Chamber
Dialyser
to Patient
10 ml from Patient
Fresh Dialysate
to Balance Chamber
Only the amount of fluid

UF Pump
removed by the UF pump
10 ml is removed from the patient.
Ultrafiltrate to Drain
May 2001
Fill Program
11st
st cycle:
May 2001
Fill Program
22nd
nd cycle:
May 2001
Open System
Pven
PDial TMP
ml
UFK = 4
Dialysate Flow electronic mmHg x h
TMP-Control
Pump Vacuum
Pump
W [kg] = TMP [mmHg] x UF K [ ml
mmHg x h [ x t [h]
Dialysate Flow
+ UF-Volume W
TMP =
UFK x t
Dialysate
Preparation
System
May 2001
j:\sd\ch\folien\tpf_nma\ope_sy_e.cdr
Closed System
Pven
1 6 0 0
PDial TMP
timer
UF-Pump counter
Dialysate
Drain Flow
Flow- Pump 1 ml
Fresh Old
UF Vol
Advantage:
Very precise volumetric ultrafiltration control
Good for High-Flux Dialyzers
fresh
Dialysate
High effective & short time dialysis
from
Preparation
System
May 2001
j:\sd\ch\folien\tpf_nma\clo_sy_e.cdr
Overview of Cleaning Programs
End of Dialysis
Rinse
Rinse Hot
Hot Rinsing
Rinsing Disinfection
Disinfection (Cleaning)
(Cleaning)
PGM
PGM 1:
1: --F-HR-C-
F-HR-C- PGM
PGM 1:
1: --F-D-M-
F-D-M-
PGM
PGM 1:
1: --R-
R- PGM
PGM 2:
2: --F-HR
F-HR PGM
PGM 2:
2: --F-HDIS-M-
F-HDIS-M-
PGM
PGM 2:
2: --R-
R- endless
endless PGM
PGM 3:
3: --IHR
IHR PGM
PGM 3:
3: --F-D-M-HR-
F-D-M-HR-
PGM
PGM 4:
4: --F-HDIS-M-HR-
F-HDIS-M-HR-
PGM
PGM 5:
5: --F-D(F)-M-
F-D(F)-M-
Dialysis
May 2001
4008
116
111
73
75
63 87
24b 112 24
109 7
86 61 3
30
97
41 76 8
29
92 54 43
31 32 33 34 114
2 5 150
6
9
66 a b c 26
68 89 88
151 a b c
77 115 84 115 85
35 36 37 38 78
65 21 74
125
94 98 95
10 12
a 90 b 91
22
23 94 95 25
71 72
May 2001

Valve Sequences in Cleaning Programs
In cleaning programs V91 opens with each BC cycle for 0.5 sec.
in order to clean the rinse chambers (90).
The Con. & Bic. Pumps are doing 1 stroke per BC cycle.
RINSE: (F, R, C)
• Normal Cycles (18) : Flushing out
- V41 controlled by Float Switch
- BC cycled like in dialysate mode
- V24, V24b, V30, V87 open
- V26, V43, V84, V86 closed
May 2001
Fill Cycles (2) :

- BC cycled like in FILL PROGRAM
- V26, V43, V86 open
- V24, V24b, V30, V41, V84, V87 closed
- ASP runs
- UF -Pump runs (max. frequency)
UF-Pump
• MANDATORY RINSE: (M)

- V43 permanent open
- UF -Pump runs permanent (max. frequency)
UF-Pump
May 2001
• RECIRCULATED CLEANING PROGRAMS: (D, HDIS, HR)
GENERALLY:
- V86 open
- V87 closed
- V43 open
- UF-Pump runs (max. frequency)
NORMAL CYCLES (D:18 / HDIS,HR:13):

- BC cycled like in dialysis mode
- V24, V24b, V30 open
- V26, V41, V84 closed
May 2001
FILL CYCLES (2):

- BC cycled like in FILL PROGRAM
- V26 open
- V24, V24b, V30, V41, V84 closed
- ASP runs
May 2001
4008
116
111
73
75
63 87
24b 112 24
109 7
86 61 3
30
97
41 76 8
29
92 54 43
31 32 33 34 114
2 5 150
6
9
66 a b c 26
68 89 88
151 a b c
77 115 84 115 85
35 36 37 38 78
65 21 74
125
94 98 95
10 12
a 90 b 91
22
23 94 95 25
71 72
May 2001

Preparation for Chem. Disinfection Programs 1…4
Prior Aspiration of Disinfectant

The given values are based on a standard machine. For machines
including Diasafe or On-Line-HDF the vol. of disinfectant are increased!
• After Rinsing Clean (F) is finished:
1. Closing of the BC valves with the current increase pulse

2. Waiting for the floater to reach “up”-position
3. V41-control disabled. V26, V43, V87 & BC fresh fluid valves open,
degassing pump delivers fluid with reduced speed from the heater block,
until the lower switch point of the floater is reached.
May 2001
Preparation for Chem. Disinfection Programs 1…4
4. 1 BC cycle → level in 66 c: 30ml below lower switch point
5. V26, V87 & BC fresh fluid valves open, V43 closed,

degassing pump off, UF-Pump: 4 strokes
→ Level: 34ml below lower switch point
6. V84, V86 open, UF-Pump: 50 strokes = 50ml disinfectant

(Dilution 1:25), the conductivity is monitored by the sensors 115:
If there is no conductivity detected after 24 strokes, the process
is stopped: alpha display “DISINFECTANT EMPTY ?”
After 50 strokes of the UF-Pump the floater must be in “up” position.
May 2001
Preparation for Chem. Disinfection Program 5
Prior Aspiration of Disinfectant

The given values are based on a standard machine. For machines
including Diasafe or On-Line-HDF the vol. of disinfectant are increased!
• After Rinsing Clean (F) is finished:
1. Closing of the BC valves with the current increase pulse

2. Waiting for the floater to reach “up”-position
3. V41-control disabled. V26, V43, V87 & BC fresh fluid valves open,
degassing pump delivers fluid with reduced speed from the heater block,
until the lower switch point of the floater is reached.
May 2001
Preparation for Chem. Disinfection Program 5
4. V26, V87 & BC fresh fluid valves open, V43 closed,

degassing pump off, UF-Pump: 23 strokes = 23ml
5. After the disinfectant is connected the aspiration is done by use of

the acid pump.
32 strokes of acid pump = 37ml disinfectant (Dilution 1:34)
6. After aspiration the floater must be in “up”-position.
May 2001
4008 Hydraulic Functions in Cleaning Programs
With
With Diasafe
Diasafe (in
(in round
round brackets)
brackets)
&
& On-Line-HDF
On-Line-HDF (in
(in square
square brackets)
brackets)
Rinse HR/HDIS 2 & 4 DIS 1 & 3 DIS 5
Flow [ml/min] 600 450 600 600

Flow Pump [ml/min] 600 600 720 720
BC Switch Delay [s] - 1 0.5 0.5
Dead Time [ms] 250 250 250 250
BC Cycles 18x normal / 13x normal / 18x normal / 18x normal /
2x Fill + ASP on 2x Fill + ASP on 2x Fill + ASP on 2x Fill + ASP on
Recirculation - X X X
UF-Pump 4000ml/h In Fill Cycle continuous continuous continuous
Mandatory Rinse:
continuous
May 2001
4008 Hydraulic Functions in Cleaning Programs
Rinse HR/HDIS 2 & 4 DIS 1 & 3 DIS 5
Vol. of Disinfectant [ml] - - /50 50 37

(66) (66) (49) [61]
[82] [82] Conc. Pump
32 strokes
UF-Pump UF-Pump (42) [52]
Disinfection Dilution - - / 1:25 1:25 1:34
Degassing Pump Speed - - by 6V - -
Reduct.
Temp. [°C] 37 84 37 37
87
at NTC 3
Temp. Limit [°C] 33.5 / 41 78.5 / 90 33.5 / 41 33.5 / 41
Timer start ≥ 80
End of prg. 10 strokes 10 strokes 10 strokes 10 strokes
Rinse Chamber Evac.
Conc. P. + Bic. P.
May 2001
4008
116
111
73
75
63 87
24b 112 24
109 7
86 61 3
30
97
41 76 8
29
92 54 43
31 32 33 34 114
2 5 150
6
9
66 a b c 26
68 89 88
151 a b c
77 115 84 115 85
35 36 37 38 78
65 21 74
125
94 98 95
10 12
a 90 b 91
22
23 94 95 25
71 72
May 2001

Dialysate Alarms: Conductivity & Temperature
• Optical Alarm (continuous)
• Audible Alarm
• Bypass (no external flow: V24 closed, V26 open)
• No Storage (self resetting)
May 2001
Upper Temperature Alarm
• All consequences like the other

“Dialysate Alarms” as before
• Additional the heater is controlled OFF (40° C)
• By actual display value exceeding the display range:

Heater Relay opens (41° C)
May 2001
Flow Problems - Water Alarm
2 conditions:
1. The floater stays in position “DOWN ”

(No water available)
Reactions: After 6 seconds:

• Alpha display shows: “WATER ALARM”
• Heater OFF
• Balancing Chamber cyclings stop
• Alarm
May 2001
Flow Problems - Water Alarm
2. The floater stays in position “UP” for more than

30 seconds
Reactions:
• Heater OFF
• Balancing chamber cyclings continue
• Alarm
May 2001
Flow Problems - Flow Alarm
Condition: No current increase impulse within 12 seconds
Reactions:
• Balancing chamber cyclings done by “EIGENTAKT”

• Heater OFF
• Alarm
May 2001
During a cleaning program - Upper Flow Alarm
Condition: The flow increased to more than 1000ml/min
Reactions:
• Program stops
• Alarm
May 2001
Flow - Troubleshooting Recommendations
• Check the pressures in the hydraulics
• Watch the drain line (fluid amount per BC cycling)
• Observe the valve sequences with the test box
May 2001
Blood Alarms
• Optical Alarm (1st alarm flashing,

following alarm continuous)
• Audible Alarm
• Blood Pump Stop
• Venous Line Clamp Closed
• UF-Pump Stop
• Alarm Storage (reset by DIALYSIS START)
May 2001
TMP Alarm
• All consequences like the other Blood Alarms as before
• Additional the Closed System opens to atmosphere

(V43 opens during DEAD TIME)
May 2001
LP631 (CPU1) DIP Switch Array 1
May 2001
May 2001
Must
Must be
be OFF
OFF
May 2001 Must

Must be
be OFF
OFF
May 2001
Miscellaneous
May 2001
4008
Filling
Filling Procedures
Procedures 87
73 111
116
•• BC
BC off
off 24b 112Fresenius Medical Care
109 7
•• V91
V91 opens
opens 63
•• Pump
Pump 29 29 3 75
86 61
⇒ 1300-1800ml/min
⇒1300-1800ml/min 24
A 30
•• Pressure
Pressure (134)
(134) 97
8
76
>> +130mbar
+130mbar 41 29
⇒⇒ V91
V91 closed
closed 92
31 32 33 34
43 114
54
•• BC
BC starts;
starts; 150
5 6
Pump 2
Pump 25 25 starts
starts 9
26
•• Pressure
Pressure (134)
(134) 66 a b c
68 89 88
a b c
<< +100mbar
+100mbar 151
84 85
35 36 37 38 78
⇒ V91
⇒ V91 opens
opens atat 77
21 74
115 115
dead -time of
dead-time of BC
BC 65
B 125
99
94 95
10 12
149 148
25
100 91 22
90 90
a b 130
123
119 117 102 137
121 P 104 134 135
138
122 P 23
120 118
124 136
131b
131a
133
132
May 2001 biBag

biBag 95 94
72 71
Last 3-min Rinse Test
•• During
During the
the last
last 33 min
min of
of
the
the mandatory
mandatory rinse
rinse program
program
•• DIP
DIP switch
switch 77 of
of DIP
DIP array
array 22 of
of LP631
LP631
set
set to
to ON
ON
May 2001
4008
73 111
87 116
24b 112
109 7 Fresenius Medical Care
63
3 75
86 61
24
A 30
97
76 8
41 29
43 114
31 32 33 34
92 54 150
5 6
2
9
26
68 89 88
66 a b c a b c
84 85
151
35 36 37 38 78
77 115 115
21 74
65
B 125
99
94 95
10 12
149 148
25
100 91 22
90 90
a b 130
123
119 117 102 137
121 P 104 134 135
138
122 P 23
120 118
124 136
131b
131a
133
132
May 2001 95 94
72 71
Last 3-min Rinse Test - 2
May 2001
Diagnostics - Applications
Prerequistes:
• Water Supply present

• Test Box connected
1. Clean V84 (disinfectant deposits, crystals)

Caution! In this application there’ll be outflow from the
disinfectant connector
- Enable FLOAT SWITCH “FL_SWITCH_EN”

- Open V35, V31, V26, V84
- Run degassing pump “STOP_EP”
May 2001
2. Check the Closed System for tightness:
2.1 With Negative Pressure
- Connect an external dialysate pressure gauge
- Eliminate air from the hydraulic unit by selecting

menu point CALIBRATION / UF-Pump (Ver 1):
machine performs FILL PROGRAM (flow must be on)
- Open V24, V24b, V30, V87

May 2001
- Create a dialysate pressure of app. -500mmHg by

the ASP
- Observe the dialysate pressure

to be stable for 3 min.
- Max. pressure change: +40mmHg
- If pressure stable, the closed system is tight
May 2001
2.2 With Positive Pressure
- Connect hydraulic pressure gauge to measure

point C (Flow Pump outlet)

menu point CALIBRATION / UF-Pump (Ver 1):
machine performs FILL PROGRAM (flow must be on)
- Enable float switch
May 2001
- Open V35, V31, V24, V24b, V87
- Run degassing pump
- Close V35, V31
- If pressure on the hydraulic pressure gauge is stable,

the closed system is tight
May 2001
- Check heater exchanger, V86, V87
- Close V87
- Open V43
- Pressure stable ?
May 2001
3. Check Balancing Chamber Valves for tightness:

menu point CALIBRATION / UF-Pump (Ver 1)
3.1 Check the fresh dialysate valves:
- Open float switch
- Open V24, V24b, V30, V87

May 2001
- Run degassing pump
- Create a dislysate pressure of app. -500mmHg by

the ASP
- Test of V35:
- Open V31
- Observe the dialysate pressure to be stable for 3 min.
- Max. pressure change: +40mmHg
- If pressure is stable, V35 is tight
- Close V31
May 2001
- Test of V37:
- Open V33 ...
- Test of V31:
- Open V35 ...
- Test of V33:
- Open V37 ...

May 2001
3.2 Check the spent dialysate valves:
- Open V24, V24b, V30, V87
- Run flow pump
- Open V43 to reduce dialysate pressure
- Close V43
May 2001
- Test of V36:
- Open V32
- Observe the dialysate pressure to be stable for 3 min.

- Max. pressure change: -40mmHg
- If pressure is stable, V36 is tight
- Close V32
May 2001
- Test of V38:
- Open V34 …
- Test of V32:
- Open V36 …
- Test of V34:
- Open V38 ...

May 2001
TSC & Maintenance Checklist
May 2001
May 2001
May 2001
May 2001

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Fresenius Medical Care

Shanghai, April 2002

HOLLOW FIBRE DIALYSER

The transport of uremic wastes by diffusion, i.e. the process in which

Fresenius Medical Care

Filtr. pump Sub. pump

Blood Blood pump

Due to the filtration of large volumes during hemofiltration, simultaneous recon-

Filtr. pump Sub. pump

Blood Blood pump

Hemodiafiltration HDF Filtrate Substituate

Hemodiafiltration is a combination of hemodialysis and hemofiltration to take advan-

Hemodiafiltration with Polysulfone membrane (Fresenius)

Creatinin Vit. B12 ß2-Microglobulin

Monitor - Control Unit

• Arterial Pressure Connector

To prevent blood clotting in the

• Prevent air entering patient body

• Venous Pressure Connector

• Venous Line Clamp (Optical Detector):

• Keys for fluid level adjustment

• Less Storage Space

1. Produce fresh dialysate

2. Provide correctly prepared dialysate to the dialyzer

3. Remove fluid from the patient by ultrafiltration

4. Handle and monitor effluent dialysate

5. Operate and control the extracorporeal circuit

• Simultaneous Display of Status & Alarms

Additional Status Display BPM

Treatment Alarm limits System Dialysis

SD / TRAINING CENTER SCHWEINFURT

Only the amount of fluid

SD / TRAINING CENTER SCHWEINFURT

Fill Cycles (2) :

• MANDATORY RINSE: (M)

• RECIRCULATED CLEANING PROGRAMS: (D, HDIS, HR)

NORMAL CYCLES (D:18 / HDIS,HR:13):

FILL CYCLES (2):

SD / TRAINING CENTER SCHWEINFURT

Prior Aspiration of Disinfectant

• After Rinsing Clean (F) is finished:

1. Closing of the BC valves with the current increase pulse

4. 1 BC cycle → level in 66 c: 30ml below lower switch point

5. V26, V87 & BC fresh fluid valves open, V43 closed,

6. V84, V86 open, UF-Pump: 50 strokes = 50ml disinfectant

Prior Aspiration of Disinfectant

• After Rinsing Clean (F) is finished:

1. Closing of the BC valves with the current increase pulse

4. V26, V87 & BC fresh fluid valves open, V43 closed,

5. After the disinfectant is connected the aspiration is done by use of

6. After aspiration the floater must be in “up”-position.

Rinse HR/HDIS 2 & 4 DIS 1 & 3 DIS 5

Flow [ml/min] 600 450 600 600

Rinse HR/HDIS 2 & 4 DIS 1 & 3 DIS 5

Vol. of Disinfectant [ml] - - /50 50 37

SD / TRAINING CENTER SCHWEINFURT

• Optical Alarm (continuous)

• Bypass (no external flow: V24 closed, V26 open)

• No Storage (self resetting)

• All consequences like the other

• Additional the heater is controlled OFF (40° C)

• By actual display value exceeding the display range:

1. The floater stays in position “DOWN ”