Prismaflex System Basic Alarm Overview Safety Feature Components Alarm Lights Display screen Blood Leak Detector Bar Code Reader Syringe Pump Pressure Monitors Scales Pressure Monitors Air Bubble Detector Return Line Clamp Blood/Patient Sensor Prismaflex Types of Alarms 1. Warning - Patient hazard • • • Patient and System at risk Needs immediate action Treatment suspended 2. Malfunction - Failure of safety system • • • Patient and System at risk Needs immediate action Treatment suspended 3. Caution - Informs operator of an action • • • Highest priority 1 2 3 4 Lowest priority Patient and System not at immediate risk Needs action Treatment continues; Blood and syringe flows continue 4. Advisory - Informs operator of an action • • Patient and System not at immediate risk Treatment continues; Blood and syringe flows continue The THREE Troubleshooting Commandments •Read Screen •Follow Steps •Check Manual Alarm Screens Trans-Membrane Pressure (TMP) • Pressure exerted on filter membrane during operation • Reflects pressure difference between fluid and blood compartments of filter • Calculated by Prismaflex software Trans-Membrane Pressure (TMP) Calculated and automatically recorded: • • • • Entering Run mode - blood flow is stabilized Blood flow rate is changed Patient fluid removal rate is changed Replacement solution rate is changed Membrane permeability TMP Filter Pressure Drop (ΔP Filter) • Change of pressure from blood entering filter and leaving filter • Determines pressure conditions inside hollow fibers • Calculated and automatically recorded: • Entering Run mode • Blood flow rate is changed • Calculated by Prismaflex software Access and Return Pressures Is it the Vascular Access?? Access Pressure Extremely Negative Due to vascular access/catheter: • • • • Sitting against vessel wall Fibrin coating on outside of catheter lumens Clots on inside of catheter lumens Size is too small (Adults require 11 Fr or larger) Other possible causes: • Stopcocks inline with Prismaflex set • Position of patient Kinking bloodlines • Ensure lines are unclamped Return Pressure Extremely Positive • Due to vascular access catheter: • • • • Sitting against vessel wall Fibrin coating on outside of catheter lumens Clots on inside of catheter lumens Size is too small Adults require 11 Fr and larger • Other possible causes: • Stopcocks inline with Prismaflex set Infusing something into Return side of the Prismaflex circuit can increase Return Pressure • Position of patient • Kinking bloodlines • Ensure lines are unclamped Warning Access Disconnection-Pressure is zero Possible Causes: Possible Solutions: •Disconnection •Pressure pod not installed properly •Debris in pod housing •BFR too low for vascular access •Pressure sensor failed •Press MUTE •Secure connection •Press OVERRIDE •Increase BFR •Clean, reinstall, reposition pod • Self-test or manually •Consult screen display for more info •Follow hospital protocol if unable to repair. Warning Return Disconnection-Pressure is zero Causes: •Disconnection •Pressure pod not installed properly •Dirty pod •BFR too low •Pressure sensor failed Solutions: •Press STOP •Press MUTE •Increase BFR •Clean, reinstall, reposition pod •Press OVERRIDE •Follow hospital protocol if unable to repair. Advisory: “Cannot Detect . . .” • Advisory: Cannot detect access: 0 to –10mmHg • Use of large bore patient catheter • Low blood flow for type of vascular access • Self-clears if condition does not exist • Advisory: Cannot detect return: 0 to +10mmHg • • • • Loose or disconnected return line Low blood flow for type of vascular access Loose or disconnected chamber monitor line Wet fluid Barrier filter Hemofilter Pressures Is it the Filter?? Filter Extremely Positive Possible Causes: Possible Solutions: •Line clamped, kinked •High return pressure •Clotting in filter has begun •Pressure sensor failed •Press MUTE •Remove clamps or kinks •Lower BFR •Press CONTINUE •Change set Safety Features Blood Leak Detected (BLD) • Leakage of blood to the fluid side of the hemofilter • Other causes: • • • • • Air in effluent line Effluent line not properly installed in BLD Myoglobin (trauma, burn, Rhabdomyolysis) Bilirubin (Liver failure, Hyperbilirubin) Conjugated only Debris in sensor housing Blood Leak Detected: First Actions • Confirm that line is properly installed • Press OVERRIDE • Press line into detector from the bottom up • Press OVERRIDE • Clean inside of detector with a lint-free cloth and isopropyl alcohol • Dry thoroughly • Reinsert line BLD Alarm: Normalize BLD • Press SYSTEM TOOLS on Status screen • Press NORMALIZE BLD soft key • Follow instructions • Observe or test effluent for blood • If positive for blood, press END TREATMENT • (Do not return blood,?) and set up new circuit . Effluent Testing Do’s & Don’t’s • When testing effluent, DO: • Use a quantitative method: • Run effluent as though it were blood • Perform RBC count • Results should be zero • Run as body fluid cell count • When testing effluent DO NOT: • Use Hem-a-Stix or other urine dipstix • Run effluent as urine sample Air Bubble Detector •Ultrasonic •Located along return line •Alarm activated by: • air in blood • micro air Air Detector Return Line Clamp Considerations for Air Detector • Monitor blood level in deaeration chamber hourly with I&O • Keep blood level at designated line on chamber • Blood level too high with return line clamping may allow Blood to enter fluid barrier and interior of control panel • Fluid level too low may cause “Air in Blood” alarm Air in Blood Possible Causes: •Improper connection • • • • Catheter Anticoagulation Replacement line Blood warmer connector •Improper priming •Return line not installed properly •Access pressure extremely negative Possible Solutions: •Check and tighten connections •Install return line properly •Perform air removal procedure: • Status Screen • SYSTEM TOOLS • ADJUST CHAMBER •Lower blood flow rate •Replace filter set Advisory: Time to Change Set •Occurs after 72 hours or when 780 L of fluid is processed •Available in HISTORY SCREEN, then CHANGE PERIOD CRRT Scales Warning (CAUTION): Scale open Specific scale identified Inspect scale component and remedy, then close properly Warning (CAUTION): Effluent bag incorrect Hanging effluent bag does not match set “Allowed effluent volume” No bag on scale or bag is partially supported Change the effluent bag or modify “Bag Volume” Hang appropriate bag Allow bag to hang freely Warning (CAUTION): Bag container empty Bag is specified Bag is empty or supported Warning (CAUTION): Effluent bag full Bag is specified Inspect scale for foreign object Replace effluent bag CRRT Scales Advisory: Clamped bag Early notice of clamped bag or line immediately after a bag change Inspect bag/line for patency View history for flow volume May cause unsafe fluid balance errors Fluid Control Unit ® Continuous Monitor feedback Balances fluid between: • Scales • Software • Pumps “Incorrect Weight Change Detected” fluid variance in Patient Fluid Removal compare to the set Fluid Removal rate Fluid Safety Guard Setting Excess Patient Fluid Limit Determined by: • Patient Size • Patient condition •Hemodynamic stability CRRT Set Default Range M60 130 ml 100-200ml over 3hr M100 HF1000 HF1400 330 ml 100-400ml over 3hr Expected Variance in Fluid Removal A small amount of variance from set patient fluid removal rate is normal due to interruptions in treatment. • Alarm condition that stops fluid pumps • Treatment is stopped , then resumed • Change bag interruption Incorrect Weight Change Detected Occurs when weight on one or more scales does not change according to set fluid flow rates. Causes: • • • • • • Frangible pin(s) in solution bags not completely broken Kinked or clamped fluid line Bags swinging on scale hook Leaking bags or bag lines not properly connected Foreign object on scales Partially supported bags (not hanging freely) What triggers the Incorrect Weight Change Alarm? • 40ml+/- for immediate variance from operator set patient fluid removal • 120ml variance in one hour from operator set patient fluid removal Incorrect Weight Change: Patient Fluid LOSS If: Dialysate, replacement, or PBP flow is obstructed Then: Fluid may be pulled from patient through blood side of filter Incorrect Weight Change: Patient Fluid GAIN If: Effluent flow is obstructed Then: Fluid may be infused to the patient from blood side of filter Early Advisory Alarms •Provides early notification of flow problems •Prevents more serious alarm situation/s •All fluid pumps are operational Fluid Safety Guard CAUTION: Incorrect Weight Change Detected Identifies affected scale Provides current information on unexpected patient fluid loss or gained over a 3hr cumulative RUN time Operator-set fluid limit Provides on-line troubleshooting instructions End Treatment • What causes the End Treatment Alarm? The excess pt fluid loss or gain limit has been met or exceeded. Fluid Safety Guard Excess Pt.Fluid Loss or Gain Limit Reached •Provides instructions to END TREATMENT •Treatment suspended; blood pump continues; fluid pumps stopped •Assess patient’s fluid status and need for medical intervention/s References and Further Reading • Prismaflex Operator Manual • Prismaflex Tutorial • Prismaflex Training Guide Software v3.20 Prismaflex System End Treatment STOP Softkey Return Blood START RETURN activates blood pump only when pressed. When blood returned, press CONTINUE. End Treatment End treatment Procedure: •Disconnect patient •Unload and remove filter set It is possible to end treatment with or without returning patient’s blood. •Disconnect bags QUESTIONS?
