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
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Patient and System at risk
Needs immediate action
Treatment suspended
2. Malfunction - Failure of safety system
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Patient and System at risk
Needs immediate action
Treatment suspended
3. Caution - Informs operator of an action
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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
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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:
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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:
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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:
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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
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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:
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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
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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:
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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?