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Post by Rhys C&V Tech on Aug 18, 2021 14:08:08 GMT
hey techs
was wondering if someone could help me out, having an alarm on a dialog+ machine for bicart not connected properly, the alarm only occurs when the cartridge is connected at the beginning of treatment, if it is connected when the machine is asking for the cartridge to be connected it doesn't alarm in the purging of the bicarbonate..
the noticeable differences i can see when the cartridge gets purged is the conductivity
Bicart connected at start : 15.9 spike
when machine asks to be connected :16.1 spike
I have checked
DBK
Replaced FPE
Replaced pump body of BICP
Replaced tubing because for some reason the bicarbonate likes to eat away at the silicone..
Checked pick up tube
Checked the degassing pressure against a monitor
Pressure checked bicarbonate circuit
I am inclining to replace the conductivity sensor for BICLF or do a conductivity calibration but I feel like i'm just clutching at straws now, any help is muchly appreciated!
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Post by Admin on Aug 18, 2021 14:20:52 GMT
Have you tried the filter FBIC or the Y connector? It doesn't seem like you're too far off base with it. Might be a slight obstruction.
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Post by Rhys C&V Tech on Aug 18, 2021 14:35:44 GMT
I haven't checked them for obstruction but will be my next step now! thankyou! I will update if it works.
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Post by biomedpete on Aug 18, 2021 16:09:22 GMT
I will piggy back on this post. We have machines running 9.1B
I have been having this issue with several machines in one location. I have been in contact with tech support trouble shooting, gone thru their guide for this error and have been unable to resolve the issue. It does not cause an issue during treatment, it only happens during set-up.
On various machines I have found bits of plastic in the lower bicart arm spike, replaced DBK springs, replaced FBIC, replaced O-rings, verified FPE and so on. Resolving these issues did not change the outcome, continued to get error during set-up. I found machine is getting air introduced into tubing from the lower bicart arm that seems to cause this error, verified it was not coming in on upper tubing, even replaced tubing and lower spike assembly with no change.
We predominantly use the new packaging 760 Bicart with the green caps on them. I found a few left over 1100 that don't have caps, and tested with them. When running the 1100's I would not get the alarm, little amount of air in tubing. Switch to the 760's and the error would come up again. Switched back and forth 5 times the results were the same each time, 1100 equal no errors 760's equal errors. I updated tech support to my finding and they had no ideas. Compared the nipples on the bicart cartridges and they appeared comparable.
If anyone else has come across this or has ideas to test, I would be much appreciative.
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Post by Chuck Weddle on Aug 18, 2021 16:38:23 GMT
Just as an experiment....try putting a little o-ring lube on the nipples of a 760 cartridge. If it is just a smidge too small and allowing air to be sucked in, the lube may seal it up enough. Naturally this isn't something you would want the staff to do out on the floor but it may help to rule out a product problem.
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DTECH
New Member
Posts: 21
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Post by DTECH on Aug 19, 2021 11:37:20 GMT
biomedpete Are you having these issues when the cartridge is connected at the beginning of treatment or are you still having the error message occur if you connect the cartridge when the dialysis machine asks for it to be connected? My team spoke to a Bbraun engineer around Christmas time and they said changing the FPE normally fixes the problem, even if trends dont show that FPE is working harder than FPA, braun still advised us to replace it to eliminate that as a possibility but 9/10 if everything else has been tried it will fix the issue in the manual it does not show the purging of the cartridge test and what the test looks for, we got told the machine looks for a conductivity spike when the cartridge is flushed of over 21mS/cm at ENDLF&ENDLF_S, VBICP opening, VVB opens and degassing pressure drops from -400mmHg(ish) to -80mmHg
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Post by biomedpete on Aug 19, 2021 13:11:32 GMT
I don't think I have tested difference of connecting right away or waiting for prompt. I will have to test it today. Our machines only have on average 3500 hours and given I had no problems with the 1100g cartridge that should rule out FPE being bad. There is a technical bulletin about this error on the technician portal. I will post try to post it in the tips and tricks thread.
As far as lubing the end of the cartridge. When I replaced the o-rings to rule them out I lubricated them and then tested, same error. But while testing today I will give it a shot again.
I will update once I have more info.
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Post by bimitiri on Aug 22, 2021 13:00:53 GMT
Sound like you have a balancing chamber issue as your conductivity with or without bicarb is high .
Maybe check the conductivity first then follow by balancing chamber volume via the drain hose
Good luck .
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Post by SrCusEngr on Aug 22, 2021 20:12:44 GMT
Bicarb cartridge not connected correctly.FIRST: let me state emphatically, that your floor crew need to STOP SPINNING THE SMALL CARTRIDGES IN THE HOLDER DURING TREATMENT! That causes the spike to shave bits of plastic (which you are finding) from the inner wall of the nib causing them to clog the bottom valve.
<bimitiri> the spike in conductivity is normal for a machine using a bicarb cartridge. It is performed as part of the test. Germany refers to it as flushing of the cartridge.
We have seen instances where, if the cartridge is installed at the beginning of preparation, that warning message may appear, but it is short lived. In other words, the test is performed, it did not complete correctly in the allotted time, leaving the machine to do it thing and the message will disappear and the concentrate pumps start up to go into conductivity. At no time does the machine attempt to reopen VBKO/VBICP (close VVB/VBKS) and retest the cartridge. However, waiting until the machine displays the message Connect bicarbonate seems to have allowed the machine to test 'without interference'. I say this because the 9.1B software changed the filling and testing of the cartridge because of the new temperature sensor certification and plausibility procedure.
After DFS pressure test, if the cartridge holder is open, the machine will attempt to start filling the cartridge with fluid. Remember that this fluid is warmed by the heater [heater output goes to either DBK or VBKO]. Also, bicarbonate is subject to breaking down (degassing) when mixed with water {one hydrogen ion and one bicarbonate ion react to produce a molecule of water and a molecule of carbon dioxide gas}. This can occur almost immediately in the machine so the warmer the water, the faster the breakdown will occur. Since this is not desired, the filling process is stopped during the new temperature sensor test, where the water is heated to greater than 60 degrees C. It is only until the heated water returns to less than approximately 45 degrees C, does the filling process resume. Now I do not know what is actually going on inside that cartridge, but I think degassing is slightly more active due to the warmer water and that is somehow affecting the cartridge testing. If you wait until the message to Connect bicarbonate occurs, you never experience any water higher than 40 degrees into your cartridge.
In a post I made in a another thread, I stated that the most important element of this is timing. From my observations, VBICP is only open for about 28 seconds. When VBICP opens, the balance chamber MUST complete two full cycles (and remember, both FPE and FPA contribute to completing those cycles). Also, because VVB is closed, VBKO and VBICP are opened, the only path for fluid flow is: output of EP feeds H; H output feeds VBKO to cartridge to VBICP to BICLF to ENDLF to FPE input. But don't stop thinking there. If there is a blockage on the output side of FPE, then there will be NO FLOW. So there has to be a clear path into BC (VEBK) then out (VDEBK) then DDE and the DF Filter to VBP to LA to FPA to BC (VDABK) to outlet (VABK) to RVDA to drain. If any blockage occurs anywhere, the two complete cycles may be slowed down to not complete in time, or the flush of fluid from the cartridge may not be strong enough to spike the concentrate sensors.
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Post by biomedpete on Aug 27, 2021 18:42:00 GMT
So I had a chance to test the procedure of waiting till prompt to connect Bicarb. I had one machine that would consistently fail and give this error. When tested and waiting for prompt I did not get the error. I tested 3 times and each time passed normally as intended. I have now sent out communication to staff to wait for prompt to install cartridge and see if this works for all the machines that would error.
I will try to post if this takes care of the issue across all the machines.
I am kind of curious, We have two locations that use the Dialog+. The location that is having this issue daily with several machines were new with software 9.1B installed. The other location has machines that are about 1 year older and came with 9.18 software and upgraded to 9.1B, this location very rarely has this issue. Is there just enough difference in the software from upgrade that would make a difference?
Thanks to all for info and suggestions.
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Post by SrCusEngr on Aug 27, 2021 21:37:40 GMT
The software 9.1B is identical across all platforms. There is no difference between a machine that arrives with it installed or one that has the software loaded into it. You can check the version numbers in TSM by pressing the Dialog icon (main TSM screen, lower right corner). It will open a new screen and show you all the software versions that are loaded. Both sites should be identical if they are both 9.1B (This is Top Level, eack group has a numeric version. I.e., 9.1B is numeric 9.81; 9.1A is numeric 9.80; 9.18 is numeric 9.18.)
What may have an influence is age/wear, operation, build/layout of the machine. FYI: A machine with a temperature sensor laying against a valve will react differently than one with the sensor free floating.
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DTECH
New Member
Posts: 21
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Post by DTECH on Sept 1, 2021 7:37:59 GMT
update -
have noticed that the balance chamber isn't quite completing its 2 cycles, but only fails when bicarb is connected from beginning, but does not fail on the prompt when machine asks for bicarb to be connected.
I have now checked for obstruction in the circuit against FBIC etc and they were all good
Replaced FPA pump, this did not help
replaced spring and cap for DBK
checked UF pump and calibrated
carried out a balance chamber calibration
checeked RVFPE, RVFPA, RVDA and DDE
Could there be a faulty MSBK sensor? if there was wouldnt it be failing under normal conditions?
could there be a slight rupture in the membranes? but again i think i would be getting bigger problems elsewhere in the treatment for any of the above two..
This machine is at a home patients house, in any other circumstance replacing FPE normally fixes the problem
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joey
Full Member
Posts: 226
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Post by joey on Sept 1, 2021 14:10:22 GMT
Not sure if it translates to version 9 . On the 8 the posts for the membrane get corroded over time and can cause the membrane initiation to fail . You can unscrew the sensors and check them. update - have noticed that the balance chamber isn't quite completing its 2 cycles, but only fails when bicarb is connected from beginning, but does not fail on the prompt when machine asks for bicarb to be connected. I have now checked for obstruction in the circuit against FBIC etc and they were all good Replaced FPA pump, this did not help replaced spring and cap for DBK checked UF pump and calibrated carried out a balance chamber calibration checeked RVFPE, RVFPA, RVDA and DDE Could there be a faulty MSBK sensor? if there was wouldnt it be failing under normal conditions? could there be a slight rupture in the membranes? but again i think i would be getting bigger problems elsewhere in the treatment for any of the above two.. This machine is at a home patients house, in any other circumstance replacing FPE normally fixes the problem. |
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DTECH
New Member
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Post by DTECH on Sept 17, 2021 13:51:51 GMT
@jj would there be corrosion on the ends of the MSBK1&2 sensors? wouldnt this cause problems in the balance chamber initializing for dialysis? we have checked them previously but there wasn't any signs on wear across them.
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Post by SrCusEngr on Sept 18, 2021 16:36:11 GMT
Let's try to talk straight. MSBK!/2 are the sensor boards. They don't corrode. The membranes each have a ferrite rod that is designed to move within a coil that is part of an LC oscillator circuit. The C is on MSBK1/2 and the L is the coil mounted on each side of BK. The ferrite rod is covered with a rubberized compound to protect the rods from the dialysate solution. However, if a pinhole in the covering happens, then the rod will begin to deteriorate and the coating will impede the movement of the rod inside the coil, thus impeding the membrane movement. This usually happens with high WTC (>15k).
You said this machine is at a patient's home. Are they disinfecting the incoming water line to the machine once a month? I have recently had two customers have low flow conditions causing all sorts of crazy problems. Why low flow? Their machines were operating from a portable RO. The incoming water line was not being disinfected. What was found: FEP was discolored; FVE (The disposable filter that replaced TSHE) was discolored; the bottom of the DF filter was discolored; and when the incoming water line was removed, a long swab was inserted up the hose and wiped against the wall. When it came out, it was black with biofilm. So that film was getting into the machines, clogging the filters and slowing the flow so that it could not work correctly. Thought I'd mention this. Many times, it is the small things we overlook that cause big problems.
P.S. I once had five machines in a hospital that had discolored filters all the way through to FBK2! And the constant heat disinfects kinda cooked it into seaweed!! I guess anything can happen.
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