another tmp post

It really depends on when the TMP alarms are happening. There are sometimes that a TMP alarm will happen almost every time, like when staff hook up the connectors to the dialyzer. TMP can also be affected by clotting in the dialyzer or in the venous chamber of the lines. If it's not when a patient is running and the TMP slowly increases over time and then sharply drops back down to a normal range and then climbs again, you're probably looking at a diasafe issue. If the TMP goes up super high and won't reset or super low and won't reset then I would look at your valves on the machine.

if multiple machines i check water loop pressures & maybe acid bicarb loop pressures if applicable

One of the biggest things I've seen is the High Flux setting is turned off. Turning that off makes the TMP settings tighter. High Flux dialyzers have larger pores to allow a greater amount of molecules to pass through so the threshold is larger (my words). I recommend verifying what type of dialyzer they are using and that the setting is turned on. If you are checking a machine with TMP issues in the office, always verify your venous pressure and pdial are within specifications.

When I am called out to the floor for any issue my first thing to check is whether this is truly a machine issue vs operator/setup issue.  So mainly determining if it is something that needs to come back to the work room or not.  As for TMP errors the first thing I would check is the relation of TMP to venous pressure.  A high TMP pressure with a lower venous pressure typically indicated that there is something wrong in the lines.  Whether that is clotting in the lines (dialyzer or venous chamber) or a wet transducer are some of the typical issues that you'll see.  Venous pressure on average will run somewhere between 150-250 dependent on blood flow rate, quality of needle stick, and fistula/catheter.  If it is way lower than that would be my first guess.  I would have the staff either try to change out the transducer or flush the lines with saline to look for a clot.  If neither are present you may have an air leak on the internal portion of the level detector.  You would likely have a bunch of blood hitting the transducer if that's the case though. (can still happen if there is clotting as well)  If the venous pressure seems fine and the tmp is either really high or really low I would suspect something machine related and would need to get pulled into the back for you to troubleshoot.  Debug screen 0 and 1 are also helpful at checking some of the numbers that you wouldn't normally be able to see as well. ie dialysate pressure, valve error (verr), checking if machine valves are lit blue or white as they are supposed to, repetitive filling programs, etc.