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Post by bsquared on May 6, 2024 17:03:18 GMT
I have new Blue Star machines and Bibags are new for some the staff. I have had many issues with these new machines, needing onsite service at times. New parts replaced, some of the issues have been user issues too. I have been getting multiple machines with Bibag Pressure sensor errors, Bibag PHT failed that will not clear. Additionally there is no water filling happening to the Bibag. When the machines are pulled and I hook them up I cannot repeat the error, I have zero issues. So it goes back out to the floor, and couple days later same issue. Each time I can find nothing wrong. it is multiple machines, and at times different ones with same issues. I have checked all pressures/ zero'd out the bibag sensor pressures, checked for flow pump dac value issue, checked for Dear pump dac issue, all good- found nothing out of spec, even condo and heat are stable in range.
In our facility they have a practice of getting machines ready much too early more than 1 hours before patients by; connecting to acid loop putting the Bibag on the machine but leaving the door in up position until 1/2hr or 45 minutes before treatment time, entering dialysis mode and letting machine pull acid for over an hour up to 2 hours before patient is coming in. This is the only thing I can think of that may cause this issue, though I can't prove it, and maybe I'm wrong. They also have started to turn flows off to save concentrate instead of having machine use the 100dfr idle mode.
I guess my question is could the errors be caused by the staff practices? what are your staff doing?
Thanks in advance!
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Post by justabiomed on May 6, 2024 18:04:10 GMT
The machines are much more sensitive than any of the older models.
ALWAYS FOLLOW YOUR COMPANIES POLICIES AND PROCEDURES and the Manufactures IFUs!
What works for multiple clinics I work with:
The machines should be rinsed in the morning, just before they will be being used. Then connect the acid and BiBag at the same time. The machine will come up in acid conductivity. Once the conductivity cell in the air separator reaches 11.7 the machine will start the process of filling the BiBag. Then set up the machine with the external circuit, not being in a rush. From starting the acid and BiBag to the test should be about 12 to 15 minutes (tell them 15 to 20 minutes). These machines take time to do their thing and balance out temp, condo, and flow. Saving time by rushing the machine, will always cost them time. They should follow the Operators Guide (latest version is available @ FMCNA.com) and P&P
The machines can run at 100, or flow off (see Operators Guide and your P&P), but should be brought back into full operation 10 minutes prior to patient treatment.
If they are using jug bicarb and BiBag back and forth you will be suffering. The machines just don't do well with this.
Leaving anything "Open" is an infection control issue.
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Icebonez
Junior Member
What is better - to be born good, or to overcome your evil nature through great effort?
Posts: 71 
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Post by Icebonez on May 7, 2024 12:31:46 GMT
If you are doing your due diligence and are unable to replicate the reported issues, it is likely they could stem from issues in the staff practices. As stated above, the bi-bag machines are very sensitive.
9 times out of 10 when they pull a machine for a bi-bag issue at my clinic, it ultimately traces back to what I surmise as user error. If they aren't following the policy and IFUs, you will have issues no doubt.
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Post by bdw on May 22, 2024 15:16:38 GMT
I worked on a new batch of 27 Bluestar machines from 2021 to 2023. The bibag system definitely caused way more problems than a batch of machines from around 2015.
If you have any bibag problems, any at all, ALWAYS check the acid and bicarb pressures on debug screen 14 and 15. Also keep an eye on the BIBAG (not bicarb) pressure on screen 14 or 15.
Check the troubleshooting guide, Bibag sections for how to check the acid and bicarb pressures in RINSE mode. THey need to rise and fall (it may take a few minutes to see that happen).
I had several machines where the bibag pressure was a bit low, maybe around 70 instsead of 90. No alarms, machines passed test, but weird intermittent problems would show up. On one machine, calibrating the regulator pressure ONCE did NOT change the bibag pressure. AFter calibrating it a second time, the bibag pressure went up to 90, and no more problems.
ALSO: I had quite a few problems, don't remember the symptoms off hand, but it always ended up being the bicarb pressure sensor. Always replace that pressure sensor if you are having weird intermittent bibag issues. I cannot emphasize enough that, for my batch of machines at least, the pressure sensor was the part to go to first. Even if the bicarb/bibag pressures look good, it is worth replacing the sensor (and doing a regulator pressure cal too, of course). That fixed a lot of problems for me. In six years with the previous batch of (NON-bluestar) T machines, I never once had to replace that sensor. I know it is a real pain to replace that sensor, BUT DO IT.
BIBAG PHT FAILURE: unfortunately, this is not in the Fresenius manual as far as I can tell, but that stupid alarm DOES NOT CLEAR: it is a software issue. The only way to clear the alarm, is to turn the machine off/on, or, to do another "bibag" test (by opening/closing the bibag door, with or without a new bibag). The problem is, even after you do this, THE ALARM DOES NOT GO AWAY UNTIL THE MACHINE PASSES THE BIBAG PHT. I tell clinical staff to look at the clock, and if the alarm does not go away on its own in 15 minutes, to put a new bibag on the machine. This state of affairs caused untold confusion.
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Post by Em on May 26, 2024 4:08:28 GMT
I am having intermittent lo bibag/lo bicarbonate errors on jug and bags and it only happens on the treatments never when I am working on the machine or trying to mimic these issues.... any suggestions? I worked on a new batch of 27 Bluestar machines from 2021 to 2023. The bibag system definitely caused way more problems than a batch of machines from around 2015. If you have any bibag problems, any at all, ALWAYS check the acid and bicarb pressures on debug screen 14 and 15. Also keep an eye on the BIBAG (not bicarb) pressure on screen 14 or 15. Check the troubleshooting guide, Bibag sections for how to check the acid and bicarb pressures in RINSE mode. THey need to rise and fall (it may take a few minutes to see that happen). I had several machines where the bibag pressure was a bit low, maybe around 70 instsead of 90. No alarms, machines passed test, but weird intermittent problems would show up. On one machine, calibrating the regulator pressure ONCE did NOT change the bibag pressure. AFter calibrating it a second time, the bibag pressure went up to 90, and no more problems. ALSO: I had quite a few problems, don't remember the symptoms off hand, but it always ended up being the bicarb pressure sensor. Always replace that pressure sensor if you are having weird intermittent bibag issues. I cannot emphasize enough that, for my batch of machines at least, the pressure sensor was the part to go to first. Even if the bicarb/bibag pressures look good, it is worth replacing the sensor (and doing a regulator pressure cal too, of course). That fixed a lot of problems for me. In six years with the previous batch of (NON-bluestar) T machines, I never once had to replace that sensor. I know it is a real pain to replace that sensor, BUT DO IT. BIBAG PHT FAILURE: unfortunately, this is not in the Fresenius manual as far as I can tell, but that stupid alarm DOES NOT CLEAR: it is a software issue. The only way to clear the alarm, is to turn the machine off/on, or, to do another "bibag" test (by opening/closing the bibag door, with or without a new bibag). The problem is, even after you do this, THE ALARM DOES NOT GO AWAY UNTIL THE MACHINE PASSES THE BIBAG PHT. I tell clinical staff to look at the clock, and if the alarm does not go away on its own in 15 minutes, to put a new bibag on the machine. This state of affairs caused untold confusion. |
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Post by bsquared on Jun 6, 2024 13:52:56 GMT
Well as an update: held a staff meeting and discussed practices against what the policy says and found some where not following policy and manager made it clear that is the only way to perform your duty. A month later much less Bibag PHT and pressure sensor errors. However a new issue had developed, dripping coming from bottom of bibag pooling on floor, no alarms treatment ran perfectly fine, a new bibag fixed the problem each time. finally I was at the clinic when this happened and it was user error, they were not removing the seal from the bibag before pushing it onto the connector! They never amaze me at stupidity.
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Post by Phillip-Ashley Ludlow on Jun 6, 2024 16:29:26 GMT
Well as an update: held a staff meeting and discussed practices against what the policy says and found some where not following policy and manager made it clear that is the only way to perform your duty. A month later much less Bibag PHT and pressure sensor errors. However a new issue had developed, dripping coming from bottom of bibag pooling on floor, no alarms treatment ran perfectly fine, a new bibag fixed the problem each time. finally I was at the clinic when this happened and it was user error, they were not removing the seal from the bibag before pushing it onto the connector! They never amaze me at stupidity. i mean, as someone who has been on that side of the room, i think saying their stupid for not seeing the clear plastic pull film is abit harsh * insert pronouns here*, esp if ppl are short staffed, or have a wonky chairtime(s), or what have you, wheich we all know NEVER happens. we're ALL human. i like to think im a pretty intelligent guy 68.27% of the time, and i left a wrench in a machine the other day. does it make the act stupid, sure. me personally? thats yet to be determined. my point? chill out with the hostility there buckaroo.  |
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Post by robertb on Jun 23, 2024 2:18:32 GMT
educate communicate and educate some more
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