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Post by biomedpete on Oct 26, 2022 18:37:49 GMT
I have several machines running 9.1B that are giving TMP low or TMP out of limit errors. I have tested Venous pressure and checked for slow leaks, Verified PDA is accurate. The blood pump rollers are good, have springs, no cracks, do not reverse spin. The machines are at about 4500-6500 hours. Staff say they need to manipulate the pressure pod positions to get it to clear and complete cycles. Anybody having similar issues or have other suggestions. It does seem to stay within about 6 machines consistently but will pop up on other machines from time to time.
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Post by Zombie on Oct 27, 2022 15:22:49 GMT
check venous luer to see if it holds pressure also clamp behind luer to make sure the level block/pressure measuring module a/v is not leaking, and replace if leaking.
The luers crack and the boards fail to hold pressure resulting in TMP and venous pressure alarms
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Post by biomedpete on Oct 28, 2022 13:08:45 GMT
Yes, I have already verified they are not leaking and in good shape.
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Post by Chuck Weddle on Oct 28, 2022 13:23:18 GMT
Yes, I have already verified they are not leaking and in good shape. If I'm understanding your problem right, the venous POD's are filling and when repositioned, fill again? The POD being full will cause TMP alarms. If the above is what your problem is, a leak somewhere in the circuit is the only thing that would cause in. Like Zombie, I have only seen this caused by the luer connector or the A/V monitoring board. If your boards have the clear tubing, I would almost guarantee that is your problem. The newer ones with black tubing are not as prone to leaking. |
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Post by biomedpete on Oct 28, 2022 17:29:52 GMT
I do have one that has been giving low TMP alarms, I will need to check that tubing (it is the clear tubing). The others the Ven pods are not filling. They can adjust the blood pump speed temporarily when the alarms happens but it continues to come back. These other machines are having TMP out of limit (code 1015). Is this more of a clinical setting issue?
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Post by Chuck Weddle on Oct 28, 2022 18:38:25 GMT
If the PV and PDA are properly calibrated and PV isn't leaking then it is very likely treatment related such as clotting, high PV, low UF requirement with a dialyzer with a very high Kuf such as a Optiflux 250.
The only other thing I can think of to check that is "machine related" is in System Configurations the Extended TMP Limit is selectable by the staff and that they are in fact selecting it during treatments.
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Post by biomedpete on Dec 28, 2022 21:51:35 GMT
Update, it seems this is a patient treatment configuration issue. They have been able to make changes to blood pump speeds that help.
The one machine I have had issues with Low TMP has been finally resolved. This machine had a Venous luer lock that needed replaced. After replacing the luer lock, machine would have issue with Venous Pod filling with blood between 1-2hrs of treatment. It would give Low TMP, staff would reset the Venous pod and finish the treatment. I tested that new luer lock several times for leaks and never would leak. What I determined was the new luer lock was changing as the machine warmed up. I replaced with a different luer lock and it passed with no leaks, now the machine has ran for 3 treatments with no problems. If for some reasons it changes I will update, but for now it has ran more treatments with out TMP errors than it has for the last 45 days.
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Post by bcjammerx on Dec 30, 2022 23:23:12 GMT
Update, it seems this is a patient treatment configuration issue. They have been able to make changes to blood pump speeds that help. The one machine I have had issues with Low TMP has been finally resolved. This machine had a Venous luer lock that needed replaced. After replacing the luer lock, machine would have issue with Venous Pod filling with blood between 1-2hrs of treatment. It would give Low TMP, staff would reset the Venous pod and finish the treatment. I tested that new luer lock several times for leaks and never would leak. What I determined was the new luer lock was changing as the machine warmed up. I replaced with a different luer lock and it passed with no leaks, now the machine has ran for 3 treatments with no problems. If for some reasons it changes I will update, but for now it has ran more treatments with out TMP errors than it has for the last 45 days. I had my fresenius and bbraun instructors both say "tmp problems are almost always access related not machine related" That said I have had two where the board was bad (a v8 and a 9.12) and two with bad ports, but as others pointed out it's pretty easy to determine if either is the cause (bulb fills up and/or port won't hold pressure). another they kept pulling but it was only on this one patient that it gave them issues...really big person...those tend to have tmp access problems I've found. I still re-calibrated the pv/pa just to be sure but they checked out even during the calibration...still did it...got pulled again so I finally told them it was the patients access and weight that was the problem and to stop pulling the machine |
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