Is there a safety issue to the bicab and acid jug running dry and having to be refilled while the patient is on the machine? Should the bicarb and acid be added to before they run dry?
The dialysis machine will simply go into bypass, and no dialysis will occur during that time.
For ease and efficiency, it probably is best to change the jugs prior to them being empty. However, no harm will actually come to the patient if it does happen.
Carol
Posts: 439 | Location: Marietta, Georgia, USA | Registered: 30 August 2000
The machine manufacturers state that a full container of concentrate, enough for the entire treatement should be place at the beginning of the treatment. If concentrate runs out the solution becomes hypotonic. This can cause hemolysis if the patients blood is exposed to it. The problem is that bypass valves do not always work. They have a failure rate the same as any other part in the dialysis machine. The machine should not be tested in this way. Full containers of concentrate for the entire treatment is what you should expect in a well run facility.
I couldn't agree with you more when you state that every machine has a failure point, and sometimes those failures are not caught. I was not implying that I desired for facilities to 'test' their equipment by purposefully allowing bicarbonate or acid jugs to run empty.
Certainly the ideal is that this never happens. I think - however - we need to be cognizant of the fact that as treatment times increase some facilities may simply not have containers large enough to accomodate the entire treament. If this does happen occasionally, please be aware if machine safety checks are being performed before the initiation of dialysis - to include low and high conductivity alarm checks - the machine will go into bypass and no harm will come to the patient (other than the lack of dialysis that will occur those few minutes).
Carol
Posts: 439 | Location: Marietta, Georgia, USA | Registered: 30 August 2000
Does the FMC 2008K machines do a check inbetween patients each time? Before each treatment? ANd, what if the acid jug is empty for over 1/2 hour? what damage can this do?
quote:
Originally posted by Carol Isaac MacKusick: Concerned Professional:
I couldn't agree with you more when you state that every machine has a failure point, and sometimes those failures are not caught. I was not implying that I desired for facilities to 'test' their equipment by purposefully allowing bicarbonate or acid jugs to run empty.
Certainly the ideal is that this never happens. I think - however - we need to be cognizant of the fact that as treatment times increase some facilities may simply not have containers large enough to accomodate the entire treament. If this does happen occasionally, please be aware if machine safety checks are being performed before the initiation of dialysis - to include low and high conductivity alarm checks - the machine will go into bypass and no harm will come to the patient (other than the lack of dialysis that will occur those few minutes).
Carol
Posts: 68 | Location: southern california | Registered: 04 July 2004
As carol mentioned if a concentrate container runs dry, the dialysis machine will alarm, and will go into bypass. All machines are equipped with redundant alarms and fail safes. For example, the althin/baxter system 1000 and Tina dialysis machines will go into a shutdown mode if the bypass system fails. I've only ever seen a bypass valve fail once, and when it did, the machine when into a shutdown mode, and the patient was safely disconnected from the machine without losing any blood.
To Advocating, If someone leaves an empty jug for over a half hour, well that is just plain neglegence. If the dialysis machine is in an alarm state, dialysis will not occur because the dialysate is bypassing the dialyzer, however, fluid can still be removed(at least if you are using system 1000/Tina/Arena). I don't know how other machines function.
My clinic uses Fresenius 2008H machines. They will go into bypass if the jugs run dry. Just turn off the dialysate flow and plug in another jug of bicarb or concentrate. What you don't want are the pumps sucking air for too long. This puts air in the system and you could lose your prime. Not a good situation for you or the patient. Make sure your tech's ( including equipment techs ) are keeping a close eye on the jug levels and you'll be ok.
Thank you all for responding. It is a 2008K machine. I have observed staff changing jugs but I have not seen them turn off machines. They just do a switch.
Posts: 68 | Location: southern california | Registered: 04 July 2004
It isn't necessary to 'turn off the machine' when changing jugs. It is helpful, however, to turn off the dialysate flow. It's been a couple of years since I've worked on the K's, but if memory is correct, the dialysate flow on/off button is on the top right hand side of the front panel. This will also stop the acid and bicarb pumps from running and keep them from sucking air, provided they haven't run dry yet, and minimize treatment interruptions (low conductivity alarms). Back in the day when I was "jugging it", that was the method I used. It's difficult to start every treatment with a completely full jug due to the fast pace of change over, more so in big clinics. However, staff should monitor the levels in the jugs and make every reasonable effort to keep enough acid/bicarb on the machine to run treatment.
Matt
Posts: 575 | Location: Midwest | Registered: 22 December 2002
GTSCC< thanks.. Am a family member and am trying to learn ALL I can, with reading everything I can get my hands on, as well as asking all the questions. However, I do find when I ask questions, often staff do not have the answers and state, "I don't know" or give some answer that even I know is not accurate. THanks for your time in answering.
Posts: 68 | Location: southern california | Registered: 04 July 2004
Simple answer : 1) when any concentrate runs dry acid or bicarb it introduces air into the hollow fiber dialyzers untill such time as the machine goes into bypass. this has two major effects. a) treatment clock is stopped and the patient is not getting his blood cleaned . b) the stoppage and prolonged bypass time adds to possible blood clotting of the system ( ie lines dialyzers and even access
As a side note the 2008k has a bicarb and acid alarm setting that you can utilize that will notify you to change jugs soon.This eliminates the worry of long treatments 5 hours 800 dialysate flow and small jugs because you enter the jug capacity and it reminds you at the 205 capacity level
Corrections to your answers: 1) Running out of acid or bicarb does not introduce air into the dialyzer. a) This statement is correct. b) Only the dialysate is bypassed which does nothing to increase the possibility of clotting anywhere.
Chuck
Posts: 875 | Location: Baltimore, MD USA | Registered: 24 October 2001
I hope you didn't make your reservations for the dates you posted or else you'll be leaving early! I'll be arriving around noon on the 17th and leaving on the 21st so I should actually have a little fun time this year!
Chuck
Posts: 875 | Location: Baltimore, MD USA | Registered: 24 October 2001
The biggest problem that i've seen, is that when jugs run empty, machine goes into bypass not just until concentrate jug is re-filled,but until accepatable conductivity is re-achieved. Then : Near the end of tx when uf time is complete, but RTD= 10-30 minutes, pt is disconnected for convenience sake. This shortening of prescribed tx time will really compound over time, effectively reducing life-expectancy. Conclusion: plan to refill jugs inadvance before it's an issue.
