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What This Guide Helps With
Troubleshoot ultrafiltration or fluid-balance problems caused by setup, tubing, dialysate flow, supply conditions, configuration, leakage, or internal hydraulic issues.
Step-by-Step Troubleshooting
1. Protect the Patient From Incorrect Fluid Removal
Do not continue dialysis if ultrafiltration delivery or fluid balance cannot be trusted. Follow clinical procedure and transfer the patient to another verified dialysis machine when necessary.
Keep the affected Dialog+ out of patient service until fluid-management performance is verified.
Expected outcome: The patient is protected from unintended fluid removal or inadequate ultrafiltration.
2. Confirm the Exact Complaint
Determine whether the reported problem is incorrect displayed ultrafiltration rate, unexpected patient fluid removal, inability to reach the programmed rate, fluid-balance test failure, or repeated balance-related alarms.
Document the programmed settings and observed behavior without changing the prescription merely to clear the problem.
Expected outcome: The fluid-management complaint is clearly defined.
3. Verify Treatment or Test Settings
Review accessible ultrafiltration-related settings and confirm they match the intended prescription or approved bench-test setup.
Look for data-entry errors before assuming a machine malfunction.
Expected outcome: The configured target and rate are correct. If correcting an entry error resolves the issue and all required checks pass, troubleshooting may stop.
4. Inspect External Dialysate and Drain Connections
Check treated-water, dialysate, concentrate, and drain hoses for kinks, restriction, leakage, loose fittings, improper routing, or connections that may affect hydraulic balance.
Expected outcome: External fluid connections are secure, unrestricted, and dry. If an external flow restriction caused the failure and correction restores normal testing, troubleshooting may stop.
5. Check for Visible Leaks
Inspect the machine exterior, accessible tubing, connectors, and surrounding floor for water or dialysate leakage.
If an internal leak is suspected or fluid is emerging from the cabinet, remove the machine from service rather than continuing operation.
Expected outcome: No external or suspected internal fluid leak is present.
6. Verify Water and Drain Infrastructure
Confirm treated-water supply and drain conditions are normal. Determine whether other machines on the same water or drain infrastructure are experiencing similar issues.
Expected outcome: The problem is isolated to the machine or an infrastructure issue is identified for appropriate escalation.
7. Repeat the Approved Fluid Balance Test
With no patient connected, repeat the applicable manufacturer-approved preparation or fluid-balance verification after external causes have been corrected.
Do not bypass a failed balance test.
Expected outcome: The machine successfully completes its fluid-balance check. If successful and no other faults remain, troubleshooting may stop after final verification.
8. Verify Ultrafiltration Performance With Approved Test Equipment
If within Clinical Engineering scope, use approved dialysis test equipment and manufacturer procedures to evaluate fluid-removal performance.
Do not alter calibration values merely to force a passing result.
Expected outcome: Measured performance meets applicable manufacturer requirements.
9. Escalate Persistent Fluid-Balance Failure
If settings, external fluid paths, treated-water supply, drain conditions, and visible leaks are ruled out but balance testing still fails, stop external troubleshooting.
Expected outcome: Internal hydraulic, balancing, valve, flow-measurement, calibration, or control problems are referred for qualified service.
If the Problem Persists
Common external causes have been ruled out. Remaining possibilities include internal hydraulic balancing components, flow measurement, valve control, calibration, leakage, or another service-level problem.
The device should be:
- Removed from service.
- Labeled Out of Service.
- Sent for repair or bench evaluation.
- Evaluated using appropriate B. Braun documentation and approved dialysis test equipment.
- Repaired or calibrated only by qualified personnel.
Complete all required fluid-balance, ultrafiltration, alarm, and functional tests before returning the machine to service.
A failed fluid-balance test should not be bypassed; stopping and escalating is proper troubleshooting.
Clinical Use Tip
Unexpected patient weight change or fluid removal should be treated as a clinical concern first, not automatically as proof of machine failure.
Work Order Documentation (CCR Method)
CCR = Complaint, Cause, Resolution
Complaint
What was reported by the clinical staff.
Example:
"Dialysis staff reported the Dialog+ repeatedly failed its fluid-balance check during preparation."
Cause
What was observed during troubleshooting.
Example:
"Clinical Engineering found the drain hose was partially kinked behind the machine and restricting outflow."
Resolution
What action was taken.
Example:
"The drain hose was rerouted, the fluid-balance test completed successfully, and the machine passed functional verification before return to service."
Helpful Details to Include (If Known)
- Exact fluid-balance alarm or message
- Programmed ultrafiltration settings
- Observed fluid-removal behavior
- Water-supply condition
- Drain-hose condition
- Visible leakage
- Whether nearby machines are affected
- Fluid-balance test results
- Independent test-equipment result
- Results after correction
- Final device status
Final Thought
Protect the patient from unreliable fluid removal, verify settings and external hydraulic conditions before assuming internal failure, confirm performance with proper testing, escalate unresolved problems, and document the final result.
That is successful troubleshooting.