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Continuous Renal Replacement Therapy (CRRT)
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Model
What This Guide Helps With
This guide helps troubleshoot the Baxter PrismaFlex Alarm: Filter Clotted, which may indicate excessive filter pressure drop, suspected clotting, restricted blood flow, anticoagulation delivery problems, excessive ultrafiltration demand, or pressure measurement issues during CRRT therapy.
Step-by-Step Troubleshooting
Ensure Patient Safety First
- Confirm the patient is being safely supported before troubleshooting the PrismaFlex.
- If therapy is interrupted, pressures are unsafe, blood flow is compromised, or clotting is suspected, involve the bedside clinical team immediately.
- Do not continue relying on the circuit if the filter is clotted or pressure conditions cannot be corrected safely.
- If needed, move the patient to a backup CRRT device or alternate therapy plan according to facility procedure.
Verify the Reported Alarm and Behavior
- Confirm the displayed alarm is exactly: Alarm: Filter Clotted.
- Observe whether the alarm occurs during active treatment, after increasing fluid removal or replacement rates, after anticoagulation interruption, or repeatedly after alarm reset.
- Check whether related messages such as Filter is Clotting Advisory or TMP Excessive Caution appeared before or with the alarm.
- Document whether the alarm is reproducible or clearly associated with high filter pressure drop.
Translate the Alarm Into the Real-World Condition
- Recognize that this alarm means the PrismaFlex is detecting excessive pressure drop across the filter.
- Possible causes include clot formation in the filter, restricted blood flow through the circuit, inadequate anticoagulation, excessive ultrafiltration demand, or pressure measurement error.
- Also consider syringe pump or PBP pump delivery failure if anticoagulant or citrate delivery is involved.
Check Blood-Flow Lines for Clamps or Kinks
- Inspect the blood-flow path for clamped, kinked, compressed, or restricted tubing.
- Confirm lines are routed correctly and are not pinched by bed rails, pump doors, equipment, or patient positioning.
- Verify that blood-flow lines are open, correctly routed, and free of obvious restriction.
Assess for Visible or Suspected Circuit Clotting
- Inspect the filter and visible circuit areas for darkening, fibrin, sluggish flow, or clot formation.
- Review filter pressure, return pressure, TMP, access pressure, and prior clotting advisories if available.
- If clotting is present or strongly suspected, stop troubleshooting the active circuit and have the clinical team change the set using the appropriate PrismaFlex STOP process.
Confirm Anticoagulation Status With Clinical Staff
- Ask whether anticoagulation has been interrupted, reduced, delayed, or changed.
- Confirm the syringe or citrate/PBP therapy is installed and programmed according to the ordered treatment.
- Verify that anticoagulation delivery matches the clinical order and has not been interrupted.
Check Syringe Pump or PBP Pump Delivery
- If anticoagulant or citrate delivery is involved, inspect the related delivery method.
- Check for an empty syringe or bag, incorrect syringe installation, occluded line, disconnected anticoagulant line, pump alarms, PBP delivery interruption, incorrect setup, or incorrect flow-rate entry.
- Confirm anticoagulant or citrate delivery is physically connected, programmed correctly, and flowing as intended.
Evaluate Ultrafiltration and Fluid Removal Demands
- Review whether replacement solution, PBP solution, or patient fluid removal rates were recently increased.
- If clinically appropriate, have the care team reduce excessive replacement solution, PBP solution, and/or patient fluid removal rate.
- Confirm therapy settings are within clinically appropriate limits for the filter and patient condition.
Check for Pressure Measurement Issues
- If the alarm does not match the physical circuit condition, inspect pressure pods and monitor lines.
- Look for improperly seated pressure pods, loose monitor-line connections, wet or contaminated pressure barriers, debris in sensor areas, or pressure readings that appear unrealistic or unstable.
- Confirm pressure monitoring components are installed correctly and pressure values respond logically.
Determine Whether the Issue Is Circuit-Related or Device-Related
- If the alarm clears after correcting a clamped line, setup issue, rate issue, or circuit clotting condition, document the finding and return the device to use as appropriate.
- If the alarm repeats after a new set is installed and common external causes have been ruled out, suspect a device-side issue such as pressure sensing error, syringe pump malfunction, or PBP pump malfunction.
Stop When Resolved
- If the alarm is resolved by correcting an external restriction, setup issue, rate issue, or disposable set problem, verify normal operation with the clinical team.
- Confirm pressures are stable and no related clotting or TMP alarms remain active.
- Return the PrismaFlex to service only when the alarm is cleared and therapy can continue safely.
If the Problem Persists
If the Filter Clotted alarm continues after external causes, circuit issues, therapy settings, and anticoagulation delivery have been checked, remove the PrismaFlex from service.
At this point, external tubing restriction, disposable set issues, therapy setting problems, visible circuit clotting, anticoagulation interruption, and pressure pod setup concerns should be considered ruled out as practical bedside causes.
- Remove the device from patient use.
- Label the device Out of Service.
- Send the device for repair or bench evaluation.
Persistent or repeated Filter Clotted alarms after a new set may indicate pressure measurement failure, syringe pump malfunction, PBP pump malfunction, or another device-side fault.
Clinical Use Tip
Never troubleshoot a suspected clotted CRRT circuit while relying on it for active patient therapy. Coordinate with the bedside team, move the patient to a backup device or alternate therapy plan first, and change the set when clotting is confirmed or strongly suspected.
Work Order Documentation (CCR Method)
CCR = Complaint, Cause, Resolution
Complaint
What was reported by the clinical staff.
Example:
"PrismaFlex removed from service due to repeated Filter Clotted alarm during CRRT treatment. Staff reported excessive filter pressure drop and clotting advisory or TMP caution conditions."
Cause
What was observed during troubleshooting.
Example:
"Inspection found no external tubing clamp or kink. Alarm recurred after user checks, indicating likely circuit clotting or possible pressure measurement, syringe pump, or PBP pump delivery issue."
Resolution
What action was taken.
Example:
"Device removed from patient use and labeled Out of Service. Recommended bench evaluation of pressure sensing function and syringe/PBP pump operation before return to service."
Helpful Details to Include (If Known)
- Alarm behavior
- Accessories swapped
- Power behavior
- Environmental factors
- Indicator lights
- Final device status
Final Thought
The Filter Clotted alarm should be approached as both a patient safety issue and a circuit performance issue. Start with simple external checks, confirm whether clotting or restricted flow is present, review anticoagulation and ultrafiltration demands, and escalate when repeated alarms suggest pressure sensing or pump failure. Clear documentation helps separate disposable set issues from true device problems.
That is successful troubleshooting.