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What This Guide Helps With
Use this guide when an ultrafiltration or fluid-balance check fails because of connections, fluid supply, leakage, setup, disposables, or hydraulic-system problems.
Step-by-Step Troubleshooting
1. Protect the Patient From Unverified Fluid Removal
Do not use a machine for treatment when ultrafiltration or fluid-balance performance cannot be verified. If a failure occurs during treatment, follow the clinical contingency procedure and transfer the patient to another verified machine when appropriate.
Expected outcome: The patient is not exposed to an unverified fluid-removal system.
2. Confirm the Exact Failure
Determine whether the machine fails a startup fluid-balance check, aborts an ultrafiltration-related test, alarms during treatment preparation, or shows inconsistent fluid-balance behavior.
Record the exact displayed condition and the stage at which the failure occurs.
Expected outcome: The failure is clearly documented and reproducible.
3. Inspect External Fluid Connections
Check incoming water, drain, concentrate, dialysate-related hoses, and accessible fluid connections for kinks, leaks, loose fittings, improper routing, or restrictions.
Inspect the area around the machine for visible fluid that may indicate an external leak.
Expected outcome: External fluid paths are secure, unrestricted, and free of visible leakage.
4. Verify Drain Conditions
Confirm the drain hose is correctly positioned, not kinked, elevated improperly, obstructed, or inserted in a way that prevents normal drainage.
Compare the setup with another functioning machine if necessary.
Expected outcome: The machine can drain freely. If correcting the drain setup allows the test to pass, proceed to final verification and stop troubleshooting.
5. Verify Water and Concentrate Supply
Confirm adequate external water supply and correct concentrate setup. A poor supply condition can interfere with hydraulic preparation and testing.
Check whether other dialysis machines connected to the same infrastructure are experiencing similar problems.
Expected outcome: Required external supplies are stable and an infrastructure problem is either identified or ruled out.
6. Inspect Applicable Disposable and Connection Setup
Verify any required external disposable, connector, or fluid pathway used for the test is installed correctly and is not leaking or obstructed.
Do not open internal hydraulic components.
Expected outcome: External setup does not explain the test failure.
7. Repeat the Test Under Controlled Conditions
After correcting any external issue, repeat the normal approved machine test once. Avoid repeated cycling of a test that continues to fail without a new corrective action.
Expected outcome: The test completes normally. If it passes consistently after correction, troubleshooting can stop after final verification.
8. Perform Final Functional Verification
Confirm the machine completes the applicable fluid-balance or ultrafiltration checks and no related alarms, leaks, or abnormal hydraulic behavior recur.
Expected outcome: Fluid-management verification completes successfully and the machine is suitable for normal return-to-service processing.
If the Problem Persists
If external water, drain, concentrate supply, hoses, disposables, connections, and visible leakage have been ruled out, the problem may involve an internal hydraulic, balancing, valve, pump, sensing, calibration, or control function.
The device should be:
- Removed from service.
- Labeled Out of Service.
- Sent for repair or bench evaluation.
- Evaluated using appropriate Fresenius Medical Care documentation and approved dialysis test equipment.
- Repaired or calibrated only by qualified personnel.
- Subjected to required fluid-balance, ultrafiltration, hydraulic, and safety verification before return to service.
A failed fluid-balance verification is a stop condition, not a reason to continue treatment and monitor the machine.
Clinical Use Tip
Reliable fluid removal is a core treatment function; never place a machine back into service simply because a failed test passes once without an identified cause.
Work Order Documentation (CCR Method)
CCR = Complaint, Cause, Resolution
Complaint
What was reported by the clinical staff.
Example:
"Dialysis staff reported the 5008S CorDiax repeatedly failed its fluid-balance test during preparation."
Cause
What was observed during troubleshooting.
Example:
"Clinical Engineering found the drain hose was sharply kinked behind the machine and restricting normal drainage."
Resolution
What action was taken.
Example:
"The drain hose was repositioned, the fluid-balance test was repeated successfully, and the machine passed final operational verification before return to service."
Helpful Details to Include (If Known)
- Exact test or displayed failure message.
- Stage of preparation when failure occurs.
- Water supply condition.
- Drain hose routing.
- Concentrate connections.
- Visible leakage.
- Disposable or connector setup.
- Whether nearby machines are affected.
- Repeat-test result.
- Final device status.
Final Thought
Fluid-balance complaints should be approached systematically from external supply and drain conditions inward, with treatment withheld until accurate fluid-management performance is verified.
That is successful troubleshooting.