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What This Guide Helps With
Use this guide for unstable or abnormal conductivity associated with concentrate supply, water, connections, configuration, or another externally verifiable condition.
Step-by-Step Troubleshooting
1. Protect the Patient and Stop Use of Unreliable Dialysate
Do not continue patient treatment when dialysate conductivity is unstable, outside the machine's acceptable condition, or cannot be independently verified as appropriate.
Move the patient to another verified machine or follow the facility's dialysis contingency process.
Expected outcome: No patient is dependent on a machine with questionable dialysate composition.
2. Confirm the Reported Condition
Determine when the conductivity issue occurs:
- During preparation
- After concentrate connection
- During treatment setup
- Intermittently during operation
- Only with one concentrate source
- After a room, water, or supply change
Record any machine message exactly.
Expected outcome: The timing and repeatability of the conductivity problem are established.
3. Verify the Water Supply Condition
Confirm that the machine has its normal approved water supply and that facility water-treatment systems are operating normally.
Check for:
- Interrupted water flow
- Kinked or restricted external water connection
- Recent water-system maintenance
- Multiple dialysis machines showing similar symptoms
Do not adjust facility water-treatment settings unless authorized.
Expected outcome: The dialysis machine is receiving its expected external water supply. A facility-wide problem is identified and escalated if multiple machines are affected.
4. Inspect Concentrate Containers and Connections
Verify the correct concentrate products intended for the prescribed treatment are present and connected to the correct external connection points.
Inspect for:
- Empty or nearly empty containers
- Loose connections
- Kinked tubing
- Cracked tubing or fittings
- Incorrect concentrate selection
- Obvious contamination
- Improperly seated pickup connections
Do not substitute unapproved fluids.
Expected outcome: Correct concentrate sources are available and securely connected without visible restriction or leakage.
5. Check for Concentrate Supply or Batch Isolation
If permitted by facility procedure, compare the issue using another approved container or source of the same required concentrate.
If multiple machines show the same conductivity problem from a common supply or batch, stop using that source and escalate appropriately.
Expected outcome: The concentrate source is either ruled out or identified as the external cause. If conductivity stabilizes with an approved known-good source, troubleshooting can stop after verification.
6. Verify Treatment Configuration
Confirm the treatment setup and concentrate selection match the intended prescription and facility workflow.
Do not alter clinical prescription values merely to force conductivity into an acceptable state.
If a configuration appears incorrect, have qualified clinical personnel verify the prescription and setup before continuing.
Expected outcome: The machine configuration corresponds to the intended treatment and no incorrect selection is producing the conductivity issue.
7. Inspect Accessible External Fluid Connections
Inspect accessible dialysate-related connections for leakage, incomplete seating, crossed connections, or restriction.
Do not disconnect or manipulate internal fluid-path components beyond approved external service actions.
Expected outcome: External fluid connections are secure, correctly routed, and free of visible leakage or obstruction.
8. Reprepare and Observe Conductivity
After correcting any external supply or connection problem, perform the approved preparation sequence and allow the system to reach its normal ready condition.
Observe whether conductivity becomes stable without repeated alarms or abnormal fluctuation.
Expected outcome: Conductivity stabilizes during preparation and remains acceptable to the machine's normal monitoring system. If successful, proceed to final verification.
9. Perform Final Functional Verification
Before return to service, complete applicable manufacturer-approved checks. Where facility procedure requires independent dialysate verification, use approved calibrated test equipment.
Do not return the machine to service simply because an alarm cleared temporarily.
Expected outcome: Conductivity remains stable and required dialysate verification passes. Troubleshooting can stop.
If the Problem Persists
If the approved water source, concentrate, connections, setup, and external fluid supply have been verified and conductivity still does not stabilize, common external causes have been ruled out.
Possible remaining categories include internal mixing, proportioning, sensing, fluid-control, calibration, or service-level configuration problems. Do not adjust internal calibration or bypass conductivity protections without approved service procedures and authorization.
The device should be:
- Removed from service
- Labeled Out of Service
- Sent for repair or bench evaluation
- Evaluated using appropriate Nipro documentation and approved test equipment
- Repaired or configured only by qualified personnel
Return the machine to service only after conductivity and applicable dialysate safety checks pass. Knowing when to stop external troubleshooting is proper troubleshooting.
Clinical Use Tip
Never compensate for an unresolved conductivity problem by changing the treatment prescription solely to make the displayed value appear acceptable.
Work Order Documentation (CCR Method)
CCR = Complaint, Cause, Resolution
Complaint
What was reported by the clinical staff.
Example:
"Dialysis staff reported the SURDIAL X would not achieve stable conductivity during treatment preparation."
Cause
What was observed during troubleshooting.
Example:
"Clinical Engineering found the concentrate connection was not fully seated and was intermittently drawing air."
Resolution
What action was taken.
Example:
"Clinical Engineering reseated the approved concentrate connection, repeated preparation, verified stable conductivity and required checks, and returned the machine to service."
Helpful Details to Include (If Known)
- Exact conductivity-related alarm or message
- When the instability occurred
- Water supply status
- Concentrate type and connection condition
- Whether a known-good concentrate source was tested
- Whether other machines were affected
- Treatment configuration observed
- Independent verification results, if performed
- Final machine status
Final Thought
Protect the patient from uncertain dialysate, verify water and concentrate supplies before assuming an internal problem, and require stable verified operation before return to service. Escalate unresolved conductivity faults and document the complete troubleshooting path.
That is successful troubleshooting.