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What This Guide Helps With
Use this guide when ultrafiltration or fluid-balance verification fails because of fluid supply, connections, setup, leaks, drainage, or service-level faults.
Step-by-Step Troubleshooting
1. Protect the Patient
Do not use the machine for patient treatment when ultrafiltration or fluid-balance performance cannot be verified.
Use another tested dialysis machine until the affected unit passes all required checks.
Expected outcome: No treatment begins on a machine with unverified fluid-removal accuracy.
2. Confirm the Exact Failed Test
Determine whether the issue involves:
- A startup fluid-balance check
- An ultrafiltration verification
- An interrupted test
- A repeated alarm
- A result that is inconsistent between attempts
- A failure following maintenance or disinfection
Record the exact message and test conditions.
Expected outcome: The specific test and repeatable failure condition are identified.
3. Check Water Supply and Drainage
Verify that external water supply and drainage are available and unobstructed.
Inspect accessible hoses for:
- Kinks
- Pinching
- Leakage
- Loose connections
- Improper drain placement
- Backflow or drainage restriction indications
Expected outcome: The machine has stable water supply and free drainage.
4. Inspect Concentrate and Fluid Connections
Verify required concentrate and external fluid connections are properly seated and free of leaks or restrictions.
An incomplete fluid path can prevent accurate preparation or balance testing.
Expected outcome: External fluid connections are complete, secure, and leak-free.
5. Check for Visible Leakage
Inspect around the machine and accessible fluid connections for moisture, dripping, pooled fluid, or evidence of recent leakage.
Do not continue operating a machine with unexplained internal or external fluid leakage.
Expected outcome: No visible leak is present. If leakage is found and cannot be corrected at an approved external connection, remove the machine from service.
6. Verify Disposable and Treatment Setup
Confirm any required disposable components or external treatment connections used during the test are correctly installed.
Check for incorrect routing, open clamps, loose fittings, or components that are not fully seated.
Expected outcome: External setup is correct and is not causing the balance failure.
7. Repeat the Approved Test Once
After correcting external conditions, repeat the manufacturer-approved test under controlled nonpatient conditions.
Avoid repeated cycling if the same test consistently fails.
Expected outcome: The fluid-balance or ultrafiltration test completes successfully. If it passes consistently, proceed to final verification.
8. Verify With Approved Test Equipment When Required
If the facility or manufacturer procedure calls for independent ultrafiltration or fluid-volume verification, use calibrated approved test equipment and the authorized procedure.
Do not adjust internal calibration merely to make the result pass.
Expected outcome: Fluid-removal or balance performance meets the approved verification criteria. Troubleshooting can stop.
If the Problem Persists
If water supply, drainage, fluid connections, disposable setup, and visible leakage have been ruled out but the fluid-balance or ultrafiltration test still fails, common external causes have been eliminated.
Possible remaining categories include internal balancing, flow measurement, valves, pumps, hydraulic pathways, calibration, or other control faults. These require approved service procedures and appropriate test equipment.
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
Do not return the machine to service until required fluid-balance and ultrafiltration verification passes. Knowing when to stop external troubleshooting is proper troubleshooting.
Clinical Use Tip
A machine that cannot verify fluid balance must not be used simply because other functions appear normal.
Work Order Documentation (CCR Method)
CCR = Complaint, Cause, Resolution
Complaint
What was reported by the clinical staff.
Example:
"Dialysis staff reported the SURDIAL X repeatedly failed its fluid-balance check during preparation."
Cause
What was observed during troubleshooting.
Example:
"Clinical Engineering found the external drain hose partially compressed behind the machine, restricting drainage."
Resolution
What action was taken.
Example:
"Clinical Engineering corrected the drain hose routing, repeated the approved test, verified successful fluid-balance checks, and returned the machine to service."
Helpful Details to Include (If Known)
- Exact failed test or alarm
- Water supply status
- Drain condition and routing
- Visible leaks
- Concentrate and fluid connections
- Disposable setup
- Whether failure followed service or disinfection
- Independent test results, if applicable
- Results before and after correction
- Final machine status
Final Thought
Fluid-balance performance is a core dialysis safety function. Verify water, drainage, external connections, and setup before suspecting internal hydraulic failure, and require successful approved testing before the machine returns to patient care.
That is successful troubleshooting.