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What This Guide Helps With
Troubleshoot unstable dialysate conductivity by checking concentrates, water preparation, consumables, connections, setup, and external conditions before service escalation.
Step-by-Step Troubleshooting
1. Protect the Patient
Do not continue dialysis when dialysate conductivity is unreliable or outside the machine's accepted operating condition. If the issue occurs during treatment, follow the facility's clinical procedure for safely stopping, maintaining, or transferring therapy.
Never bypass a conductivity alarm.
Expected outcome: The patient is not exposed to dialysate of uncertain composition, and the affected machine is available for off-patient troubleshooting.
2. Confirm the Conductivity Complaint
Determine whether conductivity:
- Fails to stabilize during setup
- Drifts after initially stabilizing
- Produces a repeated warning or alarm
- Changes after a concentrate or consumable change
- Occurs only at one location or water connection
Record exact messages and the point in the sequence where the condition appears.
Expected outcome: The failure pattern is documented and reproducible.
3. Verify the Correct Concentrates and Consumables
Confirm that all required concentrates and disposable components are the correct type for the intended treatment and are installed according to normal clinical setup.
Inspect labels, connections, expiration status when applicable, and obvious container damage or contamination.
Do not substitute products that are not approved for the system.
Expected outcome: Correct supplies are present and properly connected. If an incorrect or improperly connected supply is corrected and conductivity stabilizes, troubleshooting can stop after verification.
4. Inspect Concentrate Connections and Fluid Paths
Check accessible concentrate connections for:
- Loose fittings
- Kinks
- Pinched tubing
- Empty or inadequately supplied containers
- Air entering through an improperly seated connection
- Visible leakage
Avoid opening internal fluid-path components.
Expected outcome: External concentrate pathways are secure, unobstructed, and properly supplied.
5. Verify Water Preparation Is Normal
Confirm the machine has completed its normal water-preparation process without unresolved alarms. Review whether any recent water inlet or integrated purification problems occurred.
Conductivity instability associated with a water-preparation problem should be addressed as a water-system issue before further dialysis troubleshooting.
Expected outcome: Water preparation is stable and no unresolved water-related condition is present.
6. Check Setup and Configuration
Verify the selected treatment setup and accessible parameters are appropriate for the intended therapy and have not been accidentally changed.
Do not alter restricted calibration or service parameters.
Expected outcome: The machine is configured for the intended treatment without unintended user-level setup changes.
7. Replace Questionable External Supplies With Known-Good Supplies
If a concentrate container, connector, or disposable is suspect, replace it with an approved known-good equivalent when permitted by facility procedure.
Change one variable at a time so the corrective action can be identified.
Expected outcome: Conductivity stabilizes with the known-good supply if the original external component caused the problem. Troubleshooting can stop after successful verification.
8. Repeat the Preparation Sequence
With the machine off patient, repeat the normal preparation process and observe whether conductivity reaches and maintains the system's accepted condition.
Do not bypass or silence recurring safety checks merely to advance the setup.
Expected outcome: Conductivity stabilizes and remains accepted by the system. If so, continue to final verification.
9. Perform Final Functional Verification
Confirm the Tablo completes pre-treatment preparation without conductivity alarms and maintains stable dialysate preparation through the normal verification period.
Expected outcome: No recurrent conductivity alarm occurs and the machine reaches the expected ready state. Troubleshooting can stop.
10. Escalate Persistent Conductivity Instability
If correct concentrates, proper connections, normal water preparation, and appropriate setup are confirmed but conductivity remains unstable, remove the device from service.
Expected outcome: Internal proportioning, sensing, fluid-control, or calibration-related causes are left to qualified service evaluation.
If the Problem Persists
Common external concentrate, connection, consumable, setup, and water-preparation causes have been ruled out. A persistent problem may involve internal sensing, mixing, pumping, fluid-control, calibration, or service-level configuration.
The device should be:
- Removed from service
- Labeled Out of Service
- Sent for repair or bench evaluation
- Evaluated using appropriate Outset Medical documentation and approved test equipment
- Repaired, calibrated, or configured only by qualified personnel
Conductivity and applicable dialysis-fluid performance must be verified before return to service. Knowing when to stop external troubleshooting is proper troubleshooting.
Clinical Use Tip
Never clear a conductivity alarm and proceed with treatment until the machine has demonstrated stable, acceptable dialysate preparation.
Work Order Documentation (CCR Method)
CCR = Complaint, Cause, Resolution
Complaint
What was reported by the clinical staff.
Example:
"Dialysis staff reported the Tablo would not stabilize conductivity during treatment preparation."
Cause
What was observed during troubleshooting.
Example:
"Clinical Engineering found the concentrate connection was not completely seated, resulting in inconsistent concentrate delivery."
Resolution
What action was taken.
Example:
"Reseated the approved concentrate connection, repeated preparation, verified stable conductivity with no recurring alarm, and returned the unit to service."
Helpful Details to Include (If Known)
- Exact conductivity message
- When instability occurred
- Concentrate type used
- Concentrate connection condition
- Disposable condition
- Water-preparation status
- Recent supply changes
- Known-good substitution performed
- Results after repeating setup
- Final device status
Final Thought
Conductivity problems must be treated as patient-safety issues. Confirm supplies, connections, water preparation, and setup before assuming an internal fault, and never bypass protective checks. Verify stability after correction, escalate persistent problems, and document the complete event.
That is successful troubleshooting.