Troubleshooting. Edwin A. Burgstaler, MT., HP. (ASCP) ASFA 2015 Annual Meeting May, MFMER slide-1

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1 Troubleshooting Edwin A. Burgstaler, MT., HP. (ASCP) ASFA 2015 Annual Meeting May, MFMER slide-1

2 Troubleshooting Objectives The participant will recognize some problems in apheresis procedures and their possible causes. The participant will be able to cite examples of techniques to address troubles with apheresis procedures MFMER slide-2

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5 Apheresis Troubleshooting Pump Troubleshooting Roller Pump Dirty rollers Slippery rollers Poor tubing tension Wrong tubing diameter or platen clearance Poor roller tension, broken or weak spring Rotor slipping on shaft Obstruction in pump head 2011 MFMER slide-5

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7 Apheresis Troubleshooting Pump Troubleshooting Pneumatic Pump Pump not properly seated Poor air pressure Compressor is faulty Rubber shield out of place Kit leaks or defects 2011 MFMER slide-7

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11 Apheresis Troubleshooting Clamp Troubleshooting Dirty and sticky due to spills Poor spring tension Poor electric signal or air pressure Wrong size tubing Stacked tubing 2011 MFMER slide-11

12 Apheresis Troubleshooting Machine Components-Air Detectors Most are ultra-sonic Level sensors usually optical with light transmission Very sensitive Foam can be a problem 2011 MFMER slide-12

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15 Apheresis Troubleshooting Air Detector Troubleshooting Need very good contact with sensor Clean the sensor Load properly- floss in 2011 MFMER slide-15

16 Apheresis Troubleshooting Machine Components- Electronic Scales Very sensitive-handle with care Don t use as a miscellaneous hanger at any time Need to be tarred (zero) Watch for obstructions 2011 MFMER slide-16

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19 Apheresis Troubleshooting Centrifuge Troubleshooting Need to be installed properly Prevent multi-lumen tube breakage Proper separation Good balance Air locks are possible Difficult to remove 2011 MFMER slide-19

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22 Apheresis Troubleshooting High Centrifuge Pressure Possibilities: Strangulated or pinched tubing Air in centrifuge-leak or introduced Clot in centrifuge Kinked tubing beyond centrifuge, kit defect Poor return access Concentrated RBC High viscosity fluid-protein, HES replacement 2011 MFMER slide-22

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25 Apheresis Troubleshooting Machine Components- Pressure Sensors Measure positive, negative, or both pressures Need a good seal of sensor and pod Need a baseline reading (room air pressure) Some have protective filters for circuit boards 2011 MFMER slide-25

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33 Apheresis Troubleshooting Pressure Troubleshooting Poor seal of sensor and pod Kink in line Leak in kit Protective filter is wet Defective sensor or pod 2011 MFMER slide-33

34 Apheresis Troubleshooting Pressure Troubleshooting Access pressure low Causes: kinks, clots, bore and needle size, vein position, collapsing vein, stress of patient/donor, faulty sensor Remedy: check the line from inlet pump to access site only, correct problems, apply heat, slow down, reassure patient/donor 2011 MFMER slide-34

35 Apheresis Troubleshooting Pressure Troubleshooting Return pressure high Causes: kinks, vein position, bore and needle size, clots, clogged filter, stress, or faulty sensor Remedy: check return line from sensor to return site, correct problem, slow down, dilute replacement solution, apply heat, calm patient/donor 2011 MFMER slide-35

36 Apheresis Troubleshooting Machine Components- Optical Sensors Interface Detectors Light absorbance Camera Line Sensors Light absorbance or block Cell effect on light-ccm red vs. green light 2011 MFMER slide-36

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42 Apheresis Troubleshooting Optical Sensor Troubleshooting Proper positioning and loading Avoid smudges, oils, and films Keep clean-use recommended agents Lipemic and hemolyzed plasma could be an issue Watch for cracks, chips, and scratches 2011 MFMER slide-42

43 Apheresis Troubleshooting Machine Components- Leak Detectors Found in centrifuges Detects current flow between electric wires Usually humidity not an issue Dust, particulate build-up could affect Watch for tears and breaks after centrifuge line break Use care cleaning 2011 MFMER slide-43

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45 Specific Problems 2011 MFMER slide-45

46 Apheresis Troubleshooting Prime Failure Test- Pump,Clamp,Sensor intime Checks: Leak in kit Pump performance Clamp performance Pressure sensor performance 2011 MFMER slide-46

47 Check: Apheresis Troubleshooting Prime Failure Roller & pinch clamps completely closed Clamps correctly loaded Stacked tubing Fluids completely open Pumps loaded correctly Pressure sensor has tight seal Signs that pump roller may be sticky 2011 MFMER slide-47

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54 Apheresis Troubleshooting Air in line (post prime) Possibilities: Clot Access site blocked-against wall of vessel or catheter Kinked tubing before the pump head Leak in tubing kit-connections, couplers, tubing Leak in catheter Clamped line Replacement fluid not completely spiked 2011 MFMER slide-54

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58 Apheresis Troubleshooting Removing air in the line Open lines and direct air to waste bag, saline bag, drip chamber If in Return line: Use a syringe at the injection site to draw into syringe Disconnect from patient/donor, drain into waste container 2011 MFMER slide-58

59 Apheresis Troubleshooting Hemolysis ossibilities: Frozen pump roller Kink in tubing Extended time in the centrifuge Excessive heat in the centrifuge Pre-existing hemolysis in patient Wrong fluids attached 2011 MFMER slide-59

60 pheresis Troubleshooting Photo-Interface Creeps to Center of Bowl Possibilities: Bowl filled too fast, RBC not packed enough Using port for access Suggestion: Drop collect rate to 20-25ml/min If the interface stabilizes at the light beam, could raise the collect rate If interface creeps, stay slow, decrease speed, put in pause Change Double Needle to Single Press STOP to re-establish interface 2011 MFMER slide-60

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71 Rippled Amicus Reflector 2011 MFMER slide-71

72 Filtration Troubleshooting cont. High TMP Causes: anticoagulation, plasma pump rate too high, high triglycerides Remedy: check anticoagulant, slow plasma pump, encourage better low fat diet for patient High differential pressures Causes: clamped lines, kinks, return access anticoagulants, clogged separator, columns, or filter Remedy: correct obstructions, check anticoagulant 2011 MFMER slide-72

73 Apheresis Troubleshooting Best Practices in Trouble Shooting Know your equipment Check your equipment before you start Use care during set-up and prime Keep the equipment clean and in good shape Do not panic; but reassure the donor/patient Do localize, determine cause-effect, & correct Do seek help, if needed Inform vendors of problems with equipment and disposables 2011 MFMER slide-73

Troubleshooting/Access/Alarms Simulation. Wendy McCay, MPH, BSN, OCN Brenda Stofan, RN

Troubleshooting/Access/Alarms Simulation Wendy McCay, MPH, BSN, OCN Brenda Stofan, RN Typical Pressures During Treatment Access Pressure- Negative -50 to -150 mm Hg Filter Pressure- Positive +100 to +250