Troubleshooting...2008/05/15 · Protective filter is wet Defective sensor or pod ©2011 MFMER |...

©2011 MFMER | slide-1

Troubleshooting

Edwin A. Burgstaler, MT., HP. (ASCP)

ASFA 2015 Annual Meeting May, 2015


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.




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




Pump Troubleshooting Pneumatic Pump

Pump not properly seated

Poor air pressure

Compressor is faulty

Rubber shield out of place

Kit leaks or defects






Clamp Troubleshooting

Dirty and sticky due to spills

Poor spring tension

Poor electric signal or air pressure

Wrong size tubing

Stacked tubing



Machine Components-Air Detectors

Most are ultra-sonic

Level sensors usually optical with light transmission

Very sensitive

Foam can be a problem





Air Detector Troubleshooting

Need very good contact with sensor

Clean the sensor

Load properly- “floss in”



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





Centrifuge Troubleshooting

Need to be installed properly

Prevent multi-lumen tube breakage

Proper separation

Good balance

Air locks are possible

Difficult to remove




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





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










Pressure Troubleshooting

Poor seal of sensor and pod

Kink in line

Leak in kit

Protective filter is wet

Defective sensor or pod




• 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




• 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



Machine Components- Optical Sensors

Interface Detectors

Light absorbance

Camera

Line Sensors

Light absorbance or block

Cell effect on light-CCM red vs. green light







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


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



Specific Problems


Apheresis Troubleshooting Prime Failure

Test- Pump,Clamp,Sensor inTime

Checks:

Leak in kit

Pump performance

Clamp performance

Pressure sensor performance


Apheresis Troubleshooting Prime Failure

Check:

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








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





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


Apheresis Troubleshooting Hemolysis

Possibilities:

Frozen pump roller

Kink in tubing

Extended time in the centrifuge

Excessive heat in the centrifuge

Pre-existing hemolysis in patient

Wrong fluids attached


Apheresis 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












Rippled Amicus Reflector


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



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

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Troubleshooting...2008/05/15 · Protective filter is wet Defective sensor or pod ©2011 MFMER |...

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