Prisma™ Priming And Troubleshooting

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Prisma™ Priming And Troubleshooting

  1. 1. Prisma ™ Priming and Troubleshooting Oleh : ARI P Pusat Jantung Nasional Harapan Kita Jakarta 2008
  2. 2. Menghidupkan Mesin Tekan tombol “ON/ OFF” di bawah samping mesin Muncul layar kosong (blank), tetapi dibelakangnya ada konfigurasi kalibrasi Lakukan kalibrasi kalau perlu
  3. 3. PRISMA CRRT Machine <ul><li>Touch screen </li></ul><ul><li>Complete range of therapies </li></ul><ul><li>3 weighing scales </li></ul><ul><ul><li>accuracy < +/- 0.5% </li></ul></ul><ul><li>Custom filter / circuitry </li></ul>
  4. 4. PRISMA CRRT Machine: Basic Layout Replacement Dialysate Effluent Blood Heparin Syringe Pump Pressure Pods Scales x 3
  5. 5. PRISMA CRRT Machine: Basic Layout on Diagram
  6. 6. <ul><li>User friendly interface </li></ul><ul><li>Step by step instructions </li></ul><ul><li>Continuous display of treatment conditions </li></ul><ul><li>Easy / rapid institution of therapies (self prime) </li></ul><ul><li>Continuous 24 hour recording of treatment history </li></ul><ul><li>Alarm explanations </li></ul>PRISMA Machine: Advantages
  7. 7. <ul><li>Need for company specific filter </li></ul><ul><li>Relatively high cost </li></ul><ul><li>Limited blood flow ranges </li></ul><ul><li>Can’t change therapies mid-course </li></ul><ul><li>Scales sensitive to knocking </li></ul>PRISMA Machine: Dis-advantages
  8. 8. Kalibrasi Tekan secara bersamaan tempat yang berkode. Tunggu hingga muncul layar kalibrasi Lakukan kalibrasi
  9. 9. Kalibrasi <ul><li>DIAGNOSE SCALES </li></ul><ul><li>Access Service Mode per above procedure </li></ul><ul><li>Press Diagnose softkey to access Service-Diagnose Screens (for a complete descriptionof “Service-Diagnose Screens”, consult Prisma Service Manual, page 5-11). </li></ul><ul><li>Press Scales softkey to access the diagnose screen for scales </li></ul>
  10. 10. Kalibrasi <ul><li>Observe values displayed for A/D and Averaged-grams displayed on Prisma screen. The values should be as follows: </li></ul><ul><li>A/D values: The A/D Monitor and Control readings are displayed as bits. Each bit represents the voltage signal at the scale and each bit is approximately equal to 1 gram. When there is no weight on the scale, -3000±500 should be displayed as the A/D control and monitor readings. </li></ul><ul><li>Averaged-grams: When no weight is applied, the Averaged-grams readings should be 0 ±7 grams. If you wish to check the calibration of the scales, you can place either or both of the 2600-gram weights on the scale and monitor the values. The reading should be + 7 grams for either weight. </li></ul>DIAGNOSE SCALES
  11. 11. Kalibrasi <ul><li>Access Service Mode per procedure above </li></ul><ul><li>Press the Calibrate softkey to access calibration screens and procedures for scales, pressure sensors, setting filter clotting limits, setting the real time clock/calendar, and setting the PRISMA ID number (for a complete description of these screens, consult the Prisma Service Manual, pages 5-4 through 5-10). </li></ul><ul><li>Press Scales softkey to access calibration screen for scales.Note that the softkeys appear on the screen in the approximate location of each scale on the machine (i.e., the dialysate scale is on the left side, effluent scale is in the middle, and the replacement scale is on the right side of the machine). </li></ul>CALIBRATE SCALES
  12. 12. Kalibrasi <ul><li>Press the softkey for the scale you wish to calibrate. Verify that no weight is applied to the selected scale. </li></ul><ul><li>The first screen will instruct the user to “place weight on selected scale. Use weight of –100 to 100 grams”. DO NOT place any weight on the selected scale. Wait for the “Scale Stable” message to appear. </li></ul><ul><li>Press Next softkey </li></ul><ul><li>The second screen will instruct the user to “place weight on selected scale. Use weight of 2500 grams to 2700 grams”. Place one weight (2600 grams) on the selected scale. Wait for the “Scale Stable” message to appear. </li></ul><ul><li>NOTE: Place weight on middle hook of selected scale to insure even distribution of weight </li></ul><ul><li>Press Next softkey </li></ul><ul><li>The third calibration screen will appear and instruct the user to “place weight on selected scale. Use weight of 5100 grams to 5300 grams”. Place both Prisma weights on selected scale. Wait for “Scale Stable” message to appear. </li></ul><ul><li>NOTE: Place weights on outer hooks of selected scale to insure even distribution of weight </li></ul><ul><li>Press Store softkey </li></ul>CALIBRATE SCALES
  13. 13. Kalibrasi <ul><li>Now that the selected scale is calibrated, the Service-Scales Calibrate screen returns tothe Service Scales screen. Remove the weights and calibrate any of the other scales using this same procedure. </li></ul><ul><li>When scale calibrations are complete, press Exit softkey until the main Service screen appears. Repeat DIAGNOSE SCALES to insure all scales are in calibration. </li></ul><ul><li>Press Exit softkey until main Service screen appears. Press Restart softkey to restart the Prisma System. The machine will enter Setup Mode, Choose Patient screen. </li></ul>CALIBRATE SCALES
  14. 14. Memilih Pasien danProgram Terapi Pilih pilihan terapi sesuai dengan yang diharapkan atau sesuai dengan instruksi medik. Pilih pilihan pasien sesuai dengan pasien yang akan dipasang mesin TEKAN Continue dengan Touch Screen
  15. 15. Menyiapkan Prisma ™ Tubing(1) <ul><li>Pilih PRISMA ™ set sesuai dengan pilihan terapi </li></ul><ul><li>Filter dalam set untuk CVVH/CVVHD/CVVHDF LAIN dengan filter dalam set TPE </li></ul>
  16. 16. Memasang Prisma ™ Tubing(2)
  17. 17. Memasang Prisma ™ Tubing(3)
  18. 18. Memasang Prisma ™ Filter
  19. 19. Memasang Syringe Heparin <ul><li>Pasang syringe heparin 20 cc pada tempatnya. </li></ul><ul><li>Pastikan bagian bawah syringe sempurna masuk ke dalam snap grid syringe </li></ul>Sesuaikan program anti koagulan pada panel monitor dengan dosis yang diharapkan. Pengenceran heparin dalam 25 cc, tetapi jumlah maksimal yang bisa masuk dalam syringe snap grid adalah 23 cc.
  20. 20. Priming Self Test Clamp & Pressure Test <ul><li>Ikuti seluruh prosedur priming : gantung cairan priming NaCl 0,9% dengan heparin 1:5 </li></ul><ul><li>Gantung cairan dialisat dan replacement </li></ul><ul><li>Gantung collecting priming bag </li></ul><ul><li>Bagian terakhir priming adalah Priming Self Test dan Pressure Test Clamp . </li></ul>
  21. 21. Memprogram Terapi Lakukan pemrograman terapi sesuai dengan yang diharapkan atau sesuai dengan instruksi.
  22. 22. Pengaturan Mesin Pt Fluid Removal <ul><li>SET FLOW RATES </li></ul><ul><li>1. Press the name of the flow rate to be changed. </li></ul><ul><li>2. Select next flow rate or press CONTINUE when ready. </li></ul><ul><li>Ultrafiltration will be: 1% of blood flow rate. </li></ul><ul><li>Note: Use arrows to adjust settings. </li></ul>REPLACE Solution DIALYSATE HELP BLOOD 240 ml HR 10 0 0ml HR 80 0ml HR 1 2 0ml MIN ANTICOAG SCUF CVVH SETUP RUN END CVVHD CVVHDF STANDBY CONTINUE
  23. 23. Communication Unit Touch-screen Status Screen NORMALIZ BLOOD TREAT HISTORY HELP SET FLOW RATES SETUP STANDBY RUN END SCUF CVVH CVVHDF CVVHD Current Flow Rates Blood Flow Rate: Replacement Rate : Dialysate Flow Rate: Anticoagulation: Treatment Data Time: Dialysis Fld used: Replacement Fld used Total Effluent: Actual fluid removed: Current Pressures Access: Filter Pres: Effluent: Return: TMP: Δ P: Next Intervention: 1 min Due to: Replacement bag empty MODIFY SETTINGS EXAMINE ALARMS CHANGE BAGS
  24. 24. Prisma ™ Ready to Use
  25. 25. Penempatan Mesin
  26. 26. Menyambung ke pasien <ul><li>Lakukan penyambungan ke pasien. Paling umum dan aman adalah menyambungkan satu persatu. Setelah tubing terisi darah hampir seluruhnya, baru disambungkan bagian vena ke pasien. </li></ul><ul><li>Ada anggapan perlu untuk memberikan 1000 UI heparin pre filter sebelum darah masuk ke filter </li></ul>OBSERVASI KETAT!!! JANGAN ADA BUBBLE!!!!
  27. 27. Mengakhiri Terapi <ul><li>Dari menu pilih End Treatment. </li></ul><ul><li>Ikuti langkah langkah mengakhiri terapi sampai dengan switch off Prisma </li></ul>
  28. 28. Prisma ™ Troubleshooting(1) Tekanan Acces dan Return
  29. 29. Prisma ™ Troubleshooting(2) Resetting Skala Replacement atau Dyalisate
  30. 30. Prisma ™ Troubleshooting(3) Pressure Pod
  31. 31. Prisma ™ Troubleshooting(4) Fluid Removal Error
  32. 32. Prisma ™ Troubleshooting(5) Air in Line
  33. 33. Prisma ™ Troubleshooting(5) Error Coding
  34. 34. T E R I M A K A S I H

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