Baxter’s HomeChoice APD System

1 baxter s HomeChoice APD System Alarm Troubleshooting* and Prevention TacticsLow Drain Volume Alarm (LDVA)Root Causes Patient reabsorbed more solution than expected or incomplete Last FillPatient empty at start of Initial Drain (I-Drain)I-Drain Alarm setting too high Catheter obstructionPoor catheter positionCycler position too high relative to patient positionFibrin blockageTroubleshooting Check Drain Volume press down arrowChange position to try to drain more fluidCheck for kinks, air or fibrin in patient lineHave you changed your prescription? Have you completed a day drain?Verify cycler position relative to patient supine positionCall dialysis center to help diagnose problem causing LDVAP revention Review or adjust the Initial Drain (I-Drain) Alarm setting if the Last Fill volume, Last Fill dwell time, or if the Last Fill solution type changedDetermine root cause for patient absorbing more solution than expected- Increased sodium intake?

2 - Recently ill dehydrated? Review Therapy Log to monitor I-Drain Volume- Check for incomplete Last FillRoutinely assess catheter flowRoutinely ask patient if he/she is experiencing LDVA during treatmentNOTE: Patients should not bypass Initial Drain without talking to a Lines AlarmRoot Causes Empty solution bagsBlocked solution bag portClosed clamps KinksDisconnected solution bagsFibrin blockageTroubleshooting Reposition bags to push fluid to port and clear blocked portPrevention Use the appropriate solution volume to prevent empty solution bags The total solution volume connected must be greater than the sum of:1. Total solution volume prescribed2. Patient line - 45 and flushing volumeHeater bag prime and integrity test - 250 mLSupply bag - 120 mL for each additional supply bagExtension set - 45 mL (if used) System ERROR 2240 AlarmRoot Causes Patient presses GO to start therapy, but has not connected themselvesDisconnected disposable tubingUse of dummy tummy during trainingIncomplete prime Disrupted tip protector on unclamped and unused supply linesLoose connectionsLeaksTroubleshooting Ask patient if he/she disconnected during therapyIf patient disconnected was this during drain, fill or dwell?

3 Did patient follow the Emergency Disconnect procedure? - Press STOP before disconnecting- Press GO when reconnected- Dwell preferred phase to disconnectTherapy needs to be terminated and a new therapy (on cycler or via manual exchange) initiatedPrevention Review the Emergency Disconnect Procedure (Patient At-Home Guide, page 18-65)If a System ERROR 2240 occurs, you must end the therapy and start a new therapy (on cycler or via manual exchange)*For more information about troubleshooting alarms refer to the Troubleshooting section in the Patient At-Home s HomeChoice APD SystemTeaching Opportunity - Alarm SimulationsCaution: Federal ( ) law restricts this device to sale by or on the order of a physician or otherlicensed practitioner.

4 For safe and proper use of this device, refer to the device Operator s Manual. baxter and HomeChoice are trademarks of baxter International Inc. AL11081 05/11 Low Drain Volume Alarm When Alarm Occurs Training prescription CCPDT herapy volume 4900 mL Therapy time 1:30 Fill volume 1100 mL Last Fill volume 500 mL Dextrose SameI-Drain Alarm 350 mL Dummy tummy should have 100-150 mL of solution, no air present in dummy tummyReview Troubleshooting section in Patient At-Home Guide while waiting for alarm to occur Turn to Troubleshooting section in Patient At-Home Guide walk patient through action itemsDiscuss with patient when he/she should bypass an alarmReview treatment data drain volumesHas patient changed position and repeated drain cycle?

5 Emphasize importance of notifying dialysis clinic if patient had to bypassCheck Patient Line Alarm When Alarm Occurs Close the clamp on the patient line during Drain or Fill until the System alarms CHECK PATIENT LINEAuto Restart alarm Turn to Troubleshooting section in Patient At-Home Guide walk patient through action itemsHave patient check the line referencedHave patient correct alarmPatient did not need to press any buttonsSYSTEM ERROR 2240 or 2267 Alarm When Alarm Occurs Total volume = 6000 mL Therapy time = 1:30 Fill volume = 2000 mL Last Fill volume = 2000 mL Dextrose = SameI-Drain Alarm = 1400 mL Dummy tummy should have 2000 mL of solutionDisconnected during dwell, did not press STOP, and left clamp open on patient line Press STOP to mute the alarmWrite down the System Error number and treatment phase that appears on the display screenTurn the power switch OFF and ON to end therapy System ERROR 2267 appearsPress the power switch OFF and ON again PRESS GO TO START appearsClose all clampsDiscard the disposable set and solution bagsNotify dialysis nurseComplete treatment with a manual exchange -OR-Set up the cycler with new suppliesSTEPS TO SIMULATE THE: STEPS TO ADDRESS ALARM.