1. Training module 5 – Troubleshooting
Dialysis System SW
Training module 5 – Troubleshooting
Ref: Operator’s Manual SW
- Chapter 16 – Alarms, Information Signals, Troubleshooting

2. Troubleshooting Alarm Management Air in Venous Line Alarm
Troubleshooting
Alarm Management
Air in Venous Line Alarm
Arterial/Venous Pressure Alarms
Malfunction Alarms
SmartScan
Troubleshooting
Ref:
Operator’s Manual SW 8.08 Service code
- Chapter 16 – Alarms, Information Signals, Troubleshooting
Important Notice:
This presentation does not relieve any user of the Artis Dialysis System from his or her duty to carefully read the full text of the Operator’s Manual before using the system.
Important:
Please note that the SW change to
of this presentation does not
change the training of the Artis Dialysis
System for users.

3. Alarm Classes and Distribution
Alarm Classes and Distribution
Classes
Alarm Priority
Display Color
Sound*
Light appearance
High
HIGH
RED
High sound
10 pulses/7sec
RED Flashing
Medium
MEDIUM
YELLOW
Med Sound
3 pulses/7sec
YELLOW Flashing
Low
LOW
Low sound
2 pulses/17sec
YELLOW Constant
Notification
n/a
BLUE
Tune every 90 sec
Smartscan
GUI text, sound and light
in compliance with the IEC standard:
24% 9%
34%
33%
Alarm Classes and Distribution
Operator’s Manual. section 16.2 and section 16.3
Artis alarms are categorized based on their priority, which indicates the importance on an alarm and the urgency to address it.
The priority of each alarm has been assigned taken into account both the severity of the potential consequences of Operator’s failure to respond to the cause of the alarm and how fast these consequences may start to happen
RED - HIGH PRIORITY
Recurring high sound, 10 sound pulses repeated every 7 seconds;
Red flashing light;
Alarm message displayed with white text on red background.
YELLOW - MEDIUM PRIORITY
Recurring medium sound, 3 sound pulses repeated every 7 seconds;
Yellow flashing light;
Alarm message displayed with black text on yellow background.
YELLOW - LOW PRIORITY
Recurring low sound, 2 sound pulses repeated every 17 seconds;
Yellow constant light;
BLUE - NOTIFICATION AND SMARTSCAN
Information sound is issued every 90 seconds.
NOTIFICATIONS are usually related to customizable reminder events or machine events requiring the operator’s attention
in order to move forward in the treatment workflow
SMARTSCAN MESSAGES are triggered by SmartScan criteria enabled on the machine
Alarms are now categorized as per above mentioned standard compared to SW 6.04 when Artis was launched.
*Ref: Operator’s Manual SW 8.09 chap. 16 p. 16-2

4. Smart Alarm Management
Smart Alarm Management
Root Alarm
Related Alarms
The alarm code and message
displayed may include several
related alarm codes.
Examples to the right:
BiCart cartridge empty (#21)
Acid/Acetate Concentrate Container Empty (#1)
Alarm “Root Cause” is Displayed
Operator’s Manual, section
Artis is equipped with an intelligent Alarm system engine – the Smart Alarm Management – which consolidates many related alarms
If two or more alarm conditions are triggered related to the same cause, the Alarm Management System will distinguish the alarms in accordance with:
The Root cause (Main Alarm)
The alarm(s) resulting from the Root cause
Only the Root cause alarm is displayed in the Message Area

5. Alarm Appearance Alarm Appearance
Alarm Appearance
Alarm Appearance
Operator’s Manual, sections 16.2 and 16.4
Reset
Some alarms are displayed with a Reset symbol to the right in the alarm message bar – those alarm can be reset by pressing the Reset button displayed in the Alarm/Information Message Area when the cause of the alarm is removed
Some alarms are automatically “Reset” by the machine when the alarm is resolved “by itself” within a specified time interval – no Reset symbol/button is displayed
Confirm
Information Signals displayed with a Confirmation symbol in the information signal bar are cleared by pressing the Confirm button
The Eye symbol is specifically connected to SmartScan criteria enabled on the machine (see slide 12)
When several alarms with different priorities are triggered simultaneously those are displayed in different tabs according to their priority with the highest on top of the other
Each tab can display 3 alarms at the same time
It is possible to visualize all the alarms within the same priority using the scroll button
It is also possible to visualize all the alarms with different priorities using the color coded tabs at the bottom of the alarm message area
If the tab contains at least one alarm/information message it is highlighted, according to priority level (otherwise it is grey).

6.
Alarm Management
Alarm Management
Operator’s Manual, section and 16.4
Toggle (switch) button
When an alarm is displayed on top of an Operator’s message, press the Toggle button (switch button = “speech bubble” is only displayed when an alarm is covering an Operator’s message) to get access to the “hidden” message. Press the Return button (Situated at the same place as the switch button) to again view the alarm message
Mute icon
The Mute icon appears on the Alarm/Information Messages Area when the mute hard key is pressed. The Progress Bar at the top of the icon shows the remaining time before the alarm sound will go off again.
Highlight – Override/Pause Alarm
Only the alarm related to a Blood Leak Detection can be paused (overridden) – which gives the possibility to ignore the alarm and to continue the treatment (It is useful when a recovery of a dangerous situation requires the machine to work, reactivating some functionality that was stopped due to the alarm)
The Pause Alarm (override) symbol is displayed together with the “Blood in Dialysate” alarm and the Pause Alarm (Override) button.
During a Pause Alarm (Override) phase:
Some of the safety mechanisms are disabled for 2 minutes
The Auditory and Visible Alarm Signals are maintained
The Alarm Message is still displayed in the Alarm/Information Message Area
If one or more additional faults cause an alarm during the Pause Alarm (override) state, the description relative to each fault is displayed in the Alarm/Information Messages Area.
Only a blood leak alarm can be paused (overridden) per Operator’s manual chap 16.
Mute icon with 2 minute progress bar

7.
Alarm Help-on-screen
Alarm Help-on-line
Operator’s Manual, section and 16.5
Selecting an Alarm/Information Message on the text area and pressing the Help button, a Help Window will open, covering the Alarm/Information Messages Area
On this area, further information on possible causes and solutions of the selected alarm is provided. Press the Close button to switch back to the Alarm/Information Messages
Pressing the Help button in case an “Air in Venous Line (#4)” alarm is triggered opens a pop-up window
To the left, step by step instruction how to proceed to resolve the alarm – To display the image related to a specific step, select the step in the checklist
To the right, step by step illustrations how to perform the actions described in the checklist
The “Next” button will display the next step to perform in text (left) or illustrated (right)
The Arterial and Venous Pressures together with the UF Rate and the UF Volume values are displayed below the illustrations
Highlight
Help-on-line is automatically closed if an alarm with higher priority occurs
Help-on-screen is automatically closed if an alarm
with higher priority occurs

8.
Air in Venous Line 1.
2.&3.
Manually clamp:
The venous patient line below the venous automatic line clamp and any visible air
The dialyzer venous line
This will isolate the venous chamber
Attach a sterile luer-lock syringe to the venous infusion line and create a negative pressure of -80 mmHg in the venous chamber (vacuum effect)
The venous patient line clamp will open automatically (listen)
Remove the manual clamp from venous patient line and pull air into syringe to raise level in chamber – check that no air is present in the line
Restart blood pump and remove the manual clamp from dialyzer line
Check/adjust chamber fluid levels as needed
Air in Venous Line
Operator’s Manual, section 16.6 and 16.7 (alarm 4), Special Procedures, Adjust A/V chamber levels section 8:28
QRG page
The presence of air bubbles in the venous line after the automatic clamp do not indicate a dysfunction of the system:
The Artis has an “in line” air bubble detection system.
The distance between the air bubble detector and the automatic clamp is short.
Depending on the blood flow rate, air my pass the automatic clamp before it closes but the system is designed to never allow any air reaching the patient
In case of a major air entry it is recommended to change the circuit
When resolving the Air in Venous line alarm, manually clamp the Venous patient line below any visible air
Always check that no air is present in the venous patient line before restarting the blood pump – redo the ”Air in venous line” procedure if needed
Usually the venous chamber fluid level increases during this procedure. If so, it is recommended to adjust the level in order to avoid getting blood into the syringe if yet another ”Air in venous line” procedure should be necessary
Highlight
When solving an “Air in Venous line” alarm, the blood pump will not start as long as there is any other red alarm active - reset all red alarms before pressing the Blood Pump ON button.
When resolving the alarm, the venous clamp closes again if the venous pressure reaches 40 mmHg – if this condition occurs the ”Air in venous line” procedure must be repeated
As long as another red alarm is active it is not possible to restart the blood pump
When resolving the Air in Venous alarm, the venous clamp closes again if the venous pressure reaches + 40 mmHg

9. A/V Pressure Alarms Arterial pressure alarm: Venous pressure alarm !
A/V Pressure Alarms
Arterial pressure alarm:
occurs when a surge or a drop in the arterial
pressure goes over or below the window limits
Once the arterial pressure stabilizes, press the Reset button to reset the alarm.
The blood pump will restart automatically
Venous pressure alarm
Occurs when a surge or a drop in the venous pressure goes over or below the window limits
Once the venous pressure stabilizes, press the Reset button to reset the alarm
The blood pump will restart and the venous clamp will open automatically !
A/V Pressure Alarms
Ref: Operator’s Manual, Arterial Pressure Alarm 305 and 384, Venous Pressure Alarm 155 and 382
Machine actions:
The Arterial and the Venous Pumps are stopped
The Venous Line Clamp is closed
The UF Rate is automatically set to zero
The arterial and venous pressure alarm limits are opened
When the pressure stabilizes, select the alarm in the Alarm/Information Message Area and press the Reset button to restart the blood pump.
A Venous pressure above 450 mmHg requires the use of a sterile luer lock syringe to decrease the pressure

10. Malfunction alarm – Call for service
Malfunction alarm – Call for service
Note the alarm code (check the malfunction list in the Operator’s Manual)
Perform a “Fast Recovery” procedure (if applicable, see below)
If the malfunction alarm is not resolved / recurs - turn the machine OFF and perform a Manual Rinseback
Call your biomedical technician for Service
Pay special attention to malfunction alarm code 59 and 64
Code 59: Heater protection error
Switch the machine OFF
Perform a Manual Rinse-back
Code 64: Safe state activated “Excessive Rinseback Volume” If this alarm code occurs during Rinseback
Disconnect the patient
Malfunction alarm – Call for service
Operator’s Manual, section and Special Procedures section 8.5
When a Malfunction alarm occurs, the word MALFUNCTION together with the TECHNICAL CODE for the alarm is displayed in the Alarm/Information Message Area
In the Malfunction alarm list all malfunction alarms are listed in technical code order with a short description of the explanation of the alarm and the related priority.
If the alarm occurs during treatment:
Perform a Fast Recovery procedure (Module 6)
If the alarm persists, take note of the alarm code, switch the machine OFF and perform a Manual Rinseback procedure (Module 6) then call for Service.
EXCEPTION: Malfunction alarm 59 and 64
If the alarm occurs during disinfection:
Take note of the alarm code, switch the machine OFF and call for Service.

11. Malfunction 320 It is not necessary to disconnect the patient
Malfunction 320 is presented with this
specific alarm windows:
The touch screen is blocked
A “Fast Recovery“ procedure is required
Turn Artis machine off then restart and follow instructions on screen
Malfunction 320
Ref: Operator’s Manual, section and Special Procedures section 8.5
It is not necessary to disconnect the patient

12. Some of the SmartScan notifications are presetable
SmartScan
Treatment supervisor, alerting the Operator when the ongoing treatment may be improved by the adjustment of a parameter settings
SmartScan
Operator’s Manual, section 16.6 and 16.7
Highlight
Some of the SmartScan notifications are presetable
I.e. the clinic can decide if the notification should appear or not
Some of the SmartScan notifications are presetable

13. Examples of SmartScan notifications
Examples of SmartScan notifications
Smartscan - High QD, code 514
Smartscan - Low QD, code 513
Smartscan - Low QB, code 512
Smartscan - Low Real QB, code 577
Smartscan - High Sodium setting, code 606
Smartscan - Hemocontrol: Late on Prescription, code 229
Smartscan - Hemocontrol: Early on Prescription, code 230
Smartscan - Hemocontrol: High Na Concentration, code 231
Smartscan - Hemocontrol: Low Na Concentration, code 232
Smartscan - Not performing UF, code 443
Smartscan - Diascan: Low Clearance, code 530
Smartscan - Diascan: Low Kt/V, code 531
Examples of SmartScan notifications
Operator’s Manual, section 16.6 and 16.7
High QD – Set QD is > 3 x set QB for more then 10 minutes – once only
Low QD – Set QD is < 1.5 x set QB for more than 10 minutes – once only
Low QB – Average set QB value (measured during the last 5 minutes) is lower than 50 ml/min (SNDP excluded) - ongoing
Low Real QB – Real QB less than < 0.9 x pump speed for more than 3 minutes - ongoing
High sodium setting – The Sodium parameter set value has been higher than 155 mmol/L for more than 90 minutes
Not performing UF – The UF button has been deselected during treatment - ongoing
Low clearance – The Clearance value is below the set threshold value or when the Clearance value is lower than 55% of the QB – when measurement is taken
Low Kt/V – SmartScan has detected a Forecast Kt/V less than 0.8 or lower than the Target Kt/V set value

14. Hands on Module 5 Change A/V pressure window
Hands on Module 5
Change A/V pressure window
Change A/V pressure limits
Handle A and V pressure alarms
Handle air in venous line
Hands on Module 5
The Trainer’s Check List should be used and ticked off during the hands-on training
By following the different hands-on prescriptions all function will have been practiced at the end of the course

15.
References
IEC standard

16. Gambro is an indirect subsidiary of Baxter International Inc.
For the safe and propre use of the Artis dialysis System, refer to Warnings, Precautions and the complete Instructions For Use in the Operator’s Manual available by contacting customer support
Gambro is an indirect subsidiary of Baxter International Inc.