Renal replacement therapy: Troubleshooting

OVERVIEW

Troubleshooting:

• low arterial pressure alarm (access line)
• high venous pressure alarm (return line)
• disconnection alarm
• air in the circuit alarm
• fluid balance error

Also see preventing clotting in a CRRT circuit (includes anticoagulation strategies)

LOW ARTERIAL PRESSURE ALARM

• kinked or clamped line -> remove kink/ clamp
• clotted line -> declot access
• access device against vessel wall -> consider switching limbs
• hypovolemia -> stop UF, decrease blood flow rate

HIGH VENOUS PRESSURE ALARM

• kinked or clamped line -> remove kink/ clamp
• clotted line -> declot access
• positional vascular access obstruction -> switching consider limbs

DISCONNECTION ALARM

• line separation or disconnection from patient (rare) -> check circuit and patient and if no disconnection then override alarm
• circuit kinked or clamped before pressure sensor -> declamp line
• clot excluding pressure sensor -> evaluate for circuit change
• blood pump speed  too slow relative to catheter performance -> increase set blood flow rate

AIR IN THE CIRCUIT ALARM

• presence of small air bubbles in circuit (often due to bicarbonate CO2 coming from hemofiltration bags) -> follow instructions for degassing
• line disconnection at arterial access -> stop session
• turbulence close to sensor -> override alarm

FLUID BALANCE ERROR

• effluent or hemodialysis/ filtration bags moving or incorrectly hanged -> wait for bags to stabilise, stop or reposition them on scales
• kinking in effluent or hemofiltration/ dialysis bags -> remove line kinking
• machine occassional error -> override
• machine systemic error (if more than 10 times without reason in 3 hours) -> change machine and do not reuse before technical assistance

References and Links

• CCC – RRT Indications
• CCC – RRT principles in fluid management
• CCC – RRT Types
• CCC – RRT terminology and nomenclature
• CCC – RRT troubleshooting