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
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of three amazing children.
On Twitter, he is @precordialthump.
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