HomeChoice HomeChoice PRO APD Systems Patient At-Home Guide Creating a Better World of Care for Renal Patients PATIENT GUIDE COVERS_Update121109.
The HomeChoice and HomeChoice PRO APD Systems Patient At-Home Guide Document Number 07-19-61-244 October 2, 2009
Baxter, HomeChoice, UltraBag, MiniCap, FlexiCap, OptiChoice, Dianeal, and Extraneal are trademarks of Baxter International Inc. Copyright 2009 Baxter Healthcare Corporation. All rights reserved.
Table of Contents 1 Glossary 1.1 1.2 2 User Assistance Information 2.1 2.2 3 3.3 3.4 Side Effects and Contraindications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-1 Warnings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-1 3.2.1 Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-1 3.2.
Table of Contents 5.6 5.7 6 Environmental Conditions 6.1 6.2 7 Check-out . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-1 Set Up the HomeChoice APD System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-2 Grounding Instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Table of Contents 9 Operating Instructions – Change Program 9.1 9.2 9.3 9.4 9.5 9.6 9.7 9.8 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-1 About Your System’s Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-1 9.2.1 Nurse’s Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Table of Contents 10.2.8 10.2.9 10.2.10 Comfort Control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-13 Last Manual Drain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-14 UF Target and Alarm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-15 11 Operating Instructions – Prepare for Therapy 11.1 11.2 11.3 11.4 11.5 11.6 11.7 11.8 11.9 Gather Your Supplies . . . . . . . . . . .
Table of Contents 14 Operating Instructions – Effluent Sampling 14.1 14.2 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-1 Take an Effluent Sample . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-2 15 Cleaning 15.1 15.2 15.3 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Table of Contents 18.4 18.5 18.6 18.7 18.8 18.9 18.10 18.3.18 Temp Stabilizing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Bypass Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18.4.1 Bypass Initial Drain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18.4.2 Bypass Low Drain Volume Alarm During Initial Drain . . . . . . . . . 18.4.
Table of Contents 19.16 19.17 Determining Initial Drain Alarm Volume Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . 19-16 Determining Tidal Total UF and Last Manual Drain UF Target Volume Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19-18 20 Quick Reference 20.1 20.2 20.3 Prepare for Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Table of Contents viii HomeChoice APD Systems Patient At-Home Guide October 2, 2009 07-19-61-244
Glossary 1 1.
Glossary 1.1 Terms Used in This Guide # of Day Exchanges The number of CAPD manual exchanges performed using an UltraBag system. If no manual exchanges are performed on a given day, enter a zero (0). The maximum number of manual exchanges allowed is five (5). Abdomen The area of your body that includes your stomach. Abdominal Fullness A patient’s feeling of fullness, sometimes referred to as “overfill” or “overfull.
1. Glossary Automated Peritoneal Dialysis (APD) APD is any form of peritoneal dialysis that is performed by a mechanical device, known as a cycler. Treatment settings are programmed on the cycler and are performed automatically, generally while you sleep. Before you go to sleep, you attach the tubing and solution bags to the cycler. You then connect the tubing to your transfer set attached to your catheter.
1. Glossary Continuous Ambulatory Peritoneal Dialysis (CAPD) With CAPD, the blood is being cleaned continuously, both day and night. The dialysis solution passes from a plastic bag through the catheter and into the peritoneal cavity. The solution stays in the peritoneal cavity with the transfer set closed. After several hours, the solution is drained into a disposable bag. Then the peritoneal cavity is refilled with fresh solution through the catheter to begin the cleaning process again.
1. Glossary Dextrose A form of sugar that is an ingredient in most of the solutions used for peritoneal dialysis. The dextrose draws extra fluid from the body into the dialysis solution. Dialysis The process of cleaning waste from the blood artificially. This job is normally done by the kidneys. If the kidneys fail, the blood must be artificially cleaned with special equipment. The two major forms of dialysis are hemodialysis and peritoneal dialysis. See also Peritoneal Dialysis (PD).
1. Glossary Drain Line Extension An optional extension line that attaches to the drain line of the disposable set. This extra length allows you to drain into a shower, tub, or toilet. Drain Volume The volume of a Drain after a Dwell cycle. Dry Weight Your weight after a dialysis session when all of the extra fluid in your body has been removed. Dwell and Dwell Time The amount of time the fluid remains in your body during each cycle. Dwell Time or Dwell is part of the therapy cycle.
1. Glossary First Fill The first Fill cycle of your therapy following an Initial Drain (I-Drain). Fluid Overload Too much fluid in the body. This is caused by more fluid going into your body than is coming out. Fluid overload can be dangerous to your heart. Flush The process by which the system pumps a small amount of dialysis solution from the supply bags to the drain line after the supply line connections have been made. This helps reduce infection from supply line contamination.
1. Glossary Intermittent Peritoneal Dialysis (IPD) A form of peritoneal dialysis in which dialysis sessions take place two to four times a week, 12 to 20 hours per session. The dialysis solution is drained completely at the end of the session and the peritoneal cavity remains empty between the sessions. Intraperitoneal Volume (IPV) The amount of fluid in the peritoneal cavity at a given point in time. Last Fill Concentration This is the concentration strength of dialysis solution used for the Last Fill.
1. Glossary Night Concentration 1 This is the concentration of the primary solution bag placed on the heater pan. Night Concentration 2 This concentration is for the supply solutions that may be different from the heater bag solution. No Flow This occurs when there is no measurable flow rate of solution. No Flow can reduce the Dwell Time and decrease the amount of effective dialysis time. This can be caused by a kink or closed clamp on one or more of the lines or by an empty bag.
1. Glossary Peritoneal Dialysis (PD) A form of dialysis that uses the lining of your abdomen, called the peritoneal membrane, as a filter to remove waste products from your body. A tube known as a catheter is surgically placed through the wall of your abdomen. Dialysis solution flows from a bag through the catheter and into the peritoneal cavity. Waste products and excess fluids from your body pass from the blood through the peritoneal membrane and into the dialysis solution.
1. Glossary PRO Card The small electronic card that stores information about your treatment sessions and your system settings. This is used only with a HomeChoice PRO APD System. Pushback A small amount of fluid is pushed back from the cycler to the patient. This verifies that the patient line is not occluded when a Drain ends due to No Flow. The next Fill begins at this volume. Recovered I-Drain Volume The amount of solution that did not drain during Initial Drain.
1. Glossary Tidal Peritoneal Dialysis (TPD) Tidal dialysis is a form of APD where only a portion of the solution in your peritoneal cavity is drained and filled each cycle. Tidal Volume The volume of solution filled during each Tidal cycle. Tidal Volume Percentage The Tidal Volume expressed as a percent (%) of the Fill Volume. Total UF Total UF (ultrafiltration) is the sum of the UF for all of your cycles. The Initial Drain and your Last Fill Volume are not included in your Total UF.
1. Glossary 1.2 Symbols Used on the HomeChoice and HomeChoice PRO APD Systems Alternating current Type B applied part Date of manufacture SN Serial number Fuse – Replace only with same type and rating Recovery / Recyclable Crossed-out wheeled bin: – – – Do not dispose of this product as unsorted municipal waste. Collect this product separately. Use collection and return systems available to you. Bar below bin: – IPX1 Product brought to market after August 13, 2005.
1. Glossary NONSPILLABLE BATTERY Nonspillable lead-acid battery is recyclable Pb Canadian Standards Association – Meets applicable requirements for the U.S. and Canada. R C US Manufacturer: Baxter Healthcare Corporation Renal Division McGaw Park, IL 60085 U.S.A.
1. Glossary Stacking limit; do not stack more than 5 high 5 54°C Temperature limitation for transport and storage -32°C This way up ATTENTION: Consult accompanying documents. Read all instructions before using.
User Assistance Information 2 2.
User Assistance Information This information is important. Keep this information available at all times. 2.1 Personal and Cycler Information Name: Patient ID Number: Cycler Serial Number: Cycler Model Number: 2.
2.
Section 3.
Warnings and Cautions 3.1 Side Effects and Contraindications Baxter’s HomeChoice and HomeChoice PRO APD Systems are not designed, sold, or intended for use except as indicated. See Section 4, Indications for Use. Baxter’s HomeChoice and HomeChoice PRO APD Systems are not intended to be a substitute for monitoring the patient’s overall condition by trained and qualified personnel. 3.2 Warnings WARNING Warnings are related to things that can cause harm to you.
3. Warnings and Cautions Caregivers should use universal precautions when handling effluent dialysis solution or contaminated disposables. Failure to use universal precautions can result in infection or injury to the caregiver. All therapies using the HomeChoice/HomeChoice PRO APD System must be prescribed and performed under the responsibility of a physician who is familiar and well-informed about peritoneal dialysis. Improper use of the HomeChoice APD System can result in serious patient injury or death.
3. Warnings and Cautions 3.2.2 Treatment - Overfill / IIPV Overfilling or not draining enough can result in excess fluid in the abdomen, also known as Increased Intraperitoneal Volume (IIPV).
3. Warnings and Cautions The Minimum Drain Volume % is programmed too low. This can cause your Drain cycles to end early. Day Fill Volume, Night Fill Volume, or Last Fill Volume is programmed too high. This can cause you to be overfilled if the volume is not appropriate for your body's size. For Tidal therapies, Total UF volume is programmed too low. This can cause a gradual buildup of UF volume during the therapy.
3. Warnings and Cautions The door is opened at the end of therapy before all clamps are closed. This can cause a free flow of fluid from one bag to another and/or to the patient. Any Drain phase is bypassed, including Initial Drain, Day Drain, or Night Drain. This can cause the system to deliver a full Fill in addition to any fluid left in the peritoneal cavity. DRAIN NOT FINISHED, LOW UF, LOW DRAIN VOLUME, or CAUTION: NEGATIVE UF alarms are bypassed.
3. Warnings and Cautions Steps to perform a Manual Drain The current FILL phase appears on the display screen. Display screen FILL 3 OF 5 1. Press STOP. STOPPED: 2. Press V. FILL VOLUME: 3. Press V. BYPASS 4. Press V. CHANGE PROGRAM 5. Press V. MAKE ADJUSTMENTS 6. Press V. MANUAL DRAIN 7. Press ENTER. DRAINING: FILL ML ML The display screen shows the Drain volume. The system continues to drain until flow is no longer detected. 8. Press GO to return to therapy. 9.
3. Warnings and Cautions Make sure that you are able to complete all of your treatments as prescribed by your physician: – – – – Order your supplies on time Keep extra supplies on hand Keep supplies for a manual exchange available If your cycler can not begin or complete your treatment, or your APD supplies are not available, perform a manual exchange as instructed by your dialysis center. Too many incomplete or skipped treatments can cause reduced Dwell or Therapy Time.
3. Warnings and Cautions The solution bag must be placed properly on the heater pan. – Place the edge of the bag against the bag stops on the right side of the – – heater pan. Be sure that the bag completely covers the silver heater sensor button. If the solution bag is not placed properly, overheated or underheated dialysis fluid can be delivered. Place the solution bags on a flat, stable surface. To prevent bags from falling, do not stack bags on top of each other.
3. Warnings and Cautions When attaching your solution bags to your system and disposable set: – Make sure the solution bags are connected to the proper lines on the organizer. If the solution bag connected to the line with the RED clamp is not placed on the heater pan, room temperature solution can be delivered. Room temperature solution is cooler than body temperature. If a patient is unconscious or asleep and therapy continues for many hours, hypothermia can develop.
3. Warnings and Cautions 3.2.5 Supplies – Disposable Set Do not apply alcohol, hydrogen peroxide, or antiseptic containing alcohol to the disposable set or to the cassette interface inside the door of the cycler. Using these products can cause the cassette to develop cracks. Using damaged sets can result in contamination of the fluid or fluid pathways. Contamination of any portion of the fluid or fluid path can result in peritonitis. Do not use the disposable set more than once. Discard after each use.
3. Warnings and Cautions 3.2.6 General Leave an air gap (space) between the end of the drain line and any fluid in the drain or container when using a drain line extension. This prevents non-sterile fluid from flowing backwards up the drain line. Non-sterile fluid can contaminate the fluid path resulting in peritonitis. Verify the operation of the display screen before starting your therapy. If the display screen is not working correctly, it can display an inaccurate number.
3. Warnings and Cautions Do not use this product outdoors. Outdoor use can increase the risk of shock or damage the device. Do not use electrical nerve stimulation pain management devices while performing your dialysis therapy. Some of these devices, when used at the same time as the HomeChoice/HomeChoice PRO APD Systems, have been shown to cause damage to the system and to the cassette. Baxter can not ensure that the systems function in a safe and satisfactory manner when the system is damaged.
3. Warnings and Cautions Return the product to Baxter Technical Assistance for examination and repair if damage occurs. Contact Technical Assistance at the number listed in 2.2, Numbers to Call for Assistance, on page 2-1. Baxter Technical Assistance is available 24 hours a day for HomeChoice/HomeChoice PRO APD System users.
3. Warnings and Cautions 3.3 Cautions CAUTION Cautions are related to things that can damage the HomeChoice and HomeChoice PRO APD Systems. The cycler you are using may be the property of Baxter Healthcare Corporation. Improper care or use may result in additional expense. Wipe up any spills right away. This reduces the chance of moisture entering the system and causing a malfunction. This also reduces the chance of bacteria contamination or an unsanitary condition.
3. Warnings and Cautions Do not use chemical cleaning agents or aerosol spray cleaners. These products might damage the plastics or surface finishes. Use a small amount of mild soap and water on a damp cloth to wipe the exterior of the system. Because the system uses a disposable set, it does not need to be sterilized or disinfected between uses.
3. Warnings and Cautions 3.4 Battery Precautions The HomeChoice/HomeChoice PRO APD System contains both a lead-acid and a lithium battery. The lead-acid battery is automatically checked and recharged during the HomeChoice/HomeChoice PRO APD System operation. The batteries require no periodic maintenance. There is danger of explosion if either battery, located within the HomeChoice/HomeChoice PRO APD System, is incorrectly replaced.
Section 4 Indications for Use 4.
Indications for Use Baxter’s HomeChoice and HomeChoice PRO APD Systems are intended for automatic control of dialysis solution exchanges in the treatment of pediatric and adult renal failure patients undergoing peritoneal dialysis. WARNING Read all warnings, cautions and instructions carefully before use. (Refer to Section 3, Warnings and Cautions.) Improper use of the HomeChoice APD System can result in serious patient injury or death. CAUTION: Federal (U.S.A.
4.
Section 5 Description 5.
Description This section describes the functions, components, and features of the HomeChoice and HomeChoice PRO APD Systems (the “system”) and the basics of Peritoneal Dialysis (PD). You should learn the names of the system components, where they are located, and how they function before beginning to use the procedures in this guide. 5.
5. Description 5.2 Introduction to Peritoneal Dialysis Peritoneal Dialysis (PD) is a procedure that cleans and filters the blood. Peritoneal dialysis rids the body of unwanted waste and excess fluid, helps to control blood pressure, and maintains the proper balance of chemicals such as potassium, sodium, and bicarbonate in the body. This process of cleansing the blood uses the body’s own peritoneal membrane as a filter. See Figure 5-1. 1 2 3 1. Peritoneal Cavity 2. Catheter 3.
5. Description 3. The solution is allowed to remain (dwell) in the cavity for a period of time. During this time, waste products pass from the bloodstream through the peritoneal membrane and into the dialysis solution. 4. The used dialysis solution containing waste products and excess fluids, called effluent, is then drained from the peritoneal cavity. 5. The peritoneal cavity is then refilled with fresh solution to remain (dwell) for another period of time.
5. Description Treatment settings, such as the amount of solution to be infused and the length of time the solution remains in the peritoneal cavity, are programmed on the cycler. The cycler then automatically performs the treatment. In APD, the treatment settings can be modified to meet the needs of each patient.
5. Description 5.3.1 Fluid Pathways: Drain, Fill, and Dwell Fluid pathways change during the therapy. They are pictured below for the three (3) main phases of therapy. 1. DRAIN During the Drain phase, the system pulls fluid from your peritoneal cavity to the disposable cassette where it is measured. The fluid is then sent to the drain option. This process is repeated until the system determines you are empty. The system calculates the UF volume for each Drain cycle. 2.
5. Description 3. DWELL During the Dwell phase, the system pulls fluid from the supply bags to the disposable cassette where it is measured. This fluid is then delivered to the heater bag to replenish the solution that was used during the previous Fill phase. This is done to warm the fluid in the heater bag to prepare for the next Fill phase. 5.3.2 Fluid Flow During Power Failure If there is a power failure, all valves on the cassette close so there is no fluid flow.
5. Description 5.4 HomeChoice APD Systems Features Features of the HomeChoice/HomeChoice PRO APD System cycler include: The controls: an On/Off switch, and buttons for GO, STOP, ENTER, up arrow (U), and down arrow (V). Prompts and directions lead you step-by-step through each setting, assuring you that each setting is correct. Audible alarms and signals alert you to check the display screen. The cassette, with attached fluid lines, fits into the system only one way so you always insert it correctly.
5. Description 5.5 HomeChoice APD Systems Description There are two models of Baxter HomeChoice APD System cyclers described in this guide: HomeChoice PRO APD System cycler HomeChoice APD System cycler 5.5.1 The HomeChoice PRO APD System Cycler 2 1 3 4 00000000 GO STOP ENTER 9 5 8 6 7 1. Heater Pan 6. Door 2. Silver Heater Sensor Button 7. Handle (shown in locked position) 3. Bag Stops 4. Serial Number 8. Control Panel 5. Occluder (behind Door) 9. PRO Card Port Figure 5-2.
5. Description 1 2 3 5 4 1. Power Entry 4. Power Cord 2. J1 – Service Port 5. On/Off Switch 3. J2 – Modem Port Figure 5-3. HomeChoice PRO APD System Back Panel 1 2 3 4 5 6 1. Display Screen 4. STOP Button 2. Control Panel 5. ENTER Button 3. GO Button 6. UP/DOWN Buttons Figure 5-4.
5. Description 5.5.2 The HomeChoice APD System Cycler 2 1 3 4 GO STOP 5 ENTER 8 6 7 1. Heater Pan 6. Door 2. Silver Heater Sensor Button 7. Handle (shown in locked position) 3. Bag Stops 4. Serial Number 8. Control Panel 5. Occluder (behind Door) Figure 5-5.
5. Description 2 1 4 3 1. Power Entry 3. Power Cord 2. Service Ports 4. On/Off Switch Figure 5-6. HomeChoice APD System Back Panel 1 2 STOP GO 3 4 ENTER 5 6 1. Display Screen 4. STOP Button 2. Control Panel 5. ENTER Button 3. GO Button 6. UP/DOWN Buttons Figure 5-7.
5. Description 5.5.3 Control Panel Buttons The general functions of the control panel buttons are described below.
5. Description 5.6 Disposable Sets Disposable sets have one of two types of connections: Luer Spike The following disposable sets are available with either connection type: Automated PD Set with Cassette – 4 Prong Integrated APD Set Low Recirculation Volume APD Set with Cassette Your dialysis center determines which type of disposable set and connection you use. Figure 5-8 and Figure 5-9 show a 4-prong Luer disposable set. Figure 5-10 and Figure 5-11 show a 4-prong spike disposable set.
5. Description 5.6.1 Luer Disposable Set 3 2 1 4 1. Organizer 3. Cassette 2. Effluent Sampling Site 4. Lines Figure 5-8. Luer 4-Prong Disposable Set 6 1 2 3 4 5 1. Patient Line 4. Heater Line (Red Clamp) 2. Final Line (Blue Clamp) 5. Drain Line 3. Supply Lines (White Clamps) 6. Luer Connectors Figure 5-9.
5. Description 5.6.2 Spike Disposable Set 3 2 1 4 1. Organizer 3. Cassette 2. Effluent Sampling Site 4. Lines Figure 5-10. Spike 4-Prong Disposable Set 6 1 2 3 4 5 1. Patient Line 4. Heater Line (Red Clamp) 2. Final Line (Blue Clamp) 5. Drain Line 3. Supply Lines (White Clamps) 6. Spike Connectors Figure 5-11.
5. Description 5.7 HomeChoice APD System and HomeChoice PRO APD System Differences The HomeChoice APD System and HomeChoice PRO APD System are the same in operation, except for the PRO Card feature. The PRO Card feature stores prescription and therapy data. The data can be transferred between your cycler and your clinician. The two systems use the same disposable sets and solutions. They perform the same therapies the same way.
Environmental Conditions 6 6.
Environmental Conditions 6.1 Operating Conditions The HomeChoice and HomeChoice PRO APD Systems are designed for use in these conditions: Temperature between 59°F to 96.8°F (15°C to 36°C) Humidity between 15% and 85% Altitude of –1,100 ft to +10,000 ft (–340 m to +3,050 m) 6.2 Use While Traveling The system is designed to be portable and to allow you to travel.
6. Environmental Conditions To avoid any interruption in your therapy during long trips, obtain the needed supplies for at least a full day’s manual exchanges (CAPD). Perform manual exchanges if your cycler is lost or damaged in transit, or your supplies do not arrive on time.
Setup and Check-out 7 7.
Setup and Check-out Setup and check-out refers to installing the HomeChoice APD System or HomeChoice PRO APD System (the “system”) in your home. 7.1 Check-out 1. Check the cycler for external damage. See 5.5, HomeChoice APD Systems Description, on page 5-8 for a description of the system and its components. 2. Verify that a power cord was included in the box. 3. If you see any damage on the cycler or the cord is missing, contact Baxter Technical Assistance. See 2.
7. Setup and Check-out 7.2 Set Up the HomeChoice APD System Place the HomeChoice/HomeChoice PRO APD System cycler on a stable, clean, flat surface (table or nightstand) in a well-lighted area. The table should be large enough to hold the cycler and all of the solution bags. Make sure a three-prong grounded outlet is nearby. See 7.3, Grounding Instructions, on page 7-4 for warnings concerning the three-prong outlet. Be sure the cycler is placed at the same height as you when you are lying in bed.
7. Setup and Check-out WARNING Do not place the cycler more than 12 inches (30 cm) higher or lower than you when you are lying in bed. Placing the cycler more than 12 inches (30 cm) above your position can produce higher than normal flow rates during Fill and lower than normal flow rates during Drain. This can cause pain or discomfort during Fill and extend the duration of the Drain phase. This can result in a loss in Dwell Time or an increase in LOW DRAIN VOLUME alarms.
7. Setup and Check-out 7.3 Grounding Instructions This product must be grounded. In the event of an electrical short circuit, grounding reduces the risk of electric shock by providing an escape wire for the electric current. This product is equipped with a cord that has a grounding wire with a grounding plug. The plug must be inserted into an outlet that is properly installed with a verified ground. Please contact your dialysis center for any questions concerning the outlet.
Section 8.
Operating Instructions – PRO Card and Modem 8.1 Introduction h NOTE: If your dialysis center does not use the PRO Card feature, skip this section and continue with Section 9, Operating Instructions – Change Program. The PRO Card feature can only be used with the HomeChoice PRO APD System. Your HomeChoice PRO APD System has a computerized data transfer feature – the PRO Card. During your initial training, your dialysis nurse or physician showed you a small electronic data card that fits into your system.
8. Operating Instructions – PRO Card and Modem 2 GO STOP 1 1. PRO Card Port 2. Indicator Light Figure 8-1. PRO Card Port 1 2 3 5 4 1. Power Entry 4. Power Cord 2. J1 – Service Port 5. On/Off Switch 3. J2 – Modem Port Figure 8-2.
8. Operating Instructions – PRO Card and Modem 8.2 Using the PRO Card At the time of your initial training, your physician gave you a PRO Card. The PRO Card contains your personal therapy settings prescribed for you by your physician. Just insert your PRO Card into your HomeChoice PRO APD System. Treatment results from your therapy are recorded to the PRO Card. This data provides your physician with important information about your therapy. h NOTE: 8.2.
8. Operating Instructions – PRO Card and Modem 8.2.2 Confirm Your PRO Card When you return from a visit to your dialysis center with a new or reprogrammed PRO Card, you must verify that you have the correct card. The following steps help you to confirm your name and patient ID. Steps to confirm your PRO Card 1. With the cycler power OFF, insert the PRO Card into the PRO Card port. 2. Turn on the HomeChoice PRO APD System. Display screen CONFIRM CARD Wait until the CONFIRM CARD message appears. 3.
8. Operating Instructions – PRO Card and Modem 8.2.3 Confirm a New Therapy CONFIRM NEW PROGRAM appears if the therapy settings on your PRO Card have changed. Press ENTER if the setting is correct. The steps below show an example of a CCPD/IPD therapy. The steps taken to confirm HI-DOSE CCPD/IPD, TIDAL, or HI-DOSE TIDAL therapies are similar. Only the settings that changed appear. h NOTE: Press STOP if a displayed item is not correct. PROGRAM REJECTED appears.
8. Operating Instructions – PRO Card and Modem Steps to confirm a New Therapy – CCPD/IPD example (Continued) 6. Press ENTER. Display screen DEXTROSE: Skip this step if the LAST FILL VOLUME = 0 7. Press ENTER. MIN DRAIN VOL: 8. Press ENTER. MODE: % LOW FILL (This setting appears in Low Fill Mode only.) 9. Press ENTER. NEG UF LIMIT: % POS UF LIMIT: OFF% (This setting appears in Low Fill Mode only.) 10. Press ENTER. (This setting appears in Low Fill Mode only.) 11. Press ENTER. PLEASE WAIT..
8. Operating Instructions – PRO Card and Modem 8.2.4 HomeChoice PRO APD System Prompts The HomeChoice PRO APD System records information needed by your physician, such as your weight, blood pressure, and day or manual exchanges. The system displays daily messages to prompt you to enter this information. Three buttons are used to enter data: ENTER, U (up arrow), and V (down arrow). The data entry menu only appears when you turn on the HomeChoice PRO APD System.
8. Operating Instructions – PRO Card and Modem 8.2.5 Definitions of Data Entry Prompts Table 8-1 and Table 8-2 list all the prompts available on the HomeChoice PRO APD System. See Basic steps for entering data on page 8-7. h NOTE: Only those prompts selected by your dialysis nurse appear on your cycler. Table 8-1. Definitions of Data Entry Prompts Prompt Weight Display and Definition WEIGHT: 0.0LB Your daily weight to the tenths place.
8. Operating Instructions – PRO Card and Modem Table 8-2. Definitions of Manual Daytime Exchanges Prompts Prompt # of Day Exchanges Display and Definition # OF DAY EXCHANGES: The number of CAPD manual exchanges performed using an UltraBag system. If no manual exchanges were performed on a given day, a 0 (zero) is entered. The following data items are repeated for each manual exchange. The n is a number from one to five to indicate the manual exchange for the data entered.
8. Operating Instructions – PRO Card and Modem 8.2.6 Remove Your PRO Card h NOTE: The PRO Card must remain in the HomeChoice PRO APD System until your next visit to your dialysis center. When you visit your doctor or dialysis center, you are usually asked to bring the PRO Card with you. Follow the steps below to remove your PRO Card. Steps to remove your PRO Card 1. Turn off the HomeChoice PRO APD System. 2. Slide the PRO Card gently out of the slot. h NOTE: Do not bend the PRO Card. 3.
8. Operating Instructions – PRO Card and Modem 8.3 Display Messages The PRO Card port has an indicator light located on the control panel directly above the port. See Figure 8-1 on page 8-2. This light can be green or yellow. Green means the card is fully inserted and working. Yellow means there is a problem with the PRO Card or card reader inside the cycler. If there is a problem with the PRO Card or the card reader, the following messages can appear. 8.3.
8. Operating Instructions – PRO Card and Modem 8.3.2 Card Reader Disabled Display Message: CARD READER DISABLED Indicator Light: Off Cause: Your dialysis center disabled the PRO Card functions on your HomeChoice PRO APD System. To Correct: 1. Call your dialysis center to verify that your PRO Card is disabled. 2. Press GO to proceed to PRESS GO TO START. 8.3.
8. Operating Instructions – PRO Card and Modem 8.3.4 Invalid PRO Card, Program Not Valid Display Message: INVALID PRO CARD PROGRAM NOT VALID Indicator Light: Yellow Cause: The system found a problem with the PRO Card. The card may be blank, corrupted, or damaged. To Correct: 1. Call your dialysis center to obtain a new card. 2. Press GO to proceed to PRESS GO TO START. The program on your system is not changed.
8. Operating Instructions – PRO Card and Modem 8.4 Install the Modem Option In addition to the PRO Card, your HomeChoice PRO APD System can also transfer therapy information via a phone line using a modem. If your dialysis center uses this option, you are given a modem to install with your HomeChoice PRO APD System. Read the instructions that were provided with your modem for modem operation.
8. Operating Instructions – PRO Card and Modem Steps to install your modem (Continued) 2. Plug the data cable into the J2 Port, as shown. 3. Unplug the telephone line from the wall jack. 4. Plug the double connector into the wall jack. 5. Plug the telephone line and modem line into the double connector. 6. Plug the modem power adapter into the wall outlet.
8. Operating Instructions – PRO Card and Modem Steps to install your modem (Continued) 7. Turn modem power on. 8.4.1 Test the Modem Installation After you install the modem, call your dialysis center to let them know you are ready to test your modem connection. If possible, use a different phone line to call the dialysis center, such as a cell phone. A transfer of therapy information is initiated by the dialysis center.
8. Operating Instructions – PRO Card and Modem Steps to test your modem connection (Continued) 5. Hang up the telephone, if necessary, and allow the dialysis center to call back with their modem. Display screen TRANSFERRING... The HomeChoice PRO APD System automatically answers. An error message, MODEM ERROR n appears if a problem occurs. Call Baxter Technical Service and report the Modem Error number. See 2.2, Numbers to Call for Assistance, on page 2-1.
8.
Section 9 Operating Instructions – Change Program 9.
Operating Instructions – Change Program 9.1 Introduction CHANGE PROGRAM This section contains information about reviewing and changing your prescribed treatment and system settings. This can be done at the CHANGE PROGRAM prompt. Even if you have a PRO Card, you still need to learn how to manually change the settings on your HomeChoice PRO APD System. To program your system with your PRO Card, see Section 8, Operating Instructions – PRO Card and Modem. 9.
9. Operating Instructions – Change Program 9.3 The Nurse’s Menu NURSE'S MENU The NURSE’S MENU allows your nurse to tailor the therapy to meet your special needs. Your dialysis nurse completes the information below to record the data programmed in the Nurse’s Menu. Please keep this information available. Instructions: Please have your dialysis nurse check the appropriate box below. The Nurse’s Menu has not been changed and the factory default settings are being used.
9. Operating Instructions – Change Program Table 9-1. Nurse’s Menu Settings (Continued) Setting Description Positive Ultrafiltration (UF) Limit POS UF LIMIT: ML Low Fill Mode only. Smart Dwells SMART DWELLS: YES or NO Heater Bag Empty HEATER BAG EMPTY: YES or NO Tidal Full Drains TIDAL FULL DRNS: YES or NO Tidal Mode only. Language LANGUAGE: Flush FLUSH: YES or NO Program Locked PROGRAM LOCKED: YES or NO 9.
9. Operating Instructions – Change Program 9.5 Manual Programming To manually program your HomeChoice APD System or HomeChoice PRO APD System (the “system”), press V (down arrow) before you press GO to start your therapy. You can also review or change your settings during your therapy by pressing V. WARNING Do not change the settings for your therapy unless directed by your physician. Using incorrect settings can cause patient injury. 9.5.
9. Operating Instructions – Change Program Basic steps to change settings 1. Press V to change or review settings (before you press GO to start your therapy). Display screen PRESS GO TO START – OR – Press V during your therapy. 2. Press ENTER to access the CHANGE PROGRAM menu. CHANGE PROGRAM THERAPY is the first setting that appears. THERAPY: 3. If you do not want to change this setting, press V to see TOTAL VOL (Total Volume). TOTAL VOL: 15000ML 4.
9. Operating Instructions – Change Program Basic steps to change settings (Continued) 11. Press V to display LAST FILL VOL (Last Fill Volume). Display screen LAST FILL VOL: ML 12. Make changes, if needed, by following Steps 4–6. 13. Press V to display DEXTROSE. DEXTROSE: SAME This setting only appears if you use Last Fill. 14. Make changes, if needed, by following Steps 4–6. 15. Press V to display # OF DAY FILLS. # OF DAY FILLS: This setting only appears for Hi-Dose therapies. 16.
9. Operating Instructions – Change Program Basic steps to change settings (Continued) Display screen h NOTE: The following prompts appear if you do not change the value for Last Fill Volume: The system calculates the number of cycles. CYCLES appears briefly on the display screen. CYCLES: Then the system calculates the Dwell Time. DWELL TIME appears briefly on the display screen.
9. Operating Instructions – Change Program 9.6 Therapy Type The first setting on the Change Program menu is THERAPY type. There are four Therapy types available, as shown in Table 9-2. Table 9-2.
9. Operating Instructions – Change Program 9.7 Standard Mode (Standard Fill Mode) The following sections define the therapy settings for Standard Fill Mode. For Low Fill Mode settings, see 9.8, Low Fill Mode, on page 9-34. 9.7.1 CCPD/IPD Therapy Settings THERAPY: CCPD/IPD Table 9-3 shows the settings programmed for CCPD/IPD therapy in the Standard Fill Mode. Table 9-3.
9. Operating Instructions – Change Program Table 9-3. CCPD/IPD Settings – Standard Fill Mode (Continued) Setting Description WARNING Your Fill Volume in milliliters (mL) should normally not exceed the values shown in Table 19-7 on page 19-15. Contact your dialysis center to confirm your Fill Volume if it exceeds this volume. Exceeding this volume can result in an increased intraperitoneal volume (IIPV) situation. IIPV could result in a feeling of abdominal discomfort, serious injury, or death.
9. Operating Instructions – Change Program Table 9-3. Setting Last Fill Volume CCPD/IPD Settings – Standard Fill Mode (Continued) Description LAST FILL VOL: ML Last Fill Volume delivered at the end of the therapy and left in the peritoneal cavity during the day. Also called “Wet Day.
9. Operating Instructions – Change Program 9.7.2 CCPD/IPD Calculated Settings HomeChoice/HomeChoice PRO APD System calculates the number of night cycles and the Dwell Time. The calculated values are shown on the display screen when you press STOP after you have completed reviewing your therapy settings. Table 9-4. Definitions for CCPD/IPD Calculated Settings Setting Description Cycles Total number of cycles at night, not including the Last Fill. This parameter is calculated by the system.
9. Operating Instructions – Change Program 9.7.3 Hi-Dose CCPD Therapy Settings THERAPY:HI-DOSE CCPD Table 9-5 shows the settings programmed for Hi-Dose CCPD therapy in the Standard Fill Mode. Table 9-5. Hi-Dose CCPD Settings – Standard Fill Mode Setting Total Volume Description TOTAL VOL: ML Total Volume of solution used for the therapy. Includes the total Day Fill Volume and Night Fill Volume for all cycles, and the Last Fill Volume.
9. Operating Instructions – Change Program Table 9-5. Setting Hi-Dose CCPD Settings – Standard Fill Mode (Continued) Description WARNING Your Day Fill Volume in milliliters (mL) should normally not exceed the values shown in Table 19-7 on page 19-15. Contact your dialysis center to confirm your Day Fill Volume if it exceeds this volume. Exceeding this volume can result in an increased intraperitoneal volume (IIPV) situation. IIPV could result in a feeling of abdominal discomfort, serious injury, or death.
9. Operating Instructions – Change Program Table 9-5. Hi-Dose CCPD Settings – Standard Fill Mode (Continued) Setting Night Therapy Time Description NITE THER TIME:HH:MM Total time for the nighttime portion of therapy. This time is fixed and begins as soon as you complete daytime exchanges.
9. Operating Instructions – Change Program Table 9-5. Setting Last Fill Volume Hi-Dose CCPD Settings – Standard Fill Mode (Continued) Description LAST FILL VOL: ML Last Fill Volume delivered at the end of the therapy and left in the peritoneal cavity during the day. Also called “Wet Day.
9. Operating Instructions – Change Program 9.7.4 Hi-Dose CCPD Calculated Settings HomeChoice/HomeChoice PRO APD System calculates the number of night cycles and the Dwell Time. The calculated values are shown on the display screen when you press STOP after you have completed reviewing your therapy settings. Table 9-6. Definitions for Hi-Dose CCPD Calculated Settings Settings Description Cycles Total number of cycles at night, not including the Last Fill. This parameter is calculated by the system.
9. Operating Instructions – Change Program 9.7.5 Tidal Therapy Settings THERAPY: TIDAL With Tidal therapy, only a portion of the solution in your peritoneal cavity is drained and replaced with new solution during each therapy cycle. WARNING Pressing the STOP and GO buttons during successive Tidal Dwell cycles can lead to a gradual increase in intraperitoneal volume (IPV). An increased intraperitoneal volume (IIPV) situation can result for patients with a low Fill Volume and a high number of cycles.
9. Operating Instructions – Change Program Table 9-7. Tidal Settings – Standard Fill Mode Setting Total Volume Description TOTAL VOL: ML Total Volume of solution used for the therapy. Includes the total Fill Volume for all cycles and the Last Fill Volume.
9. Operating Instructions – Change Program Table 9-7. Tidal Settings – Standard Fill Mode (Continued) Setting Description WARNING Your Fill Volume in milliliters (mL) should normally not exceed the values shown in Table 19-7 on page 19-15. Contact your dialysis center to confirm your Fill Volume if it exceeds this volume. Exceeding this volume can result in an increased intraperitoneal volume (IIPV) situation. IIPV could result in a feeling of abdominal discomfort, serious injury, or death.
9. Operating Instructions – Change Program Table 9-7. Setting Tidal Settings – Standard Fill Mode (Continued) Description WARNING A Total UF volume set too low can result in a gradual buildup of UF volume during the therapy. This can result in an increased intraperitoneal volume (IIPV) situation. IIPV could result in a feeling of abdominal discomfort, serious injury, or death. See page 18-58 for IIPV symptoms or if IIPV is suspected.
9. Operating Instructions – Change Program Table 9-7. Setting Tidal Settings – Standard Fill Mode (Continued) Description h NOTES: (Continued) Seventy percent (70%) of your normal Night UF is a good starting point for determining your optimum Total UF. For help in converting 70% of your expected total therapy UF into a value that can be programmed as your Total UF for your Tidal therapy, see 19.17, Determining Tidal Total UF and Last Manual Drain UF Target Volume Settings, on page 19-18.
9. Operating Instructions – Change Program Table 9-7. Setting Dextrose Tidal Settings – Standard Fill Mode (Continued) Description DEXTROSE: SAME (default setting) – or – DEXTROSE: DIFFERENT The Last Fill Volume can be the same dextrose concentration as the other Fills or it can be different. This setting does not appear if LAST FILL VOL = 0. This setting only appears if you use Last Fill. Full Drains Every FULL DRAINS EVERY: The frequency of Full Drains during Tidal therapy.
9. Operating Instructions – Change Program 9.7.6 Tidal Calculated Settings The HomeChoice/HomeChoice PRO APD System calculates the number of night cycles and the Dwell Time. For a Tidal therapy, the system also calculates Tidal Volume and ultrafiltration (UF) per cycle. The calculated values are shown on the display screen when you press STOP after you have completed reviewing your therapy settings. Table 9-8.
9. Operating Instructions – Change Program 9.7.7 Hi-Dose Tidal Therapy Settings THERAPY:HI-DOSE TIDL With Tidal therapy, only a portion of the solution in your peritoneal cavity is drained and replaced with new solution during each therapy cycle. WARNING Pressing the STOP and GO buttons during successive Tidal Dwell cycles can lead to a gradual increase in intraperitoneal volume (IPV).
9. Operating Instructions – Change Program Table 9-9. Hi-Dose Tidal Settings – Standard Fill Mode Setting Total Volume Description TOTAL VOL: ML Total Volume of solution used for the therapy. Includes the total Day Fill Volume and Night Fill Volume for all cycles, and the Last Fill Volume.
9. Operating Instructions – Change Program Table 9-9. Hi-Dose Tidal Settings – Standard Fill Mode (Continued) Setting Description WARNING Your Day Fill Volume in milliliters (mL) should normally not exceed the values shown in Table 19-7 on page 19-15. Contact your dialysis center to confirm your Day Fill Volume if it exceeds this volume. Exceeding this volume can result in an increased intraperitoneal volume (IIPV) situation.
9. Operating Instructions – Change Program Table 9-9. Setting Hi-Dose Tidal Settings – Standard Fill Mode (Continued) Description WARNING Your Night Fill Volume in milliliters (mL) should normally not exceed the values shown in Table 19-7 on page 19-15. Contact your dialysis center to confirm your Night Fill Volume if it exceeds this volume. Exceeding this volume can result in an increased intraperitoneal volume (IIPV) situation.
9. Operating Instructions – Change Program Table 9-9. Setting Night Tidal Volume % Hi-Dose Tidal Settings – Standard Fill Mode (Continued) Description NITE TIDAL VOL: % Volume of fluid drained and refilled during each cycle. This is expressed as a percentage of the initial Fill Volume. Minimum setting is 5% Maximum setting is 95% Default setting is 5% Setting increment is 5% h NOTE: When the Therapy type is changed from CCPD to Tidal, the Night Tidal Volume % reverts to the default setting of 5%.
9. Operating Instructions – Change Program Table 9-9. Setting Hi-Dose Tidal Settings – Standard Fill Mode (Continued) Description WARNING A Total UF volume set too low can result in a gradual buildup of UF volume during the therapy. This can result in an increased intraperitoneal volume (IIPV) situation. IIPV could result in a feeling of abdominal discomfort, serious injury, or death. See page 18-58 for IIPV symptoms or if IIPV is suspected.
9. Operating Instructions – Change Program Table 9-9. Setting Hi-Dose Tidal Settings – Standard Fill Mode (Continued) Description h NOTES: (Continued) Seventy percent (70%) of your normal Night UF is a good starting point for determining your optimum Total UF. For help in converting 70% of your expected total therapy UF into a value that can be programmed as your Total UF for your Tidal therapy, see 19.17, Determining Tidal Total UF and Last Manual Drain UF Target Volume Settings, on page 19-18.
9. Operating Instructions – Change Program Table 9-9. Setting Dextrose Hi-Dose Tidal Settings – Standard Fill Mode (Continued) Description DEXTROSE: SAME (default setting) – or – DEXTROSE: DIFFERENT The Last Fill Volume can be the same dextrose concentration as the other Fills or it can be different. This setting does not appear if LAST FILL VOL = 0. This setting only appears if you use Last Fill. Full Drains Every FULL DRAINS EVERY: The frequency of Full Drains during Tidal therapy.
9. Operating Instructions – Change Program 9.7.8 Hi-Dose Tidal Calculated Settings The HomeChoice/HomeChoice PRO APD System calculates the number of night cycles and the Dwell Time. For a Tidal therapy, the system also calculates Tidal Volume and ultrafiltration (UF) per cycle. The calculated values are shown on the display screen when you press STOP after you have completed reviewing your therapy settings. Table 9-10.
9. Operating Instructions – Change Program 9.8 Low Fill Mode The following sections describe the therapy settings for Low Fill Mode. For Standard Fill Mode settings, see 9.7, Standard Mode (Standard Fill Mode), on page 9-9. WARNING Patients whose Fill volumes are less than 1000 mL may normally drain slowly. These patients typically weigh less than 44 lbs (20 kg). Use of the Low Fill Mode minimizes the incidence of LOW DRAIN VOLUME and CAUTION: NEGATIVE UF alarms.
9. Operating Instructions – Change Program 9.8.1 CCPD/IPD Therapy Settings THERAPY: CCPD/IPD (Low Fill Mode) Table 9-11 shows the settings programmed for CCPD/IPD therapy in the Low Fill Mode. Table 9-11. CCPD/IPD Settings – Low Fill Mode Setting Total Volume Description TOTAL VOL: ML Total Volume of solution used for the therapy. Includes the total Fill Volume for all cycles and the Last Fill Volume.
9. Operating Instructions – Change Program Table 9-11. CCPD/IPD Settings – Low Fill Mode (Continued) Setting Description WARNING Your Fill Volume in milliliters (mL) should normally not exceed the values shown in Table 19-7 on page 19-15. Contact your dialysis center to confirm your Fill Volume if it exceeds this volume. Exceeding this volume can result in an increased intraperitoneal volume (IIPV) situation. IIPV could result in a feeling of abdominal discomfort, serious injury, or death.
9. Operating Instructions – Change Program Table 9-11. CCPD/IPD Settings – Low Fill Mode (Continued) Setting Last Fill Volume Description LAST FILL VOL: ML Last Fill Volume delivered at the end of the therapy and left in the peritoneal cavity during the day. Also called “Wet Day.
9. Operating Instructions – Change Program 9.8.2 CCPD/IPD Calculated Settings HomeChoice/HomeChoice PRO APD System calculates the number of night cycles and the Dwell Time. The calculated values are shown on the display screen when you press STOP after you have completed reviewing your therapy settings. Table 9-12. Definitions for CCPD/IPD Calculated Settings Setting Description Cycles Total number of cycles at night, not including the Last Fill. This parameter is calculated by the system.
9. Operating Instructions – Change Program 9.8.3 Hi-Dose CCPD Therapy Settings THERAPY:HI-DOSE CCPD (Low Fill Mode) WARNING Patients whose Fill volumes are less than 1000 mL may normally drain slowly. These patients typically weigh less than 44 lbs (20 kg). Use of the Low Fill Mode minimizes the incidence of LOW DRAIN VOLUME and CAUTION: NEGATIVE UF alarms. These alarms can not be bypassed to prevent an increased intraperitoneal volume (IIPV) situation in Low Fill Mode.
9. Operating Instructions – Change Program Table 9-13. Hi-Dose CCPD Settings – Low Fill Mode Setting Total Volume Description TOTAL VOL: ML Total Volume of solution used for the therapy. Includes the total Day Fill Volume and Night Fill Volume for all cycles, and the Last Fill Volume.
9. Operating Instructions – Change Program Table 9-13. Hi-Dose CCPD Settings – Low Fill Mode (Continued) Setting Description WARNING Your Day Fill Volume in milliliters (mL) should normally not exceed the values shown in Table 19-7 on page 19-15. Contact your dialysis center to confirm your Day Fill Volume if it exceeds this volume. Exceeding this volume can result in an increased intraperitoneal volume (IIPV) situation. IIPV could result in a feeling of abdominal discomfort, serious injury, or death.
9. Operating Instructions – Change Program Table 9-13. Hi-Dose CCPD Settings – Low Fill Mode (Continued) Setting Description WARNING Your Night Fill Volume in milliliters (mL) should normally not exceed the values shown in Table 19-7 on page 19-15. Contact your dialysis center to confirm your Night Fill Volume if it exceeds this volume. Exceeding this volume can result in an increased intraperitoneal volume (IIPV) situation. IIPV could result in a feeling of abdominal discomfort, serious injury, or death.
9. Operating Instructions – Change Program Table 9-13. Hi-Dose CCPD Settings – Low Fill Mode (Continued) Setting Last Fill Volume Description LAST FILL VOL: ML Last Fill Volume delivered at the end of the therapy and left in the peritoneal cavity during the day. Also called “Wet Day.
9. Operating Instructions – Change Program 9.8.4 Hi-Dose CCPD Calculated Settings HomeChoice/HomeChoice PRO APD System calculates the number of night cycles and the Dwell Time. The calculated values are shown on the display screen when you press STOP after you have completed reviewing your therapy settings. Table 9-14. Definitions for Hi-Dose CCPD Calculated Settings Setting Description Cycles Total number of cycles at night, not including the Last Fill. This parameter is calculated by the system.
9. Operating Instructions – Change Program 9.8.5 Tidal Therapy Settings THERAPY: TIDAL (Low Fill Mode) With Tidal therapy, only a portion of the solution in your peritoneal cavity is drained and replaced with new solution during each therapy cycle. WARNING Pressing the STOP and GO buttons during successive Tidal Dwell cycles can lead to a gradual increase in intraperitoneal volume (IPV).
9. Operating Instructions – Change Program WARNING Patients whose Fill volumes are less than 1000 mL may normally drain slowly. These patients typically weigh less than 44 lbs (20 kg). Use of the Low Fill Mode minimizes the incidence of LOW DRAIN VOLUME and CAUTION: NEGATIVE UF alarms. These alarms can not be bypassed to prevent an increased intraperitoneal volume (IIPV) situation in Low Fill Mode.
9. Operating Instructions – Change Program Table 9-15. Tidal Settings – Low Fill Mode Setting Total Volume Description TOTAL VOL: ML Total Volume of solution used for the therapy. Includes the total Fill Volume for all cycles and the Last Fill Volume.
9. Operating Instructions – Change Program Table 9-15. Tidal Settings – Low Fill Mode (Continued) Setting Description WARNING Your Fill Volume in milliliters (mL) should normally not exceed the values shown in Table 19-7 on page 19-15. Contact your dialysis center to confirm your Fill Volume if it exceeds this volume. Exceeding this volume can result in an increased intraperitoneal volume (IIPV) situation. IIPV could result in a feeling of abdominal discomfort, serious injury, or death.
9. Operating Instructions – Change Program Table 9-15. Tidal Settings – Low Fill Mode (Continued) Setting Tidal Volume % Description TIDAL VOL: % Volume of fluid drained and refilled during each cycle. This is expressed as a percentage of the initial Fill Volume. Minimum setting is 5% Maximum setting is 95% Default setting is 5% Setting increment is 5% h NOTE: When the Therapy type is changed from CCPD to Tidal, the Tidal Volume % reverts to the default setting of 5%.
9. Operating Instructions – Change Program Table 9-15. Tidal Settings – Low Fill Mode (Continued) Setting Description WARNING A Total UF volume set too low can result in a gradual buildup of UF volume during the therapy. This can result in an increased intraperitoneal volume (IIPV) situation. IIPV could result in a feeling of abdominal discomfort, serious injury, or death. See page 18-58 for IIPV symptoms or if IIPV is suspected.
9. Operating Instructions – Change Program Table 9-15. Tidal Settings – Low Fill Mode (Continued) Setting Description h NOTES: (Continued) Seventy percent (70%) of your normal Night UF is a good starting point for determining your optimum Total UF. For help in converting 70% of your expected total therapy UF into a value that can be programmed as your Total UF for your Tidal therapy, see 19.17, Determining Tidal Total UF and Last Manual Drain UF Target Volume Settings, on page 19-18.
9. Operating Instructions – Change Program Table 9-15. Tidal Settings – Low Fill Mode (Continued) Setting Dextrose Description DEXTROSE: SAME (default setting) – or – DEXTROSE: DIFFERENT The Last Fill Volume can be the same dextrose concentration as the other Fills or it can be different. This setting does not appear if LAST FILL VOL = 0. This setting only appears if you use Last Fill.
9. Operating Instructions – Change Program 9.8.6 Tidal Calculated Settings HomeChoice/HomeChoice PRO APD System calculates the number of night cycles and the Dwell Time. For a Tidal therapy, the system also calculates Tidal Volume and ultrafiltration (UF) per cycle. The calculated values are shown on the display screen when you press STOP after you have completed reviewing your therapy settings. Table 9-16.
9. Operating Instructions – Change Program 9.8.7 Hi-Dose Tidal Therapy Settings THERAPY:HI-DOSE TIDL (Low Fill Mode) With Tidal therapy, only a portion of the solution in your peritoneal cavity is drained and replaced with new solution during each therapy cycle. WARNING Pressing the STOP and GO buttons during successive Tidal Dwell cycles can lead to a gradual increase in intraperitoneal volume (IPV).
9. Operating Instructions – Change Program WARNING Patients whose Fill volumes are less than 1000 mL may normally drain slowly. These patients typically weigh less than 44 lbs (20 kg). Use of the Low Fill Mode minimizes the incidence of LOW DRAIN VOLUME and CAUTION: NEGATIVE UF alarms. These alarms can not be bypassed to prevent an increased intraperitoneal volume (IIPV) situation in Low Fill Mode.
9. Operating Instructions – Change Program Table 9-17. Hi-Dose Tidal Settings – Low Fill Mode Setting Total Volume Description TOTAL VOL: ML Total Volume of solution used for the therapy. Includes the total Day Fill Volume and Night Fill Volume for all cycles, and the Last Fill Volume.
9. Operating Instructions – Change Program Table 9-17. Hi-Dose Tidal Settings – Low Fill Mode (Continued) Setting Description WARNING Your Day Fill Volume in milliliters (mL) should normally not exceed the values shown in Table 19-7 on page 19-15. Contact your dialysis center to confirm your Day Fill Volume if it exceeds this volume. Exceeding this volume can result in an increased intraperitoneal volume (IIPV) situation. IIPV could result in a feeling of abdominal discomfort, serious injury, or death.
9. Operating Instructions – Change Program Table 9-17. Hi-Dose Tidal Settings – Low Fill Mode (Continued) Setting Description WARNING Your Night Fill Volume in milliliters (mL) should normally not exceed the values shown in Table 19-7 on page 19-15. Contact your dialysis center to confirm your Night Fill Volume if it exceeds this volume. Exceeding this volume can result in an increased intraperitoneal volume (IIPV) situation.
9. Operating Instructions – Change Program Table 9-17. Hi-Dose Tidal Settings – Low Fill Mode (Continued) Setting Description WARNING A Total UF volume set too low can result in a gradual buildup of UF volume during the therapy. This can result in an increased intraperitoneal volume (IIPV) situation. IIPV could result in a feeling of abdominal discomfort, serious injury, or death. See page 18-58 for IIPV symptoms or if IIPV is suspected.
9. Operating Instructions – Change Program Table 9-17. Hi-Dose Tidal Settings – Low Fill Mode (Continued) Setting Description h NOTES: (Continued) Seventy percent (70%) of your normal Night UF is a good starting point for determining your optimum Total UF. For help in converting 70% of your expected total therapy UF into a value that can be programmed as your Total UF for your Tidal therapy, see 19.17, Determining Tidal Total UF and Last Manual Drain UF Target Volume Settings, on page 19-18.
9. Operating Instructions – Change Program Table 9-17. Hi-Dose Tidal Settings – Low Fill Mode (Continued) Setting Dextrose Description DEXTROSE: SAME (default setting) – or – DEXTROSE: DIFFERENT The Last Fill Volume can be the same dextrose concentration as the other Fills or it can be different. This setting does not appear if LAST FILL VOL = 0. This setting only appears if you use Last Fill.
9. Operating Instructions – Change Program 9.8.8 Hi-Dose Tidal Calculated Settings The HomeChoice/HomeChoice PRO APD System calculates the number of night cycles and the Dwell Time. For a Tidal therapy, the system also calculates Tidal Volume and ultrafiltration (UF) per cycle. The calculated values are shown on the display screen when you press STOP after you have completed reviewing your therapy settings. Table 9-18.
Section 10 Operating Instructions – Make Adjustments 10.
Operating Instructions – Make Adjustments 10.1 Make Adjustments Menu MAKE ADJUSTMENTS The following options are available from the MAKE ADJUSTMENTS menu. Adjust Brightness Adjust Loudness Auto Dim Set Clock Set Date I-Drain Time (Low Fill Mode only) I-Drain Alarm Comfort Control Last Manual Drain UF Target and Alarm 10.1.1 Changing Settings The settings for these options can be changed by your dialysis nurse or physician using your PRO Card, or you can adjust them manually.
10. Operating Instructions – Make Adjustments Follow the basic steps below to make adjustments to your settings. Basic steps to Make Adjustments 1. Before you press GO to start your therapy, press V. CHANGE PROGRAM appears on the display screen. 2. Press V again. Display screen PRESS GO TO START CHANGE PROGRAM MAKE ADJUSTMENTS MAKE ADJUSTMENTS appears. 3. Press ENTER to access the Make Adjustments menu. ADJUST BRIGHTNESS ADJUST BRIGHTNESS appears. 4.
10. Operating Instructions – Make Adjustments 10.2 Option Settings 10.2.1 Adjust Brightness Follow the steps below to adjust the brightness of the display screen. Steps to Adjust Brightness Display screen 1. Press ENTER to access the MAKE ADJUSTMENTS menu. 2. ADJUST BRIGHTNESS is the first option. ADJUST BRIGHTNESS 3. Press ENTER. PLEASE ADJUST NOW The display screen blinks. 4. Press U or V.
10. Operating Instructions – Make Adjustments 10.2.2 Adjust Loudness Follow the steps below to adjust the loudness of the beeps and alarms. Steps to Adjust Loudness Display screen 1. Press ENTER to access the MAKE ADJUSTMENTS menu. MAKE ADJUSTMENTS 2. Press V until ADJUST LOUDNESS appears. ADJUST LOUDNESS 3. Press ENTER. PLEASE ADJUST NOW The display screen blinks. 4. Press U or V. (The display screen blinks) PLEASE ADJUST NOW The loudness of the beep will change as you press U or V. 5.
10. Operating Instructions – Make Adjustments 10.2.3 Auto Dim If AUTO DIM is set to YES, the display screen turns off during your therapy if no buttons are pressed for five (5) minutes. A single dot will move from left to right across the screen. The display screen will turn back on if an alarm occurs or if a button is pressed. The default setting is AUTO DIM: NO. h NOTE: AUTO DIM will not operate when the display screen is showing the current time or estimated treatment end time.
10. Operating Instructions – Make Adjustments 10.2.4 Set Clock Follow the steps below to adjust the hour and minutes of the clock. h NOTE: The time can not be changed during therapy. Steps to set the Clock Display screen 1. Press ENTER to access the MAKE ADJUSTMENTS menu. 2. Press V until SET CLOCK appears. SET CLOCK: 7:10 AM 3. Press ENTER. SET CLOCK: 7:10 AM The hour digits blink. MAKE ADJUSTMENTS (The hour blinks) 4. Press U or V to change the hour. SET CLOCK: 8:10 AM 5.
10. Operating Instructions – Make Adjustments 10.2.5 Set Date Follow the steps below to change the day, month, or year. h NOTE: The date can not be changed during therapy. Steps to set the Date Display screen 1. Press ENTER to access the MAKE ADJUSTMENTS menu. 2. Press V until SET DATE appears. SET DATE: 8 JAN 2008 3. Press ENTER. SET DATE: 8 JAN 2008 The day digits blink. MAKE ADJUSTMENTS (The day blinks) 4. Press U or V to change the day. SET DATE: 9 JAN 2008 5.
10. Operating Instructions – Make Adjustments 10.2.6 I-Drain Time h NOTE: Initial Drain Time (I-DRAIN TIME) appears in Low Fill Mode only. Review or adjust the I-DRAIN TIME setting if you change your Last Fill Volume or if you perform a CAPD exchange during the day. Steps to set the I-Drain Time Display screen 1. Press ENTER to access the MAKE ADJUSTMENTS menu. 2. Press V until I-DRAIN TIME appears. I-DRAIN TIME: 0:22 3. Press ENTER. I-DRAIN TIME: 0:22 The digits blink. 4.
10. Operating Instructions – Make Adjustments 10.2.7 I-Drain Alarm The Initial Drain Alarm (I-DRAIN ALARM) volume is used to determine the minimum amount of Drain Volume expected during your Initial Drain. WARNING Too low an I-Drain Alarm volume can result in an incomplete Initial Drain followed by a full Fill. This can result in an increased intraperitoneal volume (IIPV) situation. See Table 10-1 on page 10-11 for the recommended starting points when determining your optimum I-Drain Alarm volume.
10. Operating Instructions – Make Adjustments WARNING Patients whose Fill volumes are less than 1000 mL may normally drain slowly. These patients typically weigh less than 44 lbs (20 kg). Use of the Low Fill Mode minimizes the incidence of LOW DRAIN VOLUME and CAUTION: NEGATIVE UF alarms. These alarms can not be bypassed to prevent an increased intraperitoneal volume (IIPV) situation in Low Fill Mode.
10. Operating Instructions – Make Adjustments Table 10-1. Recommended Starting Point for I-Drain Alarm Setting Last Fill Solution Last Fill Dwell Time % of Last Fill Volume Dianeal 8 to 16 hours 70%* Dianeal 2 to 4 hours 85%* Extraneal 8 to 16 hours 95%* * The settings for these percentages are calculated for you in Table 19-8 on page 19-17 in 19.16, Determining Initial Drain Alarm Volume Settings.
10. Operating Instructions – Make Adjustments Steps to set the I-Drain Alarm Display screen 1. Press ENTER to access the MAKE ADJUSTMENTS menu. 2. Press V until I-DRAIN ALARM appears. I-DRAIN ALARM:1400ML 3. Press ENTER. I-DRAIN ALARM:1400ML The volume digits blink. MAKE ADJUSTMENTS (The volume blinks) 4. Press U or V to change the setting. I-DRAIN ALARM:1800ML 5. Press ENTER to save the new Initial Drain Alarm volume. I-DRAIN ALARM:1800ML The blinking stops. 6.
10. Operating Instructions – Make Adjustments 10.2.8 Comfort Control Follow the steps below to adjust the temperature of the heater bag. The range is from 35°C to 37°C. The default setting is 36°C. Steps to adjust the temperature Display screen 1. Press ENTER to access the MAKE ADJUSTMENTS menu. 2. Press V until COMFORT CONTROL appears. COMFORT CONTROL: 36 3. Press ENTER. COMFORT CONTROL: 36 The temperature digits blink. MAKE ADJUSTMENTS (The temperature blinks) 4.
10. Operating Instructions – Make Adjustments 10.2.9 Last Manual Drain Baxter recommends YES be selected for the LAST MANUAL DRAIN option. A good starting point for setting your Target UF is 70% of your expected Total UF. If the UF is less than the Target UF at the end of the last Drain of the therapy, the system stops and a LOW UF alarm appears on the display screen. Occasionally, the location of the catheter tip can be in a less-than-optimal position.
10. Operating Instructions – Make Adjustments 10.2.10 UF Target and Alarm This option only appears on the Make Adjustments menu if Last Manual Drain is set to YES. WARNING Setting your UF Target too low can cause an incomplete last Drain, leaving fluid in your peritoneal cavity. This can result in an increased intraperitoneal volume (IIPV) situation during your next Fill. IIPV could result in a feeling of abdominal discomfort, serious injury, or death.
10. Operating Instructions – Make Adjustments The ALARM must be programmed YES or NO. If ALARM: YES is set, and the UF TARGET is not met, the HomeChoice/HomeChoice PRO APD System beeps continuously. A LOW UF alarm appears on the display screen. If ALARM: NO is set, and the UF TARGET is not met, only the LOW UF alarm appears on the display screen. The system will not beep. It will wait for you to wake up and finish draining. At that time, you can change your position and initiate a Manual Drain.
11 Operating Instructions – Prepare for Therapy 11.
Operating Instructions – Prepare for Therapy 11.1 Gather Your Supplies Gather all the supplies necessary for your dialysis treatment. 2 1 4 5 3 6 1. Solution Bags 2. Disposable Set (Luer shown) • Standard set for Fill volumes above 1000 mL • Low Recirculation Volume set for Fill volumes at or below 1000 mL 3. 4. 5. 6. Drain Bag or Drain Line Extension Disconnect Cap(s) Face Mask(s) Patient Line Extension, if needed Figure 11-1.
11. Operating Instructions – Prepare for Therapy WARNING Do not use a Patient Line Extension with the Low Recirculation Set. Using an extension with this set increases the recirculation volume and reduces therapy effectiveness. WARNING Do not extend the patient line beyond 34 feet (10.4 meters) for the standard set. Extending the patient line beyond this length increases the recirculation volume and reduces therapy effectiveness.
11. Operating Instructions – Prepare for Therapy 11.2 Prepare Your Solution Bags WARNING Follow aseptic technique taught by your dialysis center when handling lines and solution bags to reduce the possibility of infection. Always put on a face mask and wash and dry (or disinfect) your hands thoroughly. WARNING If any problems are found while preparing the solution bags, DO NOT USE THE SOLUTION SUPPLY BAG. DISCARD THE BAG and get a fresh dialysis solution supply bag.
11. Operating Instructions – Prepare for Therapy For your comfort, and to avoid alarms during priming: If you perform your treatment or if you store your supplies in an area colder than 15°C/59°F, turn on the HomeChoice/HomeChoice PRO APD System and place your bag on the heater pan 30 to 60 minutes prior to starting setup. In addition, place the cassette on top of heater bag to help warm it. Follow the steps below to prepare your solution bags. Steps to prepare solution bags 1. Check each solution bag.
11. Operating Instructions – Prepare for Therapy Steps to prepare solution bags (Continued) 2. Place one bag on the heater pan. a. Place the edge of the bag against the bag stops on the right side of the heater pan. b. Make sure that the bag completely covers the silver heater sensor button. b GO STO P ENTE R a h NOTE: This bag remains on the heater pan throughout the treatment. 11.
11. Operating Instructions – Prepare for Therapy Steps to turn on the system (Continued) 3. Press the On/Off Switch to the ON position ( I ). The On/Off Switch is located on the back of the cycler, next to the power cord. 4. After turning on the system, make sure you hear the beep that verifies that the audible alarm is working. 5. Observe that all of the characters on the display screen have all pixels ON (not blinking) for several seconds.
11. Operating Instructions – Prepare for Therapy 11.4 Menu Options at Startup Prior to starting a therapy you can review your therapy settings, last therapy results, and other information. Table 11-1 lists the options you can select before you press GO to start your dialysis treatment. 1. Press V to view each option. 2. Press ENTER to select an option. 3. Press STOP to return to the previous menu. Table 11-1.
11. Operating Instructions – Prepare for Therapy Table 11-1. Options Available at Startup (Continued) Option Initial Drain Volume Last Manual Drain Last Ultrafiltration Description I-DRAIN VOL: 65ML Shows the volume from the Initial Drain of your last treatment. LAST M-DRAIN: 60ML Only appears if you drained some fluid using the Manual Drain option after a Last Fill. Shows the amount of solution drained. LAST UF: 350ML Amount of ultrafiltrate removed during the last treatment.
11. Operating Instructions – Prepare for Therapy Table 11-1. Options Available at Startup (Continued) Option Therapy Log Description THERAPY LOG Press ENTER to review information about the 5 or 6 most recently performed treatments. It does not include the treatment in process. Press STOP to return to the previous menu. Modem Connect MODEM CONNECT Press ENTER to begin a modem data transfer. See 8.4, Install the Modem Option, on page 8-14 for details. Current Time 9:30 PM Shows the current time. See 10.
11. Operating Instructions – Prepare for Therapy 11.5 Load the Disposable Set WARNING Connect yourself only when CONNECT YOURSELF appears on the display screen. Connecting yourself before CONNECT YOURSELF appears can cause air to be delivered to your peritoneal cavity. This can result in shoulder and abdominal pain. This can also result in an increased intraperitoneal volume (IIPV) situation if you had fluid in your peritoneal cavity prior to the Initial Drain.
11. Operating Instructions – Prepare for Therapy WARNING Before loading the disposable set, inspect the cassette and tubing for damage. Using damaged sets can result in contamination of the fluid or fluid pathways. Contamination of any portion of the fluid or fluid path can result in peritonitis. Inspect the flexible surfaces of the cassette for obvious signs of damage, including cuts, tears, or punctures. Ensure the tip protectors on the ends of the tubing are on and unbroken.
11. Operating Instructions – Prepare for Therapy Steps to load the disposable set (Continued) 2. Prepare drain option. For Drain Bag – close the clamp on the line with the blue pull ring. For Drain Line Extension – leave the line clamp open. 3. If you are using a Patient Line Extension Set, open the package and place it on a clean surface. 4. Press GO when you are ready to begin. LOAD THE SET appears.
11. Operating Instructions – Prepare for Therapy Steps to load the disposable set (Continued) 6. Load the cassette. The cassette only fits in one way, with the lines leading to the right of the cycler. Insert the cassette bottom edge first, then press in the top. Pull the lines back toward the rear to lock the cassette into the cycler. h NOTE: Connect yourself only when CONNECT YOURSELF appears on the display screen. 7. Press down the handle to close and lock the door.
11. Operating Instructions – Prepare for Therapy 11.6 Attach the Drain Option WARNING When a drain line extension is used instead of a drain bag, you must leave an air gap (space) between the end of the drain line and any fluid in the drain or container. This prevents non-sterile fluid from flowing backwards up the drain line. Non-sterile fluid can contaminate the fluid path resulting in peritonitis. Follow the steps below to attach your drain option. Steps to attach a drain option 1.
11. Operating Instructions – Prepare for Therapy 11.7 Connect the Solution Bags h NOTE: Connect yourself only when CONNECT YOURSELF appears on the display screen. WARNING If the solution bag on the heater pan does not cover the heater button on the right end of the heater, delivery of overheated solution can result. In some circumstances, this can cause injury to the patient. Additional care should be taken when positioning small solution bags on the heater pan.
11. Operating Instructions – Prepare for Therapy Follow the steps below to connect your solution bags. h NOTE: Connect yourself only when CONNECT YOURSELF appears on the display screen. Steps to connect solution bags 1. Put on face mask and wash and dry (or disinfect) your hands thoroughly. WARNING Do not use a Patient Line Extension with the Low Recirculation Set. Using an extension with this set increases the recirculation volume and reduces therapy effectiveness.
11. Operating Instructions – Prepare for Therapy Steps to connect solution bags (Continued) 4. Connect the line to the heater bag as you have been taught by your dialysis trainer. 5. Repeat for all the solution bags necessary for your treatment. The lines with white clamps are for additional solution bags. 6. Leave any unused lines in the organizer with clamps closed. 7. Review your connections to make sure that: b GO STOP d ENTE R a c a.
11. Operating Instructions – Prepare for Therapy 11.8 Prime the Disposable Set Follow the steps below to prime your disposable set. Steps to prime the disposable set 1. Open clamps only on lines connected to solution bags. 2. Open the clamp on the patient line. 3. Make sure the end of the patient line and/or extension line is correctly positioned in the organizer. h NOTE: Do NOT connect yourself until CONNECT YOURSELF appears on the display screen.
11. Operating Instructions – Prepare for Therapy Steps to prime the disposable set (Continued) WARNING If your patient line is greater than 12 feet (3.6 meters) in length, and your Initial Drain Alarm is set to less than 30 mL, the Initial Drain can end early and result in an increased intraperitoneal volume (IIPV) situation. IIPV could result in a feeling of abdominal discomfort, serious injury, or death. See page 18-58 for IIPV symptoms or if IIPV is suspected.
11. Operating Instructions – Prepare for Therapy Steps to prime the disposable set (Continued) PRIMING . . . appears. PRIMING... The display screen alternates between CONNECT YOURSELF and CHECK PATIENT LINE. 5. Verify that the patient line is properly primed. 6. Before you wash your hands and connect yourself: a. Make sure fluid is present near the connector at the end of the patient line. b. Make sure the patient line clamp is open.
11. Operating Instructions – Prepare for Therapy WARNING CHECK FLUID LEVEL IN PATIENT LINE BEFORE CONNECTING Do not connect to your patient line unless the fluid level is at or near the connector at the end of the disposable set patient line. Connecting when air is present will result in sterile air being delivered during the first Fill if there was no Initial Drain. Air introduced into your peritoneal cavity can cause shoulder or abdominal pain.
11. Operating Instructions – Prepare for Therapy IF THE POWER IS INTERRUPTED DURING PRIME: To restart Priming after a power failure during prime: 1. Press GO to restart the treatment. 2. Press GO again when LOAD THE SET appears. 3. Open the bag clamps when CONNECT BAGS appears. 4. Make sure all clamps on the patient line and connected lines are open. WARNING If a disposable set is already present in the system after a power failure, CLOSE ALL CLAMPS before you press GO to start your therapy.
11. Operating Instructions – Prepare for Therapy 11.8.1 Reprime the Patient Line If the fluid level is not at or near the connector at the end of the patient line, follow the steps below to reprime the patient line. Steps to reprime the patient line Press STOP when the display screen alternates between CONNECT YOURSELF and CHECK PATIENT LINE. CHECK PATIENT LINE 2. Press V until REPRIME PATIENT LINE appears. REPRIME PATIENT LINE 3. Press ENTER. 4. Verify that the patient line is properly primed: 1.
11. Operating Instructions – Prepare for Therapy 11.9 Connect Yourself to the Disposable Set WARNING Follow aseptic technique taught by your dialysis center when handling lines and solution bags to reduce the possibility of infection. Always put on a face mask and wash and dry (or disinfect) your hands thoroughly. Follow the steps below to connect yourself to the system. Steps to connect yourself 1. Get your transfer set ready.
11. Operating Instructions – Prepare for Therapy Steps to connect yourself (Continued) 4. Remove the patient line from the organizer. 5. Connect the transfer set to the patient line. a. Remove pull ring from patient line connector. b. Remove cap from transfer set, and immediately connect to the patient line connector. 6. Open the transfer set. 7. Press GO to start your treatment. Treatment begins with an INITIAL DRAIN. INITIAL DRAIN STOP 8.
11.
12 Operating Instructions – Perform Therapy 12.
Operating Instructions – Perform Therapy Be sure you have followed all instructions in Section 11, Operating Instructions – Prepare for Therapy, before proceeding with this section. 12.1 Initial Drain Your treatment always begins with INITIAL DRAIN. During each Drain phase, used dialysis solution (effluent) containing waste products and excess fluids, is drained from the peritoneal cavity. h NOTE: Change position if the Drain stops and you believe that you are not empty.
12. Operating Instructions – Perform Therapy WARNING Bypassing an Initial Drain when there is still fluid left in the peritoneal cavity can result in an increased intraperitoneal volume (IIPV) situation later in your therapy. Change your position or sit up to aid draining completely during the Initial Drain. IIPV could result in a feeling of abdominal discomfort, serious injury, or death.
12. Operating Instructions – Perform Therapy If a VERIFY I-DRAIN prompt does not appear, press STOP and V to MANUAL DRAIN. Press ENTER to initiate a Manual Drain. The system will return to STOPPED: DRAIN when the Manual Drain ends. You can repeat the Manual Drain any number of times without an audible alarm. Resuming the Drain can result in an audible alarm. If your I-DRAIN ALARM setting is OFF or zero (0) because you normally have a dry day, Baxter recommends it be set to a value greater than zero (0).
12. Operating Instructions – Perform Therapy 12.1.1 Menu Options During Initial Drain INITIAL DRAIN Table 12-1 lists the options you can select during INITIAL DRAIN. 1. Press V to view each option. 2. Press ENTER to select an option. 3. Press STOP to return to the previous menu. Table 12-1. Options Available During Initial Drain Option Description Drain Volume DRAIN VOLUME: 60ML Initial Drain Volume updated every few seconds.
12. Operating Instructions – Perform Therapy 12.2 Fill WARNING IIPV could result in a feeling of abdominal discomfort, serious injury, or death. If any patient, or patient caregiver, suspects the patient has IIPV during a treatment, press STOP immediately, then press V and initiate a Manual Drain. The Manual Drain procedure is located in 18.5, Manual Drain Procedure, on page 18-53. See 18.8, Increased Intraperitoneal Volume (IIPV), on page 18-58 if IIPV is suspected.
12. Operating Instructions – Perform Therapy Table 12-2. Options Available During Fill Option Description Fill Volume FILL VOLUME: 60ML Fill Volume delivered. This is updated every few seconds. Initial Drain Volume I-DRAIN VOL: 65ML Volume from Initial Drain of the current treatment. Total Ultrafiltration TOTAL UF: 252ML The total therapy UF, updated after each Drain is completed. Press ENTER to review cycle-by-cycle information. Press STOP to return to the previous menu.
12. Operating Instructions – Perform Therapy 12.3 Dwell Phase After the first Fill, the first DWELL phase begins. During the Dwell phase, waste products and excess fluids pass from the bloodstream through the peritoneal membrane and into the dialysis solution. It is during the Dwell phase that the cycler pulls fluid from the supply bags to replenish the heater bag and warm the solution for the next Fill phase. 12.3.
12. Operating Instructions – Perform Therapy Table 12-3. Options Available During Dwell Option Description Dwell Time Left DWELL TIME LEFT 0:52 Dwell Time left in the current cycle. Initial Drain Volume I-DRAIN VOL: 65ML Volume from Initial Drain of the current treatment. Total Ultrafiltration TOTAL UF: 252ML The total therapy UF, updated after each Drain is completed. Press ENTER to review cycle-by-cycle information. Press STOP to return to the previous menu.
12. Operating Instructions – Perform Therapy 12.4 Drain Phase WARNING Bypassing the Drain phase can leave fluid in the peritoneal cavity and result in an increased intraperitoneal volume (IIPV) situation. IIPV could result in a feeling of abdominal discomfort, serious injury, or death. If any patient, or patient caregiver, suspects the patient has IIPV during a treatment, press STOP immediately, then press V and initiate a Manual Drain. The Manual Drain procedure is located in 18.
12. Operating Instructions – Perform Therapy Table 12-4. Options Available During Drain Option Description Drain Volume DRAIN VOLUME: 60ML Drain Volume updated every few seconds. Initial Drain Volume I-DRAIN VOL: 65ML Volume from Initial Drain of the current treatment. Total Ultrafiltration TOTAL UF: 252ML The total therapy UF, updated after each Drain is completed. Press ENTER to review cycle-by-cycle information. Press STOP to return to the previous menu.
12. Operating Instructions – Perform Therapy 12.5 Pause Therapy Press STOP to pause your therapy. STOPPED and the current phase appears on your display screen. 12.5.1 Menu Options When STOP is Pressed STOPPED: FILL This sample screen shows that STOP was pressed during the Fill phase. Table 12-5 lists the options you can select when you press STOP. 1. Press V to view each option. 2. Press ENTER to select an option. 3. Press GO to continue your therapy.
12. Operating Instructions – Perform Therapy Table 12-5. Options Available When STOP is Pressed Option Description Fill Volume FILL VOLUME: 60ML Shows the status of the current phase. Bypass BYPASS Press ENTER to select. See 18.4, Bypass Procedures, on page 18-37 for instructions. Change Program – OR – CHANGE PROGRAM Press ENTER to change your therapy settings. Review Program REVIEW PROGRAM REVIEW PROGRAM appears if the program is locked.
12. Operating Instructions – Perform Therapy 12.6 Hi-Dose Therapy This therapy allows you to combine your regular nighttime therapies, such as CCPD or Tidal, with additional daytime exchanges. This may help improve the quality of your dialysis treatment. Key features of Hi-Dose therapy include: Daytime exchanges. These additional exchanges may help to improve the quality of your dialysis treatment. Flexible length daytime Dwells based on your needs and daytime schedule.
12. Operating Instructions – Perform Therapy WARNING Bypassing an Initial Drain when there is still fluid left in the peritoneal cavity can result in an increased intraperitoneal volume (IIPV) situation later in your therapy. Change your position or sit up to aid draining completely during the Initial Drain. IIPV could result in a feeling of abdominal discomfort, serious injury, or death.
12. Operating Instructions – Perform Therapy 12.6.1 Day Dwell Options DAY DWELL X OF X Table 12-6 lists the options you can select during the DAY DWELL phase in Hi-Dose Therapy. 1. Press V to view each option. 2. Press ENTER to select an option. 3. Press STOP to return to the previous menu. Table 12-6. Options Available During Day Dwell Option Day Dwell Time Description DAY DWELL TIME: 0:31 The amount of time elapsed during the daytime Dwell.
12. Operating Instructions – Perform Therapy Table 12-6. Options Available During Day Dwell (Continued) Option Description Average Dwell Time AVG DWELL TIME: O:OO Average actual Dwell Time only reflects the average of the nighttime cycles. During daytime cycles, 0:00 appears. Press ENTER to review cycle-by-cycle information. Press STOP to return to the previous menu. Review Program REVIEW PROGRAM Allows you to review the programmed treatment. Current Time 6:10 PM Current time. 12.
12. Operating Instructions – Perform Therapy Steps to perform a daytime exchange (Continued) Display screen 2. When DAY FILL 1 is complete, DAY DWELL 1 begins. DAY DWELL 1 OF 1 During Day Dwell, you can disconnect from the cycler. See 12.7.1, Disconnect Yourself During Hi-Dose Dwell, on page 12-18. 3. Press V to display elapsed DAY DWELL TIME in hours and minutes. 4. Reconnect yourself when the appropriate Dwell Time is reached. See 12.7.2, Reconnect and Continue Treatment, on page 12-20.
12. Operating Instructions – Perform Therapy 12.7.1 Disconnect Yourself During Hi-Dose Dwell Follow the steps below if you choose to disconnect yourself during Hi-Dose Dwell. Steps to disconnect during Hi-Dose Dwell 1. Close your transfer set. 2. Close the clamp on the patient line. WARNING Follow aseptic technique taught by your dialysis center when handling lines and solution bags to reduce the possibility of infection. Always put on a face mask and wash and dry (or disinfect) your hands thoroughly.
12. Operating Instructions – Perform Therapy Steps to disconnect during Hi-Dose Dwell 4. Open and remove new MiniCap and FlexiCap disconnect caps from the package. 5. Disconnect the transfer set from the patient line of the disposable set. 6. Place the patient line back on the organizer. 7. Immediately place the MiniCap disconnect cap on the transfer set. Tighten the MiniCap until fully secured. 8. Attach the new FlexiCap disconnect cap to the patient line connector in the organizer.
12. Operating Instructions – Perform Therapy 12.7.2 Reconnect and Continue Treatment Follow the steps below to reconnect yourself and continue therapy. Steps to reconnect and continue treatment 1. During the Dwell phase, press V to display elapsed DAY DWELL TIME in hours and minutes. 2. When the appropriate Dwell Time is reached, prepare the room for reconnect. DAY DWELL TIME: 4:00 h NOTE: Do not press V or GO during the last Day Dwell until you are ready to begin your night treatment. 3. Press V.
12. Operating Instructions – Perform Therapy Steps to reconnect and continue treatment (Continued) 7. Remove the MiniCap disconnect cap from the transfer set connector. 8. Immediately connect the patient line connector to the transfer set. 9. Open the patient line clamp. 10. Open the transfer set. 11. Press GO. DAY DRAIN 1 OF 1 The system automatically begins DAY DRAIN 1. 12. Discard the used MiniCap disconnect cap and FlexiCap disconnect cap.
12.
Section Operating Instructions – End Therapy 13.
Operating Instructions – End Therapy 13.1 Ending Your Therapy When the last phase of your treatment cycle is complete, the HomeChoice APD System or HomeChoice PRO APD System indicates that the therapy is complete. WARNING Notify your dialysis center if you had an incomplete treatment, skipped the prescribed Last Fill, or in other situations as instructed by your clinician. Multiple incomplete or skipped treatments can cause reduced Dwell or Therapy Time.
13. Operating Instructions – End Therapy Follow the steps below to end your therapy and disconnect from the system. Steps to end your therapy 1. END OF THERAPY appears. 2. Press V to view the end of therapy summary information. 3. Record your I-DRAIN VOLUME. Display screen END OF THERAPY I-DRAIN VOL: ML LAST M-DRAIN: ML TOTAL UF: ML The amount shown is the total Initial Drain Volume from the current therapy. 4. Press V. LAST M-DRAIN appears only if LAST MANUAL DRAIN was set to YES.
13. Operating Instructions – End Therapy Steps to end your therapy (Continued) Display screen WARNING A consistently high UF in the last cycle may indicate that UF is accumulating in your peritoneal cavity during the course of your therapy. For a CCPD therapy, your Minimum Drain Volume percent may be programmed too low. For a Tidal therapy, your expected Total UF may be programmed too low. Either of these conditions can result in an increased intraperitoneal volume (IIPV) situation.
13. Operating Instructions – End Therapy Steps to end your therapy (Continued) 9. Display screen Press V. LOST DWELL: HH:MM The amount of Dwell Time LOST or ADDED is based on the estimated Dwell Time calculated at the beginning of therapy. ADDED DWELL: HH:MM If the Lost Dwell is 30 minutes or longer, and you have not viewed this information, the system will beep and display the Lost Dwell Time. 10. Press V. MANUAL DRAIN Press ENTER to select MANUAL DRAIN. 11. Press V.
13. Operating Instructions – End Therapy Steps to end your therapy (Continued) Display screen WARNING Do not press GO again until you have CLOSED ALL CLAMPS. This prevents the flow of fluid from one bag to another and/or to the patient during the time when DISCONNECT YOURSELF appears. This flow of fluid could result in an increased intraperitoneal volume (IIPV) situation. IIPV can result in a feeling of abdominal discomfort, serious injury, or death.
13. Operating Instructions – End Therapy 13.2 Disconnect Yourself WARNING Follow aseptic technique taught by your dialysis center when handling lines and solution bags to reduce the possibility of infection. Always put on a face mask and wash and dry (or disinfect) your hands thoroughly. Steps to disconnect yourself 1. Put on a face mask and disinfect your hands thoroughly. 2. Open and remove new MiniCap disconnect cap from the package.
13. Operating Instructions – End Therapy Steps to disconnect yourself (Continued) 3. Disconnect the transfer set from the patient line of the disposable set. 4. Place the patient line back on the organizer. 5. Immediately place the MiniCap disconnect cap on the transfer set. 6. Tighten the MiniCap until fully secured. WARNING Do NOT press GO again until AFTER you have disconnected! Touching any unsterile surface before completing your disconnect increases your risk of infection.
13. Operating Instructions – End Therapy 13.3 Shut Down WARNING Discard the disposable set and all solution bags at the end of therapy. Possible contamination of the fluid or fluid pathways could result if disposables are reused. Contamination of any portion of the fluid or fluid path may result in peritonitis. WARNING Do not open the door until you have CLOSED ALL CLAMPS. This prevents the flow of fluid from one bag to another, and/or to the patient.
13. Operating Instructions – End Therapy Steps to shut down the cycler h NOTE: Close all clamps and disconnect yourself by following the steps in 13.2, Disconnect Yourself, on page 13-6 before continuing. 1. Press GO. CLOSE ALL CLAMPS The display alternates between CLOSE ALL CLAMPS and DISCONNECT YOURSELF. DISCONNECT YOURSELF The occluder (behind door) retracts for 2 minutes (30 seconds for Low Fill Mode) to allow removal of the cassette. 2. Lift the latch up to unlock and open door. 3.
13. Operating Instructions – End Therapy Steps to shut down the cycler (Continued) 5. Press GO. TURN ME OFF TURN ME OFF appears. 6. Press the On/Off switch to the OFF position. 13.3.1 Menu Options During End of Therapy END OF THERAPY Table 13-1 lists the options you can select during END OF THERAPY. 1. Press V to view each option. 2. Press ENTER to select an option. 3. Press STOP to return to the previous menu.
13. Operating Instructions – End Therapy Table 13-1. End of Therapy Options Option Initial Drain Volume Last M-Drain Description I-DRAIN VOL: 65ML Volume from Initial Drain of the current therapy. LAST M-DRAIN: 60ML Only appears if you drained some fluid using the Manual Drain option before a Last Fill. Shows the amount of solution drained. Total Ultrafiltration TOTAL UF: 150ML The total amount of UF for the entire night’s therapy. Press ENTER to review cycle-by-cycle information.
13. Operating Instructions – End Therapy Table 13-1. End of Therapy Options (Continued) Option Lost Dwell Description LOST DWELL: 1:05 – or – ADDED DWELL: 1:05 Displays amount of Dwell Time “lost” or “added,” based on estimated Dwell Time calculated at the beginning of therapy. This message displays automatically if Lost Dwell is 30 minutes or greater and you have not viewed this information. Manual Drain MANUAL DRAIN Press ENTER to select.
Section 14 14.
Operating Instructions – Effluent Sampling 14.1 Introduction An effluent sample is a small amount of solution that has been drained from the peritoneal cavity during your regular drain. Your dialysis nurse will tell you how often you should take a sample. 2 1 3 1. Drain Line 2. Effluent Sampling Site 3. Effluent Sample Bag Figure 14-1.
14. Operating Instructions – Effluent Sampling WARNING Follow aseptic technique taught by your dialysis center when handling lines and solution bags to reduce the possibility of infection. Always put on a face mask and wash and dry (or disinfect) your hands thoroughly. 14.2 Take an Effluent Sample Follow the steps below to take an effluent sample. Steps to take an effluent sample 1. Put on a face mask and wash and dry your hands thoroughly. 2. Open the effluent sample bag packaging. 3.
14. Operating Instructions – Effluent Sampling Steps to take an effluent sample (Continued) 4. Prepare the sampling site. Make sure the clamp is closed on the sampling line. 5. Remove the cap from the effluent sample bag. Save the cap to recap the connectors. 6. Remove the cap from the sampling site. Save the cap to recap the connectors.
14. Operating Instructions – Effluent Sampling Steps to take an effluent sample (Continued) 7. Connect the effluent sample bag and position the bag below the level of the drain line. 8. After draining for 2 or 3 minutes, open the clamps. 9. When the effluent sample bag is full, close both clamps.
14. Operating Instructions – Effluent Sampling Steps to take an effluent sample (Continued) 10. Disconnect the effluent sample bag from the drain line and recap the connectors. h NOTE: Follow your dialysis nurse’s instructions for handling the effluent sample.
14.
Section 15 Cleaning 15.
Cleaning 15.1 Introduction WARNING Do not open the HomeChoice/HomeChoice PRO APD System cycler. Electrical circuitry inside may pose a shock hazard. WARNING Do not apply alcohol, hydrogen peroxide, or antiseptic containing alcohol to the disposable set or to the cassette interface inside the door of the cycler. Using these products can cause the cassette to develop cracks. CAUTION Do not use chemical cleaning agents or aerosol spray cleaners. These products might damage the plastics or surface finishes.
15. Cleaning 15.2 Cleaning the Cycler WARNING Unplug the HomeChoice/HomeChoice PRO APD System power cord from the wall outlet, or other AC power source, before cleaning the system. Failure to do so can cause an electric shock. The surface of the cycler should only be cleaned using mild soap and water. Follow the steps below to clean your cycler. Steps to clean the cycler 1. Turn the cycler off. 2. Unplug the cycler from the power source. 3.
15. Cleaning 15.3 Preparing the Cycler for Return to Baxter IMPORTANT Return this cycler to your dialysis center or to Baxter by calling Baxter Technical Assistance. Before you return the HomeChoice APD System cycler to Baxter, follow the steps below: Steps to prepare the cycler for return 1. Put on protective rubber gloves and an apron. 2. Mix a sanitizing solution of 1 gallon (3.8 liters) water and 16 oz or 2 cups (0.5 liter) household bleach. 3.
15.
Maintenance 16 16.
Maintenance A regular maintenance schedule is not needed. The HomeChoice/HomeChoice PRO APD System monitors itself. It will notify you if service is needed. The battery pack is automatically checked and recharged during operation. The battery does not need regular maintenance.
16.
Storage 17 17.
Storage 17.1 Cycler The HomeChoice/HomeChoice PRO APD System should be stored in the following conditions: Temperature between –25°F to 130°F (–34°C to 54°C) Humidity between 10% and 95% Altitude –1,100 ft to +18,000 ft (–340 m to +5,500 m) 17.2 Battery If the cycler is not used for more than 12 months, the battery pack must be removed. This must be done by a qualified Baxter service representative. See 2.2, Numbers to Call for Assistance, on page 2-1. 17.
17.
Section 18.
Troubleshooting This section contains information about alarms, and also contains special procedures related to alarm situations. h NOTE: Alarms pertaining to the PRO Card are described in 8.3, Display Messages, on page 8-11. 18.1 List of Alarms and Procedures The following is an alphabetical list of alarm messages and special procedures contained in this section: Alarm Messages Page Caution: Negative UF . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-22 Caution: Positive UF. . . .
18. Troubleshooting Alarm Messages Page Check Total Volume . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-10 Check Your Position . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-24 Drain Not Finished . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-11 Fill Not Finished. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-11 Load a New Set . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
18. Troubleshooting Special Procedures Page Bypass Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-37 Emergency Disconnect Procedure . . . . . . . . . . . . . . . . . . . . 18-65 End Therapy Early Procedure . . . . . . . . . . . . . . . . . . . . . . . . 18-55 Increased Intraperitoneal Volume (IIPV) . . . . . . . . . . . . . 18-58 Manual Drain Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-53 Power Failure . . . . . . . . . . . . . . . . . . . .
18. Troubleshooting 18.2.1 Types of Alarms There are three (3) types of alarm messages that can occur during therapy: Auto Restart These alarms can be corrected by reading the display screen and checking for the problem explained in the alarm message. – You do not need to press any buttons to correct these alarms. – The alarms beep 3 times, then the system continues therapy. – If the alarm continues, the system beeps 6 times then continues therapy.
18. Troubleshooting 18.3 Alarms 18.3.1 Check Lines WARNING Do not replace empty solution bags or reconnect disconnected solution bags during your therapy. Possible contamination of the fluid or fluid pathways can result if disposables are reused. Contamination of any portion of the fluid or fluid path can result in peritonitis. If a bag becomes disconnected during your therapy, follow the End Therapy Early procedure. Discard the disposable set and all solution bags at the end of therapy. (See 18.
18. Troubleshooting CHECK LINE (Continued) To Correct Cause 1: 1. Check the line referenced on the display screen for: – – – – – 2. Kinks Closed clamps Fibrin blockage Disconnected solution bags Empty solution bags Correct the issue you found. You do not need to press any buttons. – OR – If the alarm becomes a Manual Restart Alarm: 1. Press STOP to mute the alarm. 2. Check the line referenced on the display screen for: – – – – – 3.
18. Troubleshooting CHECK LINE (Continued) Cause 2: CHECK PATIENT LINE appears at start of FILL 1 in Standard Mode only. The clamp on the patient line was not opened after connecting the solution bags or after you were connected. This prevented priming of the patient line and caused the Initial Drain to end with little or no fluid drained. If this alarm occurs, do NOT open the clamp. WARNING Opening the clamp, at this point, can cause air to be delivered to your peritoneal cavity.
18. Troubleshooting CHECK LINE (Continued) To Correct Cause 2: If you suspect this is the cause: 1. Press STOP. 2. Press V until you see MANUAL DRAIN. 3. Press ENTER to initiate a Manual Drain. Then open the clamp on the patient line. Do not open the clamp until after you press ENTER. Cause 3: 4. When the Manual Drain ends, STOPPED: FILL appears. 5. Press GO to resume Fill. CHECK HEATER LINE appears at start of FILL 1 only.
18. Troubleshooting 18.3.2 Check Lines and Bags WARNING Do not replace empty solution bags or reconnect disconnected solution bags during your therapy. Possible contamination of the fluid or fluid pathways can result if disposables are reused. Contamination of any portion of the fluid or fluid path can result in peritonitis. If a bag becomes disconnected during your therapy, follow the End Therapy Early procedure. Discard the disposable set and all solution bags at the end of therapy. (See 18.
18. Troubleshooting 18.3.3 Check Therapy Setting Value Check value Display Message: Cause: CHECK THERAPY TIME CHECK TIDAL VOL PCT CHECK TOTAL UF CHECK TOTAL VOLUME The value of the programmed therapy setting is not valid. If you are using a HomeChoice/HomeChoice PRO APD System for the first time, this alarm occurs to remind you to program your therapy. This is a Manual Restart Alarm. To Correct: 1. Press STOP to mute the alarm.
18. Troubleshooting 18.3.4 Phase Not Finished WARNING Bypassing the Drain phase can leave fluid in the peritoneal cavity and result in an increased intraperitoneal volume (IIPV) situation. IIPV can result in a feeling of abdominal discomfort, serious injury, or death. If any patient, or patient caregiver, suspects the patient has IIPV during a treatment, press STOP immediately, then press V and initiate a Manual Drain. The Manual Drain procedure is located in 18.5, Manual Drain Procedure, on page 18-53.
18. Troubleshooting NOT FINISHED (Continued) To Correct: 1. Press STOP to mute the alarm. 2. Check with your dialysis center to learn when it is safe to bypass. See 18.4, Bypass Procedures, on page 18-37. 3. If you are sure that you want to bypass the alarm or phase, press V until the display screen shows BYPASS. 4. Press ENTER to select BYPASS. You have bypassed the alarm or phase and moved to the next phase in your therapy. 18.3.
18. Troubleshooting 18.3.6 Low Ultrafiltration (UF) WARNING Bypassing a LOW UF alarm can leave fluid in the peritoneal cavity and result in an increased intraperitoneal volume (IIPV) situation. IIPV can result in a feeling of abdominal discomfort, serious injury, or death. If any patient, or patient caregiver, suspects the patient has IIPV during a treatment, press STOP immediately, then press V and initiate a Manual Drain. The Manual Drain procedure is located in 18.
18. Troubleshooting LOW UF (Continued) To Correct: 1. Press STOP to mute the alarm. 2. Press GO to continue draining automatically. – OR – 3. Press V to: – View Manual Drain information. – Check with your dialysis center to learn when it is – safe to bypass. To bypass the alarm, see Steps to bypass LOW UF alarm, below. Initiate a Manual Drain. Steps to bypass LOW UF alarm Display screen LOW UF 1. Press STOP. DRAIN N OF N alternates with LOW UF 2. Press V. 3. Check DRAIN VOLUME. 4.
18. Troubleshooting Steps to bypass LOW UF alarm (Continued) 7. Press ENTER to bypass. Display screen END OF THERAPY END OF THERAPY or LAST FILL appears. – or – LAST FILL 18.3.7 Low Drain Volume WARNING Bypassing a LOW DRAIN VOLUME alarm can leave fluid in the peritoneal cavity and result in an increased intraperitoneal volume (IIPV) situation. IIPV can result in a feeling of abdominal discomfort, serious injury, or death.
18. Troubleshooting LOW DRAIN VOLUME Display Message: LOW DRAIN VOLUME A Slow Flow, No Flow, or air and fluid condition occurred before the programmed Minimum Drain Volume % (or Initial Drain Volume) completed. A No Flow condition occurred before the Low Fill Mode Minimum Drain Time completed. Cause: This is an Auto Restart Alarm. To Correct: 1. Change your position to try to drain more fluid. 2. Check for kinks in your patient line. 3. Correct the problem you found.
18. Troubleshooting WARNING Bypassing a LOW DRAIN VOLUME alarm can leave fluid in the peritoneal cavity and result in an increased intraperitoneal volume (IIPV) situation. IIPV can result in a feeling of abdominal discomfort, serious injury, or death. If any patient, or patient caregiver, suspects the patient has IIPV during a treatment, press STOP immediately, then press V and initiate a Manual Drain. The Manual Drain procedure is located in 18.5, Manual Drain Procedure, on page 18-53. See 18.
18. Troubleshooting Steps to check the Drain Volume (Continued) Display screen h NOTE: Resume the Drain or select MANUAL DRAIN unless you have absorbed a lot of fluid. Resuming the Drain can result in an audible alarm. Using Manual Drain repeatedly does not generate an audible alarm. 6. Select one of the following options: a. Press GO to return to Drain if you do not want to bypass. DRAIN 2 OF 5 DRAINING: ML This is the recommended option. – OR – a. Press V until MANUAL DRAIN appears. b.
18. Troubleshooting 18.3.8 Slow Flow Rate SLOW FLOW Display Message: Cause: SLOW FLOW DRAIN SLOW FLOW HEATER SLOW FLOW PATIENT SLOW FLOW SUPPLY Flow rate is very slow. A slow flow rate can reduce the Dwell Time and decrease the amount of effective dialysis time. There can be a partial kink on the specified line. This is an Auto Restart Alarm. To Correct: 1. Check the line shown in the display for: – – – – – 2.
18. Troubleshooting 18.3.9 Machine Tilted MACHINE TILTED Display Message: Cause: MACHINE TILTED The cycler is tilted. If this alarm occurs during therapy, it is a Auto Restart Alarm. To Correct: 1. Make sure that the system is on a flat surface and is not tilted. – OR – If the alarm becomes a Manual Restart Alarm or occurs at PRESS GO TO START: 18-20 1. Press STOP to mute the alarm. 2. Place the cycler on a flat, even surface. 3. Press GO to return to the therapy.
18. Troubleshooting 18.3.10 Warming Solution WARMING SOLUTION Display Message: Cause: WARMING SOLUTION The temperature of the fluid in the heater bag as measured by the cycler is below 33°C. Fluid delivery is not allowed at this time. The message continues to appear while the fluid in the heater bag is being heated. The message clears 5 (five) minutes after the heater bag temperature reaches 33°C.
18. Troubleshooting 18.3.11 Caution: Negative UF WARNING Bypassing a CAUTION: NEGATIVE UF alarm can leave fluid in the peritoneal cavity and result in an increased intraperitoneal volume (IIPV) situation. IIPV can result in a feeling of abdominal discomfort, serious injury, or death. If any patient, or patient caregiver, suspects the patient has IIPV during a treatment, press STOP immediately, then press V and initiate a Manual Drain. The Manual Drain procedure is located in 18.
18. Troubleshooting CAUTION: NEGATIVE UF (Continued) To Correct: 1. Press STOP to mute the alarm. 2. Follow the steps below to check Total UF. 3. Change your position. 4. Press GO to return to the therapy. Contact your dialysis center if this alarm continues. Do not bypass this alarm except on your dialysis center’s advice. This alarm can be bypassed only once. See 18.4, Bypass Procedures, on page 18-37. Steps to check Total UF Display screen 1. Press STOP. CAUTION: NEGATIVE UF 2. Press V.
18. Troubleshooting Steps to check Total UF (Continued) Display screen – OR – a. Press V until MANUAL DRAIN appears. b. Press ENTER. DRAINING: – OR – a. MANUAL DRAIN Press ENTER to bypass the alarm. ML CAUTION: NEGATIVE UF CAUTION: NEGATIVE UF appears briefly, then the next FILL begins. FILL 3 OF 5 h NOTE: By selecting BYPASS, you indicate that you are empty. The system considers your volume zero (0) and delivers your entire prescribed Fill Volume. 18.3.
18. Troubleshooting CHECK YOUR POSITION (Continued) If the alarm becomes a Manual Restart Alarm: Cause 2: 1. Press STOP to mute the alarm. 2. Place the cycler on a surface that is approximately level with you. 3. Press GO to return to the therapy. (Start of FILL 1 in Standard Mode only) The clamp on the patient line was not opened after connecting the solution bags and after you were connected.
18. Troubleshooting CHECK YOUR POSITION (Continued) To Correct Cause 2: If you suspect this is the cause: 1. Press STOP. 2. Press V until you see MANUAL DRAIN. 3. Press ENTER to initiate a Manual Drain. Then open the clamp on the patient line. Do not open the clamp until after you press ENTER. 4. When the Manual Drain ends, STOPPED: FILL appears. 5. Press GO to resume Fill. 18.3.13 Reload the Set WARNING Do not open the door until you have CLOSED ALL CLAMPS.
18. Troubleshooting RELOAD THE SET Display Message: RELOAD THE SET Cause: The cassette is loaded incorrectly or there is a problem with the system. See Table 18-1 on page 18-28 for possible causes. This is a Manual Restart Alarm. To Correct: 1. Press STOP to mute the alarm. 2. CLOSE ALL CLAMPS. 3. Open the door. 4. Remove the cassette. 5. Lift the cassette to drain fluid, if it is full. 6. Reload the cassette. 7.
18. Troubleshooting Table 18-1. Possible Causes for Reload the Set Alarms Reload Set Number Possible Cause 143, 163, 165–169 The occluder is unable to pinch off flow due to: Cold solution Cassette tubing overlapping or touching where it exits the door h NOTE: Placing the heater bag and cassette on the heater pan prior to the start of therapy can often prevent this alarm.
18. Troubleshooting 18.3.14 Caution: Positive UF CAUTION: POSITIVE UF Message Display: CAUTION: POSITIVE UF Low Fill Mode only. Cause: You have removed more than the allowable ultrafiltrate volume in either the current cycle or over the course of several cycles. The allowable volume can be set between 0 (zero) and 5000 mL. This is a Manual Restart Alarm. To Correct: 1. Press STOP to mute the alarm. 2. Press V until BYPASS appears. 3. Press ENTER to choose BYPASS.
18. Troubleshooting 18.3.15 Verify I-Drain VERIFY IDRAIN Message Display: VERIFY IDRAIN: OFF Cause 1: The I-DRAIN ALARM setting is OFF. To Correct Cause 1: 1. Press the power switch OFF and ON again. 2. Set the I-DRAIN ALARM to a value other than OFF. See 10.2.7, I-Drain Alarm, on page 10-9. h NOTE: You have permanently changed the Initial Drain Alarm setting for this therapy and all future therapy sessions. Cause 2: The I-Drain Alarm setting is lower than expected. To Correct Cause 2: 1.
18. Troubleshooting 18.3.16 System Errors 2240 or 2267 WARNING Do not attempt to reuse any disposable supplies. Possible contamination of the fluid or fluid pathways can result if disposables are reused. Contamination of any portion of the fluid or fluid path can result in peritonitis. WARNING Do not open the door until you have CLOSED ALL CLAMPS. This prevents the flow of fluid from one bag to another, and/or to the patient.
18. Troubleshooting SYSTEM ERROR 2240 or 2267 Message Display: Cause: SYSTEM ERROR 2240 SYSTEM ERROR 2267 The system detected air in the disposable tubing set and solution bag, and diverted flow to drain.
18. Troubleshooting SYSTEM ERROR 2240 or 2267 (Continued) 8. Complete your treatment with a manual exchange. – OR – 9. Set up the cycler with new supplies. A device swap is not necessary. 18.3.17 System Error nnnn WARNING Do not open the door until you have CLOSED ALL CLAMPS. This prevents the flow of fluid from one bag to another, and/or to the patient. Uncontrolled gravity flow of fluid can result in an increased intraperitoneal volume (IIPV) situation.
18. Troubleshooting SYSTEM ERROR nnnn Message Display: SYSTEM ERROR nnnn Cause: A problem occurred inside the system in the current cycle or over several cycles. To Correct: 1. 2. 3. 4. Press STOP to mute the alarm. Write down the System Error number and therapy phase that appears on the display screen. For instructions and assistance, contact Baxter Technical Assistance at the number listed in 2.2, Numbers to Call for Assistance, on page 2-1.
18. Troubleshooting 18.3.18 Temp Stabilizing TEMP STABILIZING Message Display: Cause: TEMP STABILIZING The temperature of the fluid in the heater bag measured by the cycler is above 40°C. Fluid delivery is not allowed at this time. The room temperature combined with the heat from the system (even with the bag heater off) is raising the solution bag temperature too high to deliver safe fluids to you. To Correct: 1. Press the power switch OFF. 2. Allow the system to cool for 10 to 20 minutes.
18. Troubleshooting TEMP STABILIZING (Continued) h NOTE: The system provides a display alarm only. There is no audible alarm.
18. Troubleshooting 18.4 Bypass Procedures 18.4.1 Bypass Initial Drain Follow the steps below to bypass an INITIAL DRAIN. Contact your dialysis center to learn when it is safe to bypass. WARNING Bypassing an Initial Drain when there is still fluid left in the peritoneal cavity can result in an increased intraperitoneal volume (IIPV) situation later in your therapy. Change your position or sit up to aid draining completely during the Initial Drain.
18. Troubleshooting Steps to bypass Initial Drain (Continued) 3. Press V. 4. Select one of the following options: a. Display screen BYPASS INITIAL DRAIN Press GO to return to INITIAL DRAIN if you do not want to bypass. This is the recommended option. h NOTE: Unless you have absorbed a lot of fluid, resume the Drain or select MANUAL DRAIN. Using Manual Drain repeatedly does not generate an audible alarm. h NOTE: The Manual Drain can facilitate obtaining a complete Initial Drain.
18. Troubleshooting 18.4.2 Bypass Low Drain Volume Alarm During Initial Drain Follow the steps below to bypass a LOW DRAIN VOLUME alarm during an Initial Drain. Contact your dialysis center to learn when it is safe to bypass. WARNING Bypassing a LOW DRAIN VOLUME alarm during Initial Drain when there is still fluid left in the peritoneal cavity can result in an increased intraperitoneal volume (IIPV) situation later in your therapy.
18. Troubleshooting Steps to bypass Low Drain Volume alarm during I-Drain (Continued) 2. Press V. Display screen DRAIN VOLUME: ML TOTAL UF: ML The DRAIN VOLUME appears. 3. Press V. Initial Drain is not included in TOTAL UF. 4. Press V. 5. Select one of the following options: a. BYPASS Press V until MANUAL DRAIN appears. MANUAL DRAIN This is the recommended option. Press ENTER. DRAINING: ML DRAINING: ML – OR – a. Press GO to return to Drain if you do not want to bypass.
18. Troubleshooting Steps to bypass Low Drain Volume alarm during I-Drain (Continued) 6. Change your position and resume Initial Drain as often as necessary. Display screen DRAIN VOLUME: ML I-DRAIN VOL: ML Using Manual Drain repeatedly does not generate an audible alarm. 7. Press V from the alarm stopped state to see the total Initial Drain Volume (I-DRAIN VOL). 18.4.
18. Troubleshooting Steps to bypass a Drain phase DRAIN phase number appears on the display screen. Display screen DRAIN 2 OF 5 1. Press STOP. STOPPED: 2. Press V. DRAIN VOLUME: ML I-DRAIN VOL: ML TOTAL UF: ML DRAIN The DRAIN VOLUME is shown. 3. Press V. The Initial Drain Volume (I-DRAIN VOL) is shown. 4. Press V. The TOTAL UF at the end of your previous Drain is shown. 5. Press V. 6. Press ENTER. BYPASS FILL 3 OF 5 The next FILL will begin.
18. Troubleshooting 18.4.4 Bypass Drain Not Finished Alarm WARNING Bypassing a DRAIN NOT FINISHED alarm can leave fluid in the peritoneal cavity and result in an increased intraperitoneal volume (IIPV) situation. IIPV can result in a feeling of abdominal discomfort, serious injury, or death. If any patient, or patient caregiver, suspects the patient has IIPV during a treatment, press STOP immediately, then press V and initiate a Manual Drain. The Manual Drain procedure is located in 18.
18. Troubleshooting Steps to bypass Drain Not Finished alarm The DRAIN NOT FINISHED alarm appears when you try to bypass and your current Drain Volume is less than the Minimum Drain Volume. 1. Press STOP to silence the alarm. 2. Press V. Display screen DRAIN NOT FINISHED DRAIN VOLUME: ML I-DRAIN VOL: ML TOTAL UF: ML The volume drained is subtracted from your Fill Volume. Your next Fill is reduced by this difference. If this alarm occurs during Initial Drain, DRAIN VOLUME: ML does not appear. 3.
18. Troubleshooting 18.4.5 Bypass Low Drain Volume Alarm WARNING Bypassing a LOW DRAIN VOLUME alarm can leave fluid in the peritoneal cavity and result in an increased intraperitoneal volume (IIPV) situation. IIPV can result in a feeling of abdominal discomfort, serious injury, or death. If any patient, or patient caregiver, suspects the patient has IIPV during a treatment, press STOP immediately, then press V and initiate a Manual Drain. The Manual Drain procedure is located in 18.
18. Troubleshooting Steps to bypass Low Drain Volume alarm (Continued) 2. Press V. Display screen DRAIN VOLUME: ML I-DRAIN VOL: ML TOTAL UF: ML The DRAIN VOLUME is shown. 3. Press V. The Initial Drain Volume (I-DRAIN VOL) from the current therapy is shown. 4. Press V. The TOTAL UF from the end of the previous Drain is shown.
18. Troubleshooting Steps to bypass Low Drain Volume alarm (Continued) 5. Display screen Press V. BYPASS Bypassing confirms that you are empty and that you want the next Fill delivery to equal your prescribed Fill Volume. You will achieve negative UF if you bypass the Low Drain Alarm and your Drain Volume is less than your Fill Volume. Your UF decreases by the amount your Drain is short of your prescribed Fill Volume. 6. Press GO to return to Drain. DRAIN 2 OF 5 This is the recommended option.
18. Troubleshooting Steps to bypass Low Drain Volume alarm (Continued) Display screen h NOTE: If LOW DRAIN VOLUME alarms continue to occur after you resume Drain, and it is necessary to bypass the Drain (for example, to reverse the flow in the catheter to correct a fibrin blockage issue): Press STOP to silence a LOW DRAIN VOLUME alarm. Press GO to resume Drain. Press STOP to stop the Drain (when no alarm is present). Bypass the Drain phase. See 18.4.3, Bypass Drain Phase, on page 18-41.
18. Troubleshooting 18.4.6 Bypass Caution: Negative UF Alarm WARNING Bypassing a CAUTION: NEGATIVE UF alarm can leave fluid in the peritoneal cavity and result in an increased intraperitoneal volume (IIPV) situation. IIPV can result in a feeling of abdominal discomfort, serious injury, or death. If any patient, or patient caregiver, suspects the patient has IIPV during a treatment, press STOP immediately, then press V and initiate a Manual Drain. The Manual Drain procedure is located in 18.
18. Troubleshooting Steps to bypass Caution: Negative UF alarm CAUTION: NEGATIVE UF appears on the display screen. 1. Press STOP to silence the alarm. The CAUTION: NEGATIVE UF alarm alternates with the current DRAIN phase. Display screen CAUTION: NEGATIVE UF CAUTION: NEGATIVE UF alternates with DRAIN 2 OF 5 h NOTE: The default value for the Negative UF alarm is 50% of your prescribed Fill Volume. h NOTE: The Negative UF alarm limit can be programmed at 20% to 60% in the Low Fill Mode. 2. Press V.
18. Troubleshooting Steps to bypass Caution: Negative UF alarm (Continued) 6. Press ENTER to bypass. Display screen CAUTION: NEGATIVE UF alternates with DRAIN 2 OF 5 h NOTE: Change your position to assist draining. Fluid may have pocketed near your catheter. 7. Press GO to resume DRAIN. DRAIN 2 OF 5 – OR – a. Press V until MANUAL DRAIN appears. b. Press ENTER. MANUAL DRAIN DRAINING: ML – OR – a. Press ENTER to bypass. FILL 3 OF 5 The next FILL begins.
18. Troubleshooting 18.4.7 Check Supply Line Alarm During Replenish An alarm is posted when there is insufficient fluid to complete an unscheduled replenish. This alarm can not be bypassed. To return to Fill, follow the steps below. Steps to return to Fill Display screen CHECK SUPPLY LINE 1. Press STOP. CHECK SUPPLY LINE alternates with REFILLING THE HEATER 2. Press GO. PLEASE WAIT.... appears briefly, then REFILLING THE HEATER 3. Press STOP. 4. Press V. 5. Press ENTER.
18. Troubleshooting 18.5 Manual Drain Procedure WARNING Do not STOP or BYPASS a Manual Drain during Fill. An increased intraperitoneal volume (IIPV) situation can result. IIPV can result in a feeling of abdominal discomfort, serious injury, or death. If any patient, or patient caregiver, suspects the patient has IIPV during a treatment, follow the Manual Drain procedure below. See 18.8, Increased Intraperitoneal Volume (IIPV), on page 18-58 for more information.
18. Troubleshooting Steps to perform a Manual Drain (Continued) 7. Press ENTER. Display screen DRAINING: ML The display screen shows the Drain volume. The system continues to drain until flow is no longer detected. 8. Press GO to return to therapy. 9. Reinitiate a Manual Drain if it is stopped during Fill.
18. Troubleshooting 18.6 End Therapy Early Procedure Follow the steps below to end your therapy early. h NOTE: If you end your therapy early for any reason, you can be left with more fluid in your peritoneal cavity than normal. If this occurs, your Initial Drain Alarm (I-DRAIN ALARM) setting may be too low.
18. Troubleshooting Steps to end therapy early (Continued) 4. Press V. Display screen FILL VOL: 60ML – or – DWELL TIME LEFT 1:05 – or – 5. Press V. DRAIN VOLUME: 60ML I-DRAIN VOL: 65ML Volume from Initial Drain of the current therapy is shown. 6. Press V. TOTAL UF: 150ML TOTAL UF is updated after each Drain is completed. 7. Press ENTER to review cycle-by-cycle information. Press STOP to return to the previous menu. 8. Press V.
18. Troubleshooting 18.7 Reprime Patient Line Procedure If the fluid level is not at or near the connector at the end of the patient line, follow the steps below to reprime the patient line. Steps to reprime the patient line 1. Press STOP when the display screen alternates between CONNECT YOURSELF and CHECK PATIENT LINE. Display screen CONNECT YOURSELF alternates with CHECK PATIENT LINE 2. Press V until REPRIME PATIENT LINE appears. 3. Press ENTER. 4.
18. Troubleshooting 18.8 Increased Intraperitoneal Volume (IIPV) Overfilling or not draining enough can result in excess fluid in the abdomen, also known as Increased Intraperitoneal Volume (IIPV).
18. Troubleshooting The Minimum Drain Volume % is programmed too low. This can cause your Drain cycles to end early. Day Fill Volume, Night Fill Volume, or Last Fill Volume is programmed too high. This can cause you to be overfilled if the volume is not appropriate for your body's size. For Tidal therapies, Total UF volume is programmed too low. This can cause a gradual buildup of UF volume during the therapy.
18. Troubleshooting The door is opened at the end of therapy before all clamps are closed. This can cause a free flow of fluid from one bag to another and/or to the patient. Any Drain phase is bypassed, including Initial Drain, Day Drain, or Night Drain. This can cause the system to deliver a full Fill in addition to any fluid left in the peritoneal cavity. DRAIN NOT FINISHED, LOW UF, LOW DRAIN VOLUME, or CAUTION: NEGATIVE UF alarms are bypassed.
18. Troubleshooting Steps to perform a Manual Drain The current FILL phase appears on the display screen. Display screen FILL 3 OF 5 1. Press STOP. STOPPED: 2. Press V. FILL VOLUME: 3. Press V. BYPASS 4. Press V. CHANGE PROGRAM 5. Press V. MAKE ADJUSTMENTS 6. Press V. MANUAL DRAIN 7. Press ENTER. DRAINING: FILL ML ML The display screen shows the Drain volume. The system continues to drain until flow is no longer detected. 8. Press GO to return to therapy. 9.
18. Troubleshooting 18.9 Power Failure When a power failure occurs (or if the power switch is turned OFF) during setup, the system closes the occluder and the display screen turns off. When the power is restored, the system returns to PRESS GO TO START. WARNING If a disposable set is already present in the system after a power failure, CLOSE ALL CLAMPS before you press GO to start your therapy.
18. Troubleshooting Table 18-3 lists the options you can view during a loss of power. 1. Press any button to activate the display. 2. Press STOP to silence the alarm. 3. Press V to view each option. h NOTE: If no button is pressed for two (2) minutes, the display turns off. Press any button to activate the display again. Table 18-3.
18. Troubleshooting If the power is restored within 30 minutes: The system automatically resumes therapy without any alarms. During the first 30 minutes of a power failure, press any key to retrieve therapy information. Press STOP and GO to start therapy after power is restored. If the power is not restored within 30 minutes: An alarm occurs after 30 minutes without power. Press STOP to mute the alarm. Press V to retrieve therapy information.
18. Troubleshooting 18.10 Emergency Disconnect Procedure WARNING This procedure is intended for emergency disconnection for short periods of time only. Extended time away from the system during therapy can result in Lost Dwell Time. If Lost Dwell is 30 minutes or greater, a Lost Dwell message appears when therapy is completed. WARNING Follow aseptic technique taught by your dialysis center when handling lines and solution bags to reduce the possibility of infection.
18. Troubleshooting 18.10.1 Disconnect from the System Steps to disconnect from the system 1. Press STOP. The specific therapy phase and STOPPED appear on the display screen when STOP is pressed. If treatment is stopped during the Dwell phase, the system continues to count down the Dwell Time to zero (0). 2. Close the clamp on the patient line and close your transfer set. 3. Using aseptic technique, prepare to disconnect: a. Open a new FlexiCap disconnect cap and a new MiniCap disconnect cap. b.
18. Troubleshooting 18.10.2 Return to Therapy After an Emergency Disconnect WARNING Follow aseptic technique taught by your dialysis center when handling lines and solution bags to reduce the possibility of infection. Always put on a face mask and wash and dry (or disinfect) your hands thoroughly. Steps to return to therapy 1. Using aseptic technique, prepare to connect: a. Remove the FlexiCap disconnect cap from the patient line connector. b.
18.
Section 19 Technical Data 19.
Technical Data The specifications in this section apply to the Baxter HomeChoice and HomeChoice PRO APD Systems. 19.1 Physical Specifications Height: Width: Depth: Weight: U.S. Standard 7.0 in 19.5 in 15.7 in 27 lbs Metric 17.8 cm 49.5 cm 39.9 cm 12.3 kg 19.
19. Technical Data 19.2.1 Extension Cords The use of extension cords is not recommended since they reduce the available voltage. Only heavy-duty extension cords rated for at least 1200 watts (10 Amps @ 120V) that are no longer than 12 feet should be used. The extension cord must have the grounding wire that mates with the grounding plug on the HomeChoice/HomeChoice PRO APD System power cord. 19.3 System Performance U.S.
19. Technical Data 19.5 Battery Backup When power failure occurs during therapy, the HomeChoice/HomeChoice PRO APD System stops the therapy and the display screen turns off. However, the display powers up each time a key is pushed during the first 30 minutes of a power failure. If power is restored within two hours, the therapy can be restarted from where it left off. If the power is not restored within two hours, the therapy is not allowed to continue. 19.
19. Technical Data In the case of unexplained EMI, consider the locations of nearby transmitters, such as radio or TV stations. You may have to move the cycler or place shield material between the transmitter and the cycler. Be aware that modifying the cycler or adding accessories or components not specifically authorized by Baxter may make the cycler more susceptible to interference from radio waves.
Compliance Group 1 Class B Class A Complies Emissions Test RF emissions CISPR 11 RF emissions CISPR 11 Harmonic emissions IEC 61000-3-2 Voltage fluctuations/flicker emissions IEC 61000-3-3 The HomeChoice/HomeChoice PRO APD System is suitable for use in all establishments, including domestic establishments and those directly connected to the public low-voltage power supply network that supplies buildings used for domestic purposes.
19-6 ±1 kV differential mode ±2 kV common mode <5% UT (>95% dip in UT) for 0.5 cycles 40% UT (60% dip in UT) for 5 cycles 70% UT (30% dip in UT) for 25 cycles <5% UT (>95% dip in UT) for 5 seconds ±1 kV differential mode ±2 kV common mode <5% UT (>95% dip in UT) for 0.
3Vrms 150 kHz to 80 MHz 3V/m 80 MHz to 2.5 GHz Conducted RF IEC 61000-4-6 Radiated RF IEC 61000-4-3 3V/m 3V Compliance Level where P is the maximum output power rating of the transmitter in watts (W) according to the transmitter manufacturer, and d is the recommended separation distance in meters (m). Field strengths from fixed RF transmitters, as determined by an electromagnetic site surveya, should be less than the compliance level in each frequency range.
19-8 0.37 1.20 3.70 12.00 0.1 1 10 100 P 12.00 3.70 1.20 0.37 0.12 d = [3.5 / 3] P 80 MHz to 800 MHz 23.00 7.40 2.30 0.74 0.23 d = [7 / 3] P 800 MHz to 2.5 GHz At 80 MHz and 800 MHz, the higher frequency applies. These guidelines may not apply in all situations. Electromagnetic propagation is affected by absorption and reflection from structures, objects and people.
19. Technical Data 19.7 Solution Temperature Protective System Overheated solution is prevented from reaching the patient by the solution temperature protective system that uses a microprocessor, temperature sensor, and cutoff switch that are independent of the temperature control system. The protective system temperature sensing is accurate to ±2°C. The HomeChoice/ HomeChoice PRO APD System sounds a system alarm within 5 seconds of sensing an overheated condition. 19.
19. Technical Data 19.11 Protective System Preventing Air Infusion The HomeChoice/HomeChoice PRO APD System is capable of detecting air in the vertically oriented pumping chambers. If air volumes exceeding 3 cc are detected, the air is pumped out of the top of the chamber to the drain line. Air volumes that are smaller than this are physically unable to exit the bottom of the chamber to the Fill line.
19. Technical Data 19.13 Drain Logic Options 19.13.1 Standard Fill Mode Drain Logic The HomeChoice/HomeChoice PRO APD System drains until the system encounters Slow Flow from the patient line for a period of time, or a single pump stroke of No Flow from the patient line. If Slow Flow persists for a preset period of time, the system looks at the Minimum Drain Volume to determine what to do next. If the Minimum Drain Volume has not been met, a 3-beep auto restart LOW DRAIN VOLUME alarm is posted.
19. Technical Data 19.13.2 Low Fill Mode Drain Logic The Low Fill Mode Drain Logic is similar to the Standard Fill Mode Drain Logic. The thresholds for Slow Flow and No Flow are lower because Low Fill Mode patients typically drain slower. The Low Fill Mode also has an Initial Drain Time (I-DRAIN TIME) setting in the Make Adjustments menu. There is a Minimum Drain Time (MIN DRAIN TIME) setting for Day and Night Drains in the Nurse’s Menu.
19. Technical Data The Low Fill Mode logic will continue to drain without alarming for lower flow rates when compared to the Standard Fill Mode logic. It also has a Minimum Drain Time setting that must be met along with the Minimum Drain Volume before the system can move on to Fill. The Low Fill Mode is restricted to Fill volumes of 60 mL to 1000 mL. This mode is suitable for patients with small Fill volumes who may normally drain slowly.
19. Technical Data 19.14.2 Unscheduled Replenish If the heater bag empties before the end of the Fill phase, the system will usually, but not always, transfer solution from the supply bags to the heater bag in order to complete the Fill phase. This is an unscheduled replenish because the heater bag ran dry unexpectedly during Fill. An unscheduled replenish is performed if the Fill Volume delivered to the patient when the heater bag empties is less than the volumes shown in the Table 19-6 on page 19-14.
19. Technical Data To use Table 19-7, find the row with your weight in pounds (or kilograms) and read across to find the corresponding Fill Volume Limit. EXAMPLE: If dry weight is 120 pounds, the Fill Volume Limit is 2500 mL. If your weight is between the values listed in two adjacent rows, choose the row with lower weight and read across to find the corresponding Fill Volume Limit. EXAMPLE: If dry weight is 137 pounds, the Fill Volume Limit for 135 pounds is 2800 mL.
19. Technical Data 19.16 Determining Initial Drain Alarm Volume Settings Table 19-8 on page 19-17 allows you to determine the Initial Drain Alarm (I-DRAIN ALARM) volume setting based on different percentages of the Last Fill Volume. To use Table 19-8, identify the row with your Last Fill Volume (mL) and read across to the column with the desired percentage (%) to find the corresponding Initial Drain Alarm volume setting.
19. Technical Data Table 19-8.
19. Technical Data 19.17 Determining Tidal Total UF and Last Manual Drain UF Target Volume Settings Table 19-9 on page 19-19 allows you to determine the: Total UF volume setting for a Tidal therapy, or UF Target volume setting for the Last Manual Drain based on different percentages of the estimated Total UF volume.
19. Technical Data Table 19-9.
19. Technical Data Table 19-9.
Section 20 Quick Reference 20.
Quick Reference This section is intended to guide you through common procedures. It should not replace the complete operating instructions contained in the other sections of this guide. Read the entire manual before operating the HomeChoice APD System or HomeChoice PRO APD System.
20. Quick Reference 20.1 Prepare for Therapy 1. Gather your supplies.
20. Quick Reference WARNING The solution bag must be positioned properly on the heater pan, covering the silver heater sensor button. Failure to properly position the solution bag can result in overheated or underheated dialysis fluid. WARNING DO NOT use external heating sources (i.e., microwave oven) to warm solution bags. This can result in overheated solution delivered into your peritoneal cavity. 2. Place a solution bag on the heater pan. 3. Turn on the cycler.
20. Quick Reference WARNING Before loading the disposable set, inspect the cassette and tubing for damage. Using a damaged set can result in contamination of the fluid which can result in peritonitis. 4. Prepare the disposable set. Open the packaging by grasping the top and pulling down in opposite directions. Close all clamps on the disposable set. 5. Prepare your drain option. For Drain Bag: close the clamp on the line with the blue pull ring. For Drain Line Extension: leave the line clamp open.
20. Quick Reference WARNING If a disposable set is already present in the cycler, CLOSE ALL CLAMPS before you press GO. This prevents fluid from flowing from one bag to another, or to the patient, when LOAD THE SET appears. The uncontrolled gravity flow of fluid can result in an increased intraperitoneal volume (IIPV) situation. 6. Press GO when you are ready to begin. LOAD THE SET appears. 7. Open the door. Push the handle up to unlock and open the door.
20. Quick Reference 8. Load the cassette. The cassette only fits one way, with the lines leading to the right of the cycler. Press the handle down to close and lock the door. 9. Place the organizer. Place the long slot of the organizer over the hook at the top of the door.
20. Quick Reference 10. Prepare your drain option. Drain Bag: close clamp on the short tube to prevent leakage. Drain Line Extension: remove tip protectors from both ends of drain. 11. Attach your drain option. 12. Open all drain clamps. 13. Press GO. SELF TESTING appears on the display screen. When the self-test is complete, CONNECT BAGS appears on the display screen.
20. Quick Reference WARNING Follow aseptic technique taught by your dialysis center when handling lines and solution bags to reduce the possibility of infection. 14. Put on face mask and wash and dry your hands thoroughly. 15. Connect bags. Connect the line with the RED clamp to the heater bag. Connect the line with the BLUE clamp to the Last Fill bag. Connect the lines with the white clamps to additional solution bags, if needed.
20. Quick Reference 16. Check connections and open clamps. Open clamps only on lines connected to solution bags. Make sure the patient line is in the left slot of the organizer. Open the clamp on the patient line. WARNING Failure to open the clamp on the patient line after connecting the solution bags will prevent the patient line from being primed. This can cause air to be delivered to you during FILL 1. 17. Press GO to begin priming.
20. Quick Reference 18. Priming complete. When priming is complete, the display screen alternates between CONNECT YOURSELF and CHECK PATIENT LINE. WARNING Verify that the fluid level is at or near the connector at the end of the disposable set patient line. Connecting when air is present can result in sterile air being delivered, which can cause shoulder or abdominal pain. 19. Get your transfer set ready.
20. Quick Reference 20. Put on face mask and wash and dry your hands thoroughly. 21. Connect yourself. Remove the MiniCap from the transfer set. Connect the transfer set to the patient line by removing the pull ring and attaching the transfer set. Open the transfer set.
20. Quick Reference 22. Press GO. Treatment begins with INITIAL DRAIN. If you perform a Hi-Dose therapy, skip to 20.2, Perform a Hi-Dose Therapy. If you are not performing a Hi-Dose therapy, skip to 20.3, End Therapy, on page 20-19.
20. Quick Reference 20.2 Perform a Hi-Dose Therapy 1. Hi-Dose therapy begins when INITIAL DRAIN is complete. 2. DAY FILL begins automatically when INITIAL DRAIN is complete.
20. Quick Reference 3. During DAY DWELL, you may choose to disconnect yourself from the cycler. 4. If you choose to disconnect yourself: Close the transfer set. Clamp the patient line. Disconnect the transfer set from the patient line. Connect a MiniCap disconnect cap to the transfer set (shown). Connect a FlexiCap disconnect cap to the patient line.
20. Quick Reference 5. Press V to display the elapsed Dwell Time in hours and minutes. 6. When you are ready to continue your therapy, press V until the display reads PRESS GO TO CONTINUE.
20. Quick Reference 7. Press GO and the system prompts you to CONNECT YOURSELF. 8. Put on face mask and wash and dry your hands thoroughly.
20. Quick Reference 9. Connect yourself. Remove the MiniCap disconnect cap from the transfer set. Remove the FlexiCap disconnect cap from the patient line. Connect the transfer set to the patient line. Open the transfer set. Open the patient line clamp. 10. Press GO and the system automatically begins DAY DRAIN 1.
20. Quick Reference 11. When DAY DRAIN 1 is complete, the nighttime therapy begins with FILL 1. – OR – If more than one Hi-Dose exchange is programmed, the next DAY FILL begins.
20. Quick Reference 20.3 End Therapy 1. The HomeChoice APD System tells you when your therapy is complete. 2. Press V to view the end of therapy summary information. 3.
20. Quick Reference 4. Press GO. CLOSE ALL CLAMPS appears on the display screen. 5. Close all clamps! 6. Put on face mask and wash and dry your hands thoroughly.
20. Quick Reference 7. Open a new MiniCap disconnect cap. 8. Disconnect the transfer set from the patient line. 9. Connect a MiniCap disconnect cap to the transfer set.
20. Quick Reference 10. Press GO. DISCONNECT YOURSELF appears on the display screen. 11. Open the door. 12. Remove and discard the disposable set. 13. Press GO. TURN ME OFF appears on the display screen. 14. Press the On/Off switch to the OFF position.
Index Index
Index A Abdomen 1-1, 5-2 Abdominal fullness 1-1 Added dwell 13-12 Adjust brightness 10-3 Adjust loudness 10-4 Aerosols 3-11, 3-15, 15-1, 19-2 Air infusion 1-1, 3-2, 11-19, 19-10 Alarm caution negative UF 18-22 caution positive UF 18-29 check drain line 18-5 check final line 18-5 check heater line 18-5 check lines and bags 18-9 check patient line 18-5 check supply line 18-5 check therapy time 18-10 check Tidal Vol PCT 18-10 check total UF 18-10 check total volume 18-10 check your position 18-24 drain not fin
Index ENTER 5-9, 5-12 GO 5-9, 5-12 silver heater sensor 5-8, 5-10 STOP 5-9, 5-12 Up/Down 5-9, 5-12 Bypass 1-2, 12-12 Bypass procedure caution negative UF alarm 18-49 drain not finished alarm 18-43 drain phase 18-41 initial drain 18-37 initial drain alarm 18-39 low drain volume alarm 18-45 C Calculated settings cycles 9-7 dwell time 9-7 tidal volume 9-7 UF per cycle 9-7 CAPD 1-3 Card reader disabled 8-12 Card reader error 8-13 Cassette 1-2, 3-10, 5-4, 5-7, 5-14, 5-15, 11-13 Catheter 1-2, 5-2 poor drainage 3
Index Day drain 8-9 Day dwell 12-15 Day dwell time 12-15 Day exchanges 1-1, 8-9, 12-13, 12-16 Day fill n 8-9 Day fill volume 1-3, 9-14, 9-27, 9-41, 9-57 Day fills 1-3, 9-13, 9-26, 9-40, 9-56 Description 5-1 Dextrose 1-4, 3-7, 9-11, 9-16, 9-23, 9-32, 9-37, 9-43, 9-52, 9-61, 11-4 Dialysis 1-4 Dialysis solution 1-4 Dianeal 10-11 Disconnect cap 1-4, 11-1, 12-19, 13-6 Disconnect yourself 12-18, 13-6 Display precision 19-2 Display screen 5-9, 5-11, 11-6 HomeChoice 5-11 HomeChoice PRO 5-9 Display screen test 11-6
Index low 19-13 phase 5-5 replenish logic 19-13 volume 1-5 Fill volume 9-10, 12-6, 12-12, 19-14 Fill volume limit 19-15 Final line 5-14, 5-15 Fluid circuit 5-4 Fluid line 5-6 Fluid overload 1-6, 3-2, 13-1 Fluid pathways 5-5 Fluid temperature control 19-2 Flush 1-6, 9-3 Frequency range 19-1 Front view HomeChoice 5-10 HomeChoice PRO 5-8 Full drains every 9-23, 9-32, 9-52, 9-61 Fuse 19-1 G GO button 5-12 Grounding 7-2, 11-5, 19-2 instructions 7-4 H Handle 5-8, 5-10 Heater 11-3 bag 11-5 line 5-14, 5-15 pan 3-
Index Log alarm 11-8 therapy 11-9 Lost dwell 13-12 Low drain volume 10-10 Low fill mode 1-7, 9-2, 9-34, 19-13 Low recirculation volume set 1-7 M Maintenance 16-1 Make adjustments 10-1, 11-7, 12-12 Manual drain 12-12, 13-12, 18-53 Manual restart alarm 18-4 Maximum fill volume 19-14 Maximum pressures 19-9 Medication port 3-7 Minimum drain time 9-2 Minimum drain volume 9-2, 19-11 Mode low fill 1-7, 9-2, 9-34, 19-13 operation 19-1 standard fill 1-10, 9-2, 9-9 Modem 3-11, 8-14 testing 8-16 Modem connect 11-9 Mo
Index Power cord 3-11, 5-9, 5-11, 7-1, 7-4, 8-2, 11-5, 19-2 Prepare for therapy 11-1 Prescription settings 9-1 Press go to start 11-7 Prime patient line 11-20 Priming 1-9, 11-18 PRO Card 1-10, 5-16, 8-1, 11-5 care 8-3 confirm card 8-4 handling 8-3 indicator light 8-2, 8-11 inserting 8-4 messages 8-11 port 5-8, 8-2 prompts 8-7 removing 8-10 PRO card full 8-12 Product code 19-1 Program locked 9-3 Program not valid 8-13 Programming 8-7, 9-1, 9-4 Protective system preventing air infusion 19-10 preventing IIPV 1
Index crossed-out wheeled bin 1-12 date of manufacture 1-12 fuse 1-12 ingress protection 1-12 mains power 1-13 manufacturer 1-13 rechargeable battery 1-12 recyclable 1-12 serial number 1-12 type B 1-12 Symbols 1-12 System 1-10 performance 19-2 System error 18-31, 18-33 System error alarm 18-4 System settings 9-1 T Temperature accuracy 19-2 adjusting 10-13 fluid control 19-2 measurement 19-2 operating 6-1, 19-2 storage 17-1, 19-2 Therapy 11-1, 12-1 Therapy end time 12-4, 12-6, 12-8, 12-10 Therapy log 11-9 T
Index W Warnings 3-1, 4-1 Waste 1-12 WEEE 2002/96/EC 3-15 Weight 8-8 I-8 HomeChoice APD Systems Patient At-Home Guide October 2, 2009 07-19-61-244
24-hour Technical Assistance is available for the HomeChoice and HomeChoice PRO APD Systems at 1.800.553.6898 07-19-61-244 October 2, 2009 Software version: 10.210 PATIENT GUIDE COVERS_Update121109.indd 2 Baxter Healthcare Corporation Renal Division McGaw Park, IL 60085 U.S.A 1.888.736.
