Fresenius Medical Care

Technical Training
on
4008 Dialysis Machine
Shanghai, April 2002
Hotin

May 2001

Dialyzer Membrane
Fresenius Medical Care

May 2001

Fresenius Polysulfone - Structure

Fresenius Medical Care

May 2001

Fresenius Polysulfone - Structure

Fresenius Medical Care

HOLLOW FIBRE DIALYSER

PORE
PORESIZE
SIZEisisdependant
dependanton
onthe
thetype
type
ofofmembrane;
membrane;
HF Dialyser:
Pore size ~ 0.3nm

LF Dialyser:
Pore size ~ 0.1nm

May 2001

Venous Pressure
Measurement

Fresenius Medical Care

Blood out

Venous
Bubble Catcher
Dialysate in

Dialyzer

Dialysate out
Venous Clamp
Blood in

Blood Pump

Arterial Pressure
Measurement

HEMODIALYSIS

HD

The transport of uremic wastes by diffusion, i.e. the process in which

of particles move across a semipermeable membrane from the area
of higher concentration (blood) to the area of lower concentration
(dialysate).
May 2001

j:\sd\ch\folien\tpf_nma\hd_arm_e.cdr

SD / TRAINING CENTER SCHWEINFURT

Heater

Fresenius Medical Care

Hemofilter

Blood leak
detector

cleared blood

Filtr. pump

Blood

Sub. pump

Blood pump

Hemofiltration HF
Filtrate

Substituate

Removal of uremic wastes by convective transport. The driving force is provided

by the transmembrane pressure present at the hemofilter.
Due to the filtration of large volumes during hemofiltration, simultaneous reconstitution of blood with appropriate amounts of physiologic replacements solution
is required.

Fluid balance

May 2001
SD / TRAINING CENTER SCHWEINFURT

j:\sd\ch\folien\tpf_nma\hf_e.cdr

Heater

Fresenius Medical Care

Hemofilter

cleared blood

Blood leak
detector

Filtr. pump
Blood

Sub. pump

Blood pump

Hemodiafiltration HDF

Filtrate

Substituate

Hemodiafiltration is a combination of hemodialysis and hemofiltration to take advantage of the benefits of hemodialysis - high clearance of small-molecular substances
and hemofiltration - good clearance with middle-molecular substances.
Fluid balance

May 2001
SD / TRAINING CENTER SCHWEINFURT

j:\sd\ch\folien\tpf_nma\hdf_e.cdr

Display of the Clearance with the different Dialysis Treatment Procedures

Clearance
(ml/min)

Fresenius Medical Care

200

conventional Hemodialysis
Hemofiltration
Hemodiafiltration with Polysulfone membrane (Fresenius)

150

100

50

102

103

104
Inulin

Urea
Creatinin

Vit. B12

105
Albumin

Molecularweight
(Dalton)

2-Microglobulin

May 2001
SD / TRAINING CENTER SCHWEINFURT

FMC HD Machines - 4008B/S

Fresenius Medical Care

May 2001

FMC HD Machines - 4008E/H

Fresenius Medical Care

May 2001

FMC HD Machine - 4008S

Fresenius Medical Care

May 2001

FMC HD Machine - 4008H

Fresenius Medical Care

May 2001

Structure of Haemodialysis Machine

Fresenius Medical Care

Main Components
Monitor

- Control Unit

Modules

- Extracorporeal
Blood Circuit

Hydraulics - Preparation of
Dialysis Fluid

May 2001

Structure of Haemodialysis Machine

Fresenius Medical Care

Monitor
Extracorporeal
Blood Circuit
Hydraulics

May 2001

Operating Elements
Displays
Alarms
Blood Pump
Heparin Pump
Air Detector
Preparation
Preparation of
of Dialysis
Dialysis Fluid
Fluid
-- Mixing
Mixing
-- Heating
Heating
-- Degassing
Degassing
Transport
Transport of
of dialysis
dialysis Fluid
Fluid
Fluid
Fluid Balance
Balance &
& Ultrafiltration
Ultrafiltration

Electronic Compartment
Fresenius Medical Care

May 2001

Blood Pump
Fresenius Medical Care

Arterial Pressure Connector

Delivery Rate: 15 - 600 ml/min
Automatic Stop in blood alarms
Sensor to check the cover is open/closed

May 2001

Heparin Pump
Fresenius Medical Care

Anticoagulation:
To prevent blood clotting in the
extracorporeal blood circuit

May 2001

Air Detector
Fresenius Medical Care

Ultrasonic Sensors
Prevent air entering patient body
Holder Size: 22 or 30 mm
Venous Pressure Connector
Venous Line Clamp (Optical Detector):
Closed in blood alarms
Keys for fluid level adjustment
May 2001

bibag Module
Fresenius Medical Care

May 2001

bibag Module
Fresenius Medical Care

May 2001

Less Storage Space

Lightweight
Safe
Clean
Practical
Long Shelf Life
Environmentally Friendly

Tasks of Haemodialysis Machine

Fresenius Medical Care

1.

Produce fresh dialysate

2.

Provide correctly prepared dialysate to the dialyzer

3.

Remove fluid from the patient by ultrafiltration

4.

Handle and monitor effluent dialysate

5.

Operate and control the extracorporeal circuit

May 2001

Basic Haemodialysis Setup

Fresenius Medical Care

Monitor
Hydraulics
ECC

Dialyzer

Preparation
& handling
of fresh
dialysate
Handling of
used dialysate
and
ultrafiltrate

HD Machine

Ultrafiltrate

Blood
lines

Extracorporeal
Circuit

May 2001

General Features / Benefits

Fresenius Medical Care

High
High Safety
Safety Level
Level
-- 22 independent
independent microprocessor
microprocessor systems
systems
-- approved
approved hydraulic
hydraulic parts
parts
-- cyclic
cyclic pressure
pressure holding
holding tests
tests
Proven
Proven Volumetric
Volumetric Ultrafiltration
Ultrafiltration
Auto
Auto Self-test
Self-test
Auto
Auto Disinfection
Disinfection Programs
Programs
UF
UF // Na
Na Profiles
Profiles
Emergency
Emergency Battery
Battery Operation
Operation of
of Blood
Blood Systems
Systems (15
(15
20
20 min)
min) (Power
(Power Failure)
Failure)
Program
Program Heparinization
Heparinization Time
Time // Bolus
Bolus

May 2001

Features / Benefits in Operation / Handling

Fresenius Medical Care

Simultaneous Display of Status & Alarms

Additional Alphanumeric Display
Direct Selection of UF-parameters
Intelligent Setting of Pressure Limits
Pressure-corrected Blood Flow & Blood Volume Calculation
Service Programs

May 2001

Options in 4008 System

Fresenius Medical Care

Additional Status Display

BPM

SN-Double Pump

BTM

DIASAFE / DIASAFEplus Filter

BVM

4008 HDF

CDS

Online HDF / HF

OCM

ONLINEplus

IrDA

bibag
May 2001

Fresenius Medical Care

SCREEN
SCREEN11

Green
Greenindicates
indicatesthat
that
this
screen
can
be
this screen can be
viewed
viewedby
bypressing
pressing
confirm.
To
confirm. Tomove
move
the
cursor
press
the cursor pressthe
the
arrow
arrowacross
across 

May 2001

Here
Hereisisdisplayed
displayedthe;
the;
Machine
type
Machine type
Software
Softwareversion
version

Fresenius Medical Care

SCREEN
SCREEN22

T1
T1Test
Test
IfIfan
anerror
erroroccurs
occursaa
xx oror
number
numberappears
appears
totoinform
you
inform youofofthe
thefailure.
failure.
The
alarm
occurs
at
the
The alarm occurs at theEND
END
ofofthe
test
procedure
the test procedure

May 2001

The
Thevarious
varioussteps
stepsofofthe
the
T1
TEST
T1 TEST
green
greenhighlights
highlightsthe
thespecific
specific
part
of
the
test
sequence
part of the test sequence

Fresenius Medical Care

SCREEN
SCREEN 33

IfIfthe
theT1
T1Test
Testisissuccessful
successful
the
screen
will
be
the screen will becompleted
completed
with
with



May 2001

Fresenius Medical Care

Ultrafiltration
Menu

Dialysate
UF Values

UF Goal
UF Time Left
UF Rate
UF Profile
UF Volume

ISO Values

SO Goal
ISO Time
ISO Rate
ISO Volume

MAIN
MAINSCREEN
SCREENDISPLAY
DISPLAY

Treatment
mode

HDF
SN Click Clack

May 2001

Menu

Alarm limits
menu

Reinfusion
Needle Adjustment
prog
Arterial Limits
Venous Limits
TMP Limits

Mixing Ratio
Base Na+
Concentrate
Bicarbonate
Temperature
Flow
Na+ Profile
Start Na+
CDS
Conductivity window

System
parameters

Reset treatment
parameters
Brightness
Auto-On programme
(cleaning modes)
Date
System Time
(actual time)

Dialysis
representations

Graphic displays for

the front screen
UF / Na Profiles
Arterial/Venous pressures
BPM (syst/dias)
BPM MAP
BTM
BVM
BPM / BVM
Cumulative bloodflow
Effective Dialysis time

Fresenius Medical Care

UF
UFMENU
MENU11

Entering
Enteringthe
theUF
UFData
Data
GREEN
GREENcursor
cursorshows
showsyou
you
which
data
can
be
entered
which data can be entered
WHITE
WHITEhighlight
highlighttells
tellsyou
you
which
figure
you
can
enter
which figure you can enter
To
Tomove
movethrough
througheach
eachfield
field
press
the
arrow
press the arrow
up
up
down
down

May 2001

Isolated
Isolatedsequential
sequential
ultrafiltration
ultrafiltrationcan
canalso
also
be
performed.
be performed.
To
Toenter
enterthis
thisfield
fieldpress
press
arrow
across

arrow across 
Then
Thenfollow
followthe
thesame
same
process
as
for
entering
process as for entering
the
thedata
datafor
forUF.
UF.
Remember
to
Remember toenter
enterthe
the
Total
Goal
and
Time
Total Goal and Timeinin
the
theUF
UFvalues
valuesand
andthen
then
ONLY
the
values
for
ONLY the values for
the
theIsolated
Isolatedininthe
theISO
ISO
values
values

Fresenius Medical Care

UF
UFMENU
MENU22

When
Whenusing
usingaaUF
UFprofile
profile
select
the
profile
required
select the profile required
11- -66and
andthe
theappropriate
appropriate
graph
will
be
displayed
graph will be displayed
Max
MaxRate
Ratewill
willthen
thenbe
be
displayed.
This
is
the
displayed. This is thestart
start
value
of
the
ultrafiltration
value of the ultrafiltration
CHECK
CHECKtotoensure
ensurethat
thatthe
the
UF
Co-eff
of
the
dialyser
UF Co-eff of the dialyser
isissuitable
suitable!!!!

May 2001

Fresenius Medical Care

DIALYSATE
DIALYSATE MENU
MENU
Setting
Settingthe
theDialysate
Dialysate
concentration
concentration

Conductivity
Conductivitywindow
window
allows
us
to
move
allows us to move
ororcentre
centrethe
thealarm
alarm
guards
when
we
guards when we
change
changeany
anyofofthe
the
dialysate
parameters
dialysate parameters

May 2001

check
checkthe
themixing
mixingratio
ratio
concentration
of
the
concentration of thecanister
canister
concentration
required
concentration requiredfor
for
the
patient
the patient
bicarbonate
bicarbonatelevel
levelfor
forthe
the
patient
patient
dialysate
dialysatetemperature
temperature
dialysate
flow
dialysate flow
profile
profileififrequired
required++graphic
graphic
when
selected
a
start
value
when selected a start value
1mmol
1mmolgreater
greaterthan
thanthe
the
concentrate
level
will
concentrate level willbe
beshown
shown
This
can
then
be
increased
This can then be increased
according
according totothe
theDoctors
Doctors
prescription
prescription

Fresenius Medical Care

TREATMENT
TREATMENTMODE
MODESCREEN
SCREEN
Single
SingleNeedle
NeedleClick-Clack
Click-Clack
can
canbe
beused
usedininemergencies
emergencies
e.g.
when
one
of
e.g. when one ofthe
theneedles
needlesblows
blows
and
it
is
difficult
to
insert
a
second
and it is difficult to insert a second
upper
upperlimit
limitshould
shouldbe
belowered
lowered
totothe
desired
value
by
pressing
the desired value by pressingthe
the
- -minus
key
minus key
lower
lowerlimit
limitshould
shouldbe
beraised
raisedtotoaa
value
value20
20mmHg
mmHghigher
higherthan
thanthe
the
pressure
already
achieved
using
pressure already achieved usingthe
the
++key
key
then
thenmove
movethe
thecursor
cursortotothe
theOFF
OFF
and
switch
ON
again
by
using
and switch ON again by usingthe
the
++/ /- -key
key

May 2001

IfIfdesired
desiredyou
youcan
canalways
alwaysreturn
returntototwo
two
needle
dialysis
at
a
later
time.
needle dialysis at a later time.

Fresenius Medical Care

ALARM
ALARMLIMITS
LIMITSSCREEN
SCREEN

Here
Hereititisispossible
possibletoto
reposition
repositionand
andmake
makethe
the
alarm
guards
either
alarm guards either
wider
widerorornarrower
narrower
Arterial,
Arterial,
Venous
Venous
TMP
TMPLimits
Limits

Reinfusion
Reinfusion
allows
allowsusustotogive
givesaline
saline
during
or
at
the
end
during or at the endofof
the
thedialysis
dialysisby
by
OPENING
the
OPENING thealarm
alarm
guards
to
avoid
nuisance
guards to avoid nuisance
alarms
alarms
ItItisisactive
activefor
for3minutes
3minutes
ororititwill
automatically
will automatically
return
returntotonormal
normalstatus
statusifif
blood
bloodisisseen.
seen.
Needle
NeedleAdjustment
Adjustment
deactivates
deactivatesthe
thealarm
alarm
guards
for
arterial
guards for arterialand
and
venous
pressures
for
venous pressures for
33min.
min.totoallow
allowyou
youtoto
turn
turnorormanipulate
manipulatethe
the
needle
with
the
blood
needle with the blood
pump
pumprotating.
rotating.

May 2001

Fresenius Medical Care

SYSTEM
SYSTEMPARAMETERS
PARAMETERSSCREEN
SCREEN
Auto
Auto-On
-Onprogramme
programme
allows
you
allows youtotoselect
selectaa
cleaning
cleaningprogramme
programmeand
andthe
the
time
you
would
like
the
time you would like the
programme
programmetotocommence
commence
ininthe
morning,
the morning,sosothat
thatthe
the
machine
will
be
cleaned
machine will be cleanedand
and
ready
for
use
before
the
staff
ready for use before the staff
arrive
arriveininthe
theunit
unit

The
Thenumber
numberindicated
indicated
here
can
be
entered
here can be enteredusing
using
key
board
to
quickly
key board to quicklyenter
enter
the
data
for
the
Auto-On
the data for the Auto-On
programme
programme

Brightness
Brightnessallows
allowsyou
youtoto
dim
dimororbrighten
brightenthe
thelights
lights
on
the
machine
on the machine

Reset
Resetmeans
meanstotoerase
eraseall
allthe
the
data
you
have
in
the
UF
menu
data you have in the UF menu
during
duringthe
thetreatment.
treatment.
ALL
DATA
ALL DATAwill
willthen
thenbe
belost
lost
System
SystemTime
Timeand
andDate
Dateshould
shouldbe
bechanged
changedtotoyour
yourlocal
localtime
time
This
leaves
the
factory
with
the
Time
in
Germany
!!
This leaves the factory with the Time in Germany !!

May 2001

4008
116
111

73

75

87

63

109 7

24b

112

24

61

86

Fresenius Medical Care

30

97

41

76

29
92

54

31 32

43

33 34

2
66

114

150

6
9

68

89 88

151

26
c
115

77
35 36

37 38

85

78
21

65

84 115

74

125
94

98

95

10

12
a

90 b

91

22
23 94

May 2001

71

95 25
72

SD / TRAINING CENTER SCHWEINFURT

4008
111

73

87

116
7

109

112

24b

Fresenius Medical Care

63
3

75

61

86

24

30
97
76

8
29

41
43

114

33 34

31 32

92

54

150

9
68

66

89

26
88

35 36

77

78

37 38

115
21

65
B
99

10

149

125

95

94

12

148

25
100
123
119

P
P

137

124

104

134

135

138

23

136

131a

133
132

120 118

22
130

102

117

121
122

91
90
b

May 2001

131b

90
a

85

84

151

95

94

72

71

74

115

Theory of Operation of Balancing Chamber

Fresenius Medical Care

1st cycle:

31

32

33

34

BC2

BC1

from Patient

Balance Chamber

35

36

37

Fresh Dialysate

May 2001

38

21

Dialyser

to Patient

Theory of Operation of Balancing Chamber

Fresenius Medical Care

2nd cycle:
Spend Dialysate to Drain

31

32

33

34

BC2

BC1

from Patient
Balance Chamber

35

36

37

Fresh Dialysate

May 2001

38

21

Dialyser

to Patient

Closed System
Fresenius Medical Care

0 ml

10 ml

10 ml

May 2001

Closed System
Fresenius Medical Care

Spend Dialysate
to Drain

Balance Chamber
to Patient
Dialyser

from Patient
Fresh Dialysate
to Balance Chamber

May 2001

Closed System with UF

Fresenius Medical Care

Spend Dialysate
to Drain

Balance Chamber
Dialyser
to Patient

10 ml

from Patient

Fresh Dialysate
to Balance Chamber

UF Pump
10 ml
Ultrafiltrate to Drain

May 2001

Only the amount of fluid

removed by the UF pump
is removed from the patient.

Fill Program
Fresenius Medical Care

11st
st cycle:

May 2001

Fill Program
Fresenius Medical Care

22nd
nd cycle:

May 2001

Open System
Fresenius Medical Care

Pven

PDial
Dialysate Flow

Pump

TMP
electronic
TMP-Control

UFK = 4

ml
mmHg x h

Vacuum
Pump

W [kg] = TMP [mmHg] x UF K

Dialysate Flow
+ UF-Volume

TMP =

ml
mmHg x h

W
UFK x t

Dialysate
Preparation
System
May 2001
SD / TRAINING CENTER SCHWEINFURT

j:\sd\ch\folien\tpf_nma\ope_sy_e.cdr

x t [h]

Closed System
Fresenius Medical Care

Pven

PDial

1 6 0 0

TMP

timer
counter

UF-Pump
Drain

Dialysate
Flow

Flow- Pump

Fresh

1 ml

Old
UF Vol

fresh
Dialysate
from
Preparation
System

Advantage:
Very precise volumetric ultrafiltration control
Good for High-Flux Dialyzers
High effective & short time dialysis

May 2001
SD / TRAINING CENTER SCHWEINFURT

j:\sd\ch\folien\tpf_nma\clo_sy_e.cdr

Overview of Cleaning Programs

Fresenius Medical Care

End of Dialysis

Rinse
Rinse

PGM
RPGM 1:
1: --RPGM
R- endless
PGM 2:
2: --Rendless

Hot
Hot Rinsing
Rinsing
PGM
F-HR-CPGM 1:
1: --F-HR-CPGM
F-HR
PGM 2:
2: --F-HR
PGM
IHR
PGM 3:
3: --IHR

Dialysis
May 2001

Disinfection
Disinfection (Cleaning)
(Cleaning)
PGM
F-D-MPGM 1:
1: --F-D-MPGM
F-HDIS-MPGM 2:
2: --F-HDIS-MPGM
F-D-M-HRPGM 3:
3: --F-D-M-HRPGM
F-HDIS-M-HRPGM 4:
4: --F-HDIS-M-HRPGM
F-D(F)-MPGM 5:
5: --F-D(F)-M-

4008
116
111

73

75

87

63

109 7

24b

112

24

61

86

Fresenius Medical Care

30

97

41

76

29
92

54

31 32

43

33 34

2
66

114

150

6
9

68

89 88

151

26
c
115

77
35 36

37 38

85

78
21

65

84 115

74

125
94

98

95

10

12
a

90 b

91

22
23 94

May 2001

71

95 25
72

SD / TRAINING CENTER SCHWEINFURT

Valve Sequences in Cleaning Programs

Fresenius Medical Care

In cleaning programs V91 opens with each BC cycle for 0.5 sec.
in order to clean the rinse chambers (90).
The Con. & Bic. Pumps are doing 1 stroke per BC cycle.
RINSE: (F, R, C)
Normal Cycles (18) : Flushing out
- V41 controlled by Float Switch
- BC cycled like in dialysate mode
- V24, V24b, V30, V87 open
- V26, V43, V84, V86 closed
May 2001

Valve Sequences in Cleaning Programs

Fresenius Medical Care

Fill Cycles (2) :

- BC cycled like in FILL PROGRAM
- V26, V43, V86 open
- V24, V24b, V30, V41, V84, V87 closed
- ASP runs
- UF
-Pump runs (max. frequency)
UF-Pump
MANDATORY RINSE: (M)
- V43 permanent open
- UF
-Pump runs permanent (max. frequency)
UF-Pump
May 2001

Valve Sequences in Cleaning Programs

Fresenius Medical Care

RECIRCULATED CLEANING PROGRAMS: (D, HDIS, HR)

GENERALLY:
-

V86 open
V87 closed
V43 open
UF-Pump runs (max. frequency)

NORMAL CYCLES (D:18 / HDIS,HR:13):

-

BC cycled like in dialysis mode

V24, V24b, V30 open
V26, V41, V84 closed

May 2001

Valve Sequences in Cleaning Programs

Fresenius Medical Care

FILL CYCLES (2):

-

May 2001

BC cycled like in FILL PROGRAM

V26 open
V24, V24b, V30, V41, V84 closed
ASP runs

4008
116
111

73

75

87

63

109 7

24b

112

24

61

86

Fresenius Medical Care

30

97

41

76

29
92

54

31 32

43

33 34

2
66

114

150

6
9

68

89 88

151

26
c
115

77
35 36

37 38

85

78
21

65

84 115

74

125
94

98

95

10

12
a

90 b

91

22
23 94

May 2001

71

95 25
72

SD / TRAINING CENTER SCHWEINFURT

Preparation for Chem. Disinfection Programs 14

Fresenius Medical Care

Prior Aspiration of Disinfectant

The given values are based on a standard machine. For machines
including Diasafe or On-Line-HDF the vol. of disinfectant are increased!
After Rinsing Clean (F) is finished:
1. Closing of the BC valves with the current increase pulse
2. Waiting for the floater to reach up-position
3. V41-control disabled. V26, V43, V87 & BC fresh fluid valves open,
degassing pump delivers fluid with reduced speed from the heater block,
until the lower switch point of the floater is reached.
May 2001

Preparation for Chem. Disinfection Programs 14

Fresenius Medical Care

4. 1 BC cycle level in 66 c: 30ml below lower switch point

5. V26, V87 & BC fresh fluid valves open, V43 closed,
degassing pump off, UF-Pump: 4 strokes
Level: 34ml below lower switch point
6. V84, V86 open, UF-Pump: 50 strokes = 50ml disinfectant
(Dilution 1:25), the conductivity is monitored by the sensors 115:
If there is no conductivity detected after 24 strokes, the process
is stopped: alpha display DISINFECTANT EMPTY ?
After 50 strokes of the UF-Pump the floater must be in up position.

May 2001

Preparation for Chem. Disinfection Program 5

Fresenius Medical Care

Prior Aspiration of Disinfectant

The given values are based on a standard machine. For machines
including Diasafe or On-Line-HDF the vol. of disinfectant are increased!
After Rinsing Clean (F) is finished:
1. Closing of the BC valves with the current increase pulse
2. Waiting for the floater to reach up-position
3. V41-control disabled. V26, V43, V87 & BC fresh fluid valves open,
degassing pump delivers fluid with reduced speed from the heater block,
until the lower switch point of the floater is reached.
May 2001

Preparation for Chem. Disinfection Program 5

Fresenius Medical Care

4. V26, V87 & BC fresh fluid valves open, V43 closed,

degassing pump off, UF-Pump: 23 strokes = 23ml
5. After the disinfectant is connected the aspiration is done by use of
the acid pump.
32 strokes of acid pump = 37ml disinfectant (Dilution 1:34)
6. After aspiration the floater must be in up-position.

May 2001

4008 Hydraulic Functions in Cleaning Programs

Fresenius Medical Care

With
With Diasafe
Diasafe (in
(in round
round brackets)
brackets)
&
& On-Line-HDF
On-Line-HDF (in
(in square
square brackets)
brackets)
Rinse

HR/HDIS 2 & 4

DIS 1 & 3

DIS 5

Flow [ml/min]

600

450

600

600

Flow Pump [ml/min]

600

600

720

720

BC Switch Delay [s]

0.5

0.5

250

250

250

250

18x normal /
2x Fill + ASP on

13x normal /
2x Fill + ASP on

18x normal /
2x Fill + ASP on

18x normal /
2x Fill + ASP on

In Fill Cycle
Mandatory Rinse:
continuous

continuous

continuous

continuous

Dead Time [ms]

BC Cycles
Recirculation
UF-Pump 4000ml/h

May 2001

4008 Hydraulic Functions in Cleaning Programs

Fresenius Medical Care

Vol. of Disinfectant [ml]

Disinfection Dilution
Degassing Pump Speed Reduct.
Temp. [C]

Temp. Limit [C]

End of prg.
Rinse Chamber Evac.
Conc. P. + Bic. P.
May 2001

Rinse

HR/HDIS 2 & 4

DIS 1 & 3

DIS 5

- /50
(66)
[82]

50
(66)
[82]

UF-Pump

UF-Pump

37
(49) [61]
Conc. Pump
32 strokes
(42) [52]

- / 1:25
by 6V

1:25
-

1:34
-

37

84
87
at NTC 3

37

37

33.5 / 41

78.5 / 90
Timer start 80

33.5 / 41

33.5 / 41

10 strokes

10 strokes

10 strokes

10 strokes

4008
116
111

73

75

87

63

109 7

24b

112

24

61

86

Fresenius Medical Care

30

97

41

76

29
92

54

31 32

43

33 34

2
66

114

150

6
9

68

89 88

151

26
c
115

77
35 36

37 38

85

78
21

65

84 115

74

125
94

98

95

10

12
a

90 b

91

22
23 94

May 2001

71

95 25
72

SD / TRAINING CENTER SCHWEINFURT

Dialysate Alarms: Conductivity & Temperature

Fresenius Medical Care

Optical Alarm (continuous)

Audible Alarm
Bypass (no external flow: V24 closed, V26 open)
No Storage (self resetting)

May 2001

Upper Temperature Alarm

Fresenius Medical Care

All consequences like the other

Dialysate Alarms as before
Additional the heater is controlled OFF (40 C)
By actual display value exceeding the display range:
Heater Relay opens (41 C)

May 2001

Flow Problems - Water Alarm

Fresenius Medical Care

2 conditions:
1.

The floater stays in position DOWN

(No water available)

Reactions: After 6 seconds:

Alpha display shows: WATER ALARM
Heater OFF
Balancing Chamber cyclings stop
Alarm
May 2001

Flow Problems - Water Alarm

Fresenius Medical Care

2.

The floater stays in position UP for more than

30 seconds
Reactions:
Heater OFF
Balancing chamber cyclings continue
Alarm

May 2001

Flow Problems - Flow Alarm

Fresenius Medical Care

Condition: No current increase impulse within 12 seconds

Reactions:
Balancing chamber cyclings done by EIGENTAKT
Heater OFF
Alarm

May 2001

During a cleaning program - Upper Flow Alarm

Fresenius Medical Care

Condition: The flow increased to more than 1000ml/min

Reactions:
Program stops
Alarm

May 2001

Flow - Troubleshooting Recommendations

Fresenius Medical Care

Check the pressures in the hydraulics

Watch the drain line (fluid amount per BC cycling)
Observe the valve sequences with the test box

May 2001

Blood Alarms
Fresenius Medical Care

Optical Alarm (1st alarm flashing,

following alarm continuous)
Audible Alarm
Blood Pump Stop
Venous Line Clamp Closed
UF-Pump Stop
Alarm Storage (reset by DIALYSIS START)
May 2001

TMP Alarm
Fresenius Medical Care

All consequences like the other Blood Alarms as before

Additional the Closed System opens to atmosphere
(V43 opens during DEAD TIME)

May 2001

LP631 (CPU1) DIP Switch Array 1

Fresenius Medical Care

May 2001

LP631 (CPU1) DIP Switch Array 2

Fresenius Medical Care

May 2001

LP632 (CPU2) DIP Switch Array 1

Fresenius Medical Care

Must
Must be
be OFF
OFF

May 2001

Must
Must be
be OFF
OFF

LP632 (CPU2) DIP Switch Array 2

Fresenius Medical Care

May 2001

Miscellaneous
Fresenius Medical Care

May 2001

4008
Filling
Filling Procedures
Procedures
BC
BC off
off
V91
V91 opens
opens
Pump
Pump 29
29

1300-1800ml/min
1300-1800ml/min
Pressure
Pressure (134)
(134)
>> +130mbar
+130mbar

V91
V91 closed
closed
BC
BC starts;
starts;
Pump
Pump 25
25 starts
starts
Pressure
Pressure (134)
(134)
<< +100mbar
+100mbar

V91
V91 opens
opens at
at
dead
-time of
dead-time
of BC
BC

24

30
97
76
43

54

150

9
68

66

89

26
88

121
122

35 36

78

37 38

115
21

65
125

95
12

148

124

22
130
137

134

135

138

23

136

131a
133
132

120 118

91
90
b

104

May 2001

85

84

77

102
P
P

151

biBag
biBag

131b

123

114

33 34

31 32

92

100

117

8
29

41

25

119

Medical Care
75

61

86

10

90
a

112Fresenius

24b

63

94

149

116
109

B
99

111

73

87

95

94

72

71

74

115

Last 3-min Rinse Test

Fresenius Medical Care

During
During the
the last
last 33 min
min of
of
the
the mandatory
mandatory rinse
rinse program
program

DIP
DIP switch
switch 77 of
of DIP
DIP array
array 22 of
of LP631
LP631
set
set to
to ON
ON

May 2001

4008
111

73

87

116
7

109

112

24b

Fresenius Medical Care

63
3

75

61

86

24

30
97
76

8
29

41
43

114

33 34

31 32

92

54

150

9
68

66

89

26
88

35 36

77

78

37 38

115
21

65
B
99

10

149

125

95

94

12

148

25
100
123
119

P
P

137

124

104

134

135

138

23

136

131a

133
132

120 118

22
130

102

117

121
122

91
90
b

May 2001

131b

90
a

85

84

151

95

94

72

71

74

115

Last 3-min Rinse Test - 2

Fresenius Medical Care

May 2001

Diagnostics - Applications
Fresenius Medical Care

Prerequistes:
Water Supply present
Test Box connected
1.

Clean V84 (disinfectant deposits, crystals)

Caution! In this application therell be outflow from the
disinfectant connector

May 2001

Enable FLOAT SWITCH FL_SWITCH_EN

Open V35, V31, V26, V84
Run degassing pump STOP_EP

Diagnostics - Applications
Fresenius Medical Care

2.

Check the Closed System for tightness:

2.1

With Negative Pressure

- Connect an external dialysate pressure gauge
- Eliminate air from the hydraulic unit by selecting
menu point CALIBRATION / UF-Pump (Ver 1):
machine performs FILL PROGRAM (flow must be on)
- Open V24, V24b, V30, V87

May 2001

Diagnostics - Applications
Fresenius Medical Care

- Create a dialysate pressure of app. -500mmHg by

the ASP
- Observe the dialysate pressure
to be stable for 3 min.
- Max. pressure change: +40mmHg
- If pressure stable, the closed system is tight

May 2001

Diagnostics - Applications
Fresenius Medical Care

2.2

With Positive Pressure

- Connect hydraulic pressure gauge to measure
point C (Flow Pump outlet)
- Eliminate air from the hydraulic unit by selecting
menu point CALIBRATION / UF-Pump (Ver 1):
machine performs FILL PROGRAM (flow must be on)
- Enable float switch

May 2001

Diagnostics - Applications
Fresenius Medical Care

- Open V35, V31, V24, V24b, V87

- Run degassing pump
- Close V35, V31
- If pressure on the hydraulic pressure gauge is stable,
the closed system is tight

May 2001

Diagnostics - Applications
Fresenius Medical Care

- Check heater exchanger, V86, V87

- Close V87
- Open V43
- Pressure stable ?

May 2001

Diagnostics - Applications
Fresenius Medical Care

3.

Check Balancing Chamber Valves for tightness:

- Connect an external dialysate pressure gauge
- Eliminate air from the hydraulic unit by selecting
menu point CALIBRATION / UF-Pump (Ver 1)

3.1

Check the fresh dialysate valves:

- Open float switch
- Open V24, V24b, V30, V87

May 2001

Diagnostics - Applications
Fresenius Medical Care

- Run degassing pump

- Create a dislysate pressure of app. -500mmHg by
the ASP
- Test of V35:
- Open V31
- Observe the dialysate pressure to be stable for 3 min.
- Max. pressure change: +40mmHg
- If pressure is stable, V35 is tight
- Close V31
May 2001

Diagnostics - Applications
Fresenius Medical Care

- Test of V37:
- Open V33 ...
- Test of V31:
- Open V35 ...
- Test of V33:
- Open V37 ...
May 2001

Diagnostics - Applications
Fresenius Medical Care

3.2

Check the spent dialysate valves:

- Connect an external dialysate pressure gauge
- Open V24, V24b, V30, V87
- Run flow pump
- Open V43 to reduce dialysate pressure
- Close V43

May 2001

Diagnostics - Applications
Fresenius Medical Care

- Test of V36:
- Open V32
-

Observe the dialysate pressure to be stable for 3 min.

Max. pressure change: -40mmHg
If pressure is stable, V36 is tight

- Close V32

May 2001

Diagnostics - Applications
Fresenius Medical Care

- Test of V38:
- Open V34
- Test of V32:
- Open V36
- Test of V34:
- Open V38 ...
May 2001

TSC & Maintenance Checklist

Fresenius Medical Care

May 2001

TSC & Maintenance Checklist

Fresenius Medical Care

May 2001

TSC & Maintenance Checklist

Fresenius Medical Care

May 2001

TSC & Maintenance Checklist

Fresenius Medical Care

May 2001