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Author
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Topic: High Conductivity
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Greg
unregistered
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posted 09-26-2002 01:21 AM
 
Still having problems with the high conductivity alarm. One tx the alarm goes off a lot, and the next tx it may not go off at all, or goes off in the last few minutes. The machine has been serviced and still the high cond. alarm goes off. The techs say it doesn't go off all day until I come on. I am on a straight 140 sodium. I found out that the two patients on the earlier shifts are on a straight 144 sodium. The bicarb is mixed by a machine. If the alarm doesn't go off all day, what could be different about my peramiters that could be setting it off?
IP: 209.240.198.61 |
additional info
unregistered
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posted 09-26-2002 10:57 PM
Need some additional info. What type of machine? Is the bicarb mixed in jugs or actually mixed by the dialysis machine (like a Bicart)? If it is mixed in the back by staff, the strength could be varing causing the alarm. How high is the conductivity going to cause the alarm? what are the limits set at? There should be a "tolerance" built in to allow for variances such as bicarb strength, pump calibrations, etc. Please give us some more info. thanks
IP: 64.12.96.233 |
Greg
unregistered
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posted 09-27-2002 03:23 AM
I am on a Fresenius 2008H. The tech told me the bicarb is mixed by a machine in the back. I will try to get more specifics next time I go to tx. With 140 sodium the machine will alarm if the conductivity goes past 14.5. The limits are set for 13.5, 14.0, 14.5.
IP: 209.240.198.61 |
additional info 2
unregistered
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posted 09-29-2002 12:23 AM
Here are some other things to check; what potassium is your bath compared to other patients, on the H machine the staff should be setting the machine for what type of "bath" (dialysate) you run on. If they are not changing that it could be causing a problem. The fact that it is climbing so high is suspect. Normally the limits would be set from 13.5 - 14.5 with ideal being 14.0 (sodium of 140), that is to allow for the variances I discussed in the first posting. Also check to see if this is the same machine (most facilities have a machine number on the front). The fresenius machines have a very straight forward proportioning system, when you go into dialysis mode the pumps (acid and bicarb) start stroking and basically deliver a set amount of each solution to be mixed with water to make the dialysate. If it is the same machine and the conductivity screen is set for the right concentrate then I would request another machine, while looking at the conducivity screen also check the bicarb setting and make sure it is correct for your prescription. One last piece of info needed does the conductivity vary or does it go high and stay high? Please post some more info.
IP: 205.188.208.165 |
Greg
unregistered
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posted 09-29-2002 02:08 PM
At my next tx, I will observe if they are changing the K and the bicarb from the previous patient to the correct settings for me. I know I have double checked this with them before, so I would think they are. But to be sure, I will definitely double check it from now on. I am definitely on the same machine each tx. The reason I know this is because I have dialyzed on other machines that have a conductivity of less than about 14, and I can not dialyze at that conductivity level or I get extremely uncomfortable symptoms starting the last hour and a half. I have read info on this subject before, that a too low conductivity causes crampy symptoms. So, I specifically asked that I be kept on this machine since the conductivity range it is calibrated for runs higher. I have no symptoms of crampiness on this machine. The lowest it runs is 14.2, but then at a certain point it will get up to 14.5, and then at some point in the tx it will go above 14.5 setting off the alarm. Sometimes this happens a few brief times and other times it is more frequent. And then like last tx, it did not alarm a single time. Also, the techs hit the mute button and the conductivity either drops back down for a short time or a longer time. Every tx is different.
IP: 209.240.198.61 |
Nova
Member
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posted 09-30-2002 10:35 AM
K values have little effect on conductivity. Mostly it is governed by Acid and Bicarbonate proportioning. Sorry I cannot be of more help.
IP: 199.175.65.31 |
JP
unregistered
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posted 10-01-2002 08:26 AM
K value have very little effect on conductivity. Mostly is governed by sodium (for about 95%)contained in acid and bicar concentrates. Adequacy hemodialysis means PH dialysate 7.3-7.5 and conductivity setted to 14.3-14.5 mS/cm and very stable flow dialysate.
If PH = 7.00 that means bicar is too low (if cond is really 14.3-14.5) and have to set lower acid conductivity to increase bicar conductivity.
That is my opinion...but not only mine 
Hope this help
IP: 172.182.172.31 |
gizzman
unregistered
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posted 10-02-2002 07:35 PM
Have a main. tech. observe the DAC for the flow pump in the troubleshooting screen. It should only fluctuate a little. If it fluctuates for than 5 I would check the gearhead of both the flow pump and dearation. I had this happen to me and found the magnet of the dearation gearhead cracked.
IP: 64.26.163.142 |
Greg
unregistered
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posted 10-03-2002 05:17 PM
My doctor wants to solve the problem by putting me on another machine (I don't want this unless another machine runs an adequate conductivity of 14.2 or above like my current machine does, as lower conductivity gives me highly uncomfortable crampy conditions), and my RN wants to solve the problem by upping my sodium to 142 or 141 (she thinks that will prevent the high conductivity alarm from going off, but I don't know if that is in my best interest, because when I dialyzed at 144 sodium once because the setting was not changed to 140 from the previous patient, I experienced excessive thirst). I am hoping to be able to present this discussion of the problem to the biotech. The question I still have is, why does the high conductivity alarm only go off on me and no other patient???
IP: 209.240.198.61 |
Greg
unregistered
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posted 10-05-2002 10:48 AM
At my last tx the high conductivity alarm did not go off at all. The conductivity stayed steady at 14.3 the entire tx. The tx before last, the alarm went off one time at the beginning of the tx and did not alarm again the entire tx. I hope the machine has decided to repair itself lol, because so far no one has approached me with the solution.
IP: 209.240.198.61 |
Greg
unregistered
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posted 10-08-2002 10:57 AM
To update again, I had another tx and for the 3rd time now, the high conductivity alarm did not go off. The conductivity stayed steady at 14.2 this time. I have noticed that as of the first tx that the alarm stopped going off, my appetite began to improve following the tx. I don't recall if I mentioned it, but ever since this problem started with the high conductivity alarm, I've had a noticeable loss of appetite for the meal when I get home from dialysis. I'm ok the next day, but can not eat a thing after dialysis. Well the appetite picked up again which shows me that the alarms had really affected me. I've been like this for a month or more which is how long the alarms have been occuring. Now that the alarms have suddenly quit going off for 3 txs in a row, can anyone venture a guess as to what the problem has been?
IP: 209.240.198.61 |
just a thought
unregistered
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posted 10-08-2002 10:07 PM
It is possible there was a temperature problem with the machine. If temperature was displaying as 37 but was actually say 36 that would change your conductivity(cond is temp compensated). did you notice if your temp display was stable. Also find out if machine had any service recently. Temperature display accuracy is supposed to be checked quarterly.
IP: 63.26.7.100 |
gizzman
unregistered
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posted 10-10-2002 01:41 PM
It doesn't make sense the connection between your appetite and the high conductivity alarms. The high alarms indicate a problem with the machine and when the conductivity goes beyond the upper or lower limit it goes into alarm and the machine bypasses the dialyser until the conductivity falls within the limits.
Are you on a fixed base sodium ie 142? As far the mixing of the bicarb, I have the same equipment for mixing bicarb in bulk. When the solution is prepared the conductivity is checked and must be within a certain tolerance, 50mS +/- 2mS. I spoke with one of our most experienced dialysis nurses and she sees no connection between conductivity alarms and loss of appetite. She did indicate if you are being under dialysed thatcould possibly cause this. Did you have so many alarms that you were not dialysed enough?
IP: 4.17.129.194 |
Greg
unregistered
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posted 10-10-2002 03:22 PM
My string of luck ended at my last tx. With just an hour to go the high conductivity alarm went off. It went off 2 more times before txs end causing my time to be extended 4 minutes. I observed that I began to feel uncomfortable symptoms in my body as soon as the alarms began going off, whereas previous to that I felt fine and was having a comfortable tx. You asked if I am on a fixed sodium. I am on a straight 140 sodium. Regarding the RNs comments, my understanding is that when the conductivity alarm keeps going off it compromises the tx. My kt/v dropped from 1.9 to 1.3. So yes, I had a loss of appetite directly related to the conductivity alarms going of anywhere from 2-6 times a tx which have compromised my txs. I haven't been able to talk to the bio tech yet regarding the two suggested repair solutions (gear and temp.) suggested in this discussion (don't even know if I will be permitted to talk to him. I requested the RN to tell him that I wanted to speak to him, myself, but she acted like I wouldn't be able to speak to him. She wanted me to up my sodium to 142 or 141 and said that would probably solve the problem. I told her that might be so, but I wanted to talk to the biotech (and the doctor) before changing my sodium level. I couldn't tell if what she was offering was a valid solution or just a quick fix not in my best interests. Will ask the doctor next time he rounds to put me in touch with the biotech. I was allowed to talk to the biotech at a previous unit I was at. I don't know if they are going to permit it here). Still holding out hope that this tx problem will be resolved...
IP: 209.240.198.61 |
Kevin Abrahams
unregistered
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posted 10-10-2002 05:24 PM
It seems like you have a eletronic problem.It seems that the control board heats up after a long day and that the board alouse the acid pump start to run fast and then slows down again.It could also be that the bicarb could be losing Co2.It could also be that the bicarb is causing the pumps to run iratice.
Hope this help.
IP: 196.2.33.11 |
qwer
New Member
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posted 10-24-2002 11:43 AM
you should check on the deairation and flow motor of the machine. Maybe is time to get the carbon brush of the motor change. i faced this problems before for few times. Is really works.
IP: 202.188.230.83 |
Greg
unregistered
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posted 01-16-2003 05:34 PM
Update--Asked several times to talk to the repair tech, but no such luck. Have continued to have days where the high conuctivity alarm goes off frequently, and then other days where it doesn't go off at all. Finally, I may have found the source of the problem. A staffer ran over to my machine to shut off the alarm. He revealed to me that the reason the high conductivity alarm goes off on only my tx (I run at 140 sodium) is because the rest of the patients run at 144 sodium due to insurance requirements and the machine is calibrated for their rate, not mine (I'm the only one on different insurance). Can someone give me a technical explaination for how on a Fresenius 2008H the calibration is set for the other patients 144 rate so that it does not accept my rate of 140 without triggering the alarm? Because how are machines calibrated in units where everyone runs at a different rate of sodium? Also, please take into account that as the machine is currently calibrated, the conductivity runs 14.3 - 14.5 and I feel very well at this level. But when I have been on a machine that shows a conductivity of less than 14.3, I am very symptomatic.
IP: 209.240.198.61 |
mgunsolus
Member
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posted 01-17-2003 12:34 PM
Greg,
What is the Bicarb set at in your machine? This to will effect the conductivity high alarms.
IP: 208.46.13.226 |
Greg
unregistered
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posted 01-17-2003 02:45 PM
Bicarb is 38.
IP: 209.240.198.61 |
TD
unregistered
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posted 01-17-2003 09:03 PM
the fact that you feel uncomfortable as soon as the alarm goes off tells me that you are experiencing a nervous response to the alarm, and not to the change in condo. As stated before, if the machine alarms, the dialysate is bypassed around the dialyzer, and it would take a few minutes for the "bad" dialysate to get downstream in the machine to your dialyzer. I would propose that the machine is fine, sometimes alarm limits are not calibrated perfectly.
IP: 24.51.172.96 |
Tailor
unregistered
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posted 01-17-2003 10:23 PM
Just a omment to people who earlier posted about potassium having little effect on conductivity. In purely chemical terms the potassium chloride is a minor player, being outranked by the NaCl by 50 to 1 mEq/L, it is the most common difference between baths. As well, it has a higher conductance factor, so you'll get spikes of 0.1 to 0.2 ms/cm. While this doesn't sound like a lot, you have to remember that when you raise the sodium, you're also raising the amount of potassium, and so it will have a proportionally higher effect on the final conductivity.
IP: 167.83.10.20 |
Chuck W
Member
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posted 01-17-2003 11:52 PM
Tailor,I am far from a chemist but, sodium and potassium each have a single + charge, how can potassium have a higher conductance factor? It just dosnt make sense.
IP: 64.12.96.233 |
JP
unregistered
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posted 01-18-2003 04:09 AM
Hi all,Greg said:
>Bicarb is 38. How has to be the PH dialysate ?
IP: 172.196.166.132 |
Chuck W
Member
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posted 01-18-2003 02:16 PM
Greg,Now you have given us enough information to make a pretty good educated guess. You say that you run on a 140 Na while everyone else runs on 144. This leads me to think it would be one of the following: Every dialysate formula used is supposed to be programmed into the 2008H machine. The machine then calculates what the conductivity should be (TCD) and bases the alarm limits on that calculation. 1. The machine tech may not have your formula programmed in. 2. Your PCT is not selecting the correct formula. 3. Your PCT is not connecting your machine to the correct acid concentrate. Since you state that some treatments there are no alarms, I would lean more towards #2 or #3. Also, in my 22+ years in this field I have never heard of an insurance company dictating a sodium level. More likely would be that you have a different Dr than most of your fellow patients.
IP: 152.163.189.98 |
GTSCSS
Member
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posted 01-20-2003 02:34 PM
One more possibility is an intermittent flow error. This may cause intermittent problems with the conductivity but would also cause temperature problems. Ultimately, I agree with Chuck because his causes seem much more likely. Perhaps you could ask them to see the conductivity screen to make sure everything is set right? If they're doing what they're supposed to they shouldn't have a problem with it. I would rule out the bicarb being a problem because you say none of the other machines are having problems. quote:
Originally posted by Chuck W:
Greg,Now you have given us enough information to make a pretty good educated guess. You say that you run on a 140 Na while everyone else runs on 144. This leads me to think it would be one of the following: Every dialysate formula used is supposed to be programmed into the 2008H machine. The machine then calculates what the conductivity should be (TCD) and bases the alarm limits on that calculation. 1. The machine tech may not have your formula programmed in. 2. Your PCT is not selecting the correct formula. 3. Your PCT is not connecting your machine to the correct acid concentrate. Since you state that some treatments there are no alarms, I would lean more towards #2 or #3. Also, in my 22+ years in this field I have never heard of an insurance company dictating a sodium level. More likely would be that you have a different Dr than most of your fellow patients.
IP: 65.215.145.67 |
patient
unregistered
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posted 01-23-2003 10:32 PM
Chuck and GTSCSS,
I have double checked the screen numerous times to make sure everything is set properly, and always check the acid concentrate. I wonder if I'm leaving anything out..sodium 140, bicarb 38, 2K, Ca2.5? Can you say more on how everyones dialysate formulas are programmed in by the machine tech? Both the cond. and the temp fluctuate a point or two up and down throughout the tx..is that normal?I was told again the machine tech would call so I can present the suggested repair options to him, but did not hear from him again.
IP: 209.240.198.61 |
In a position to know
unregistered
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posted 01-24-2003 07:48 AM
quote:
Originally posted by patient:
Chuck and GTSCSS,
I have double checked the screen numerous times to make sure everything is set properly, and always check the acid concentrate. I wonder if I'm leaving anything out..sodium 140, bicarb 38, 2K, Ca2.5? Can you say more on how everyones dialysate formulas are programmed in by the machine tech? Both the cond. and the temp fluctuate a point or two up and down throughout the tx..is that normal?I was told again the machine tech would call so I can present the suggested repair options to him, but did not hear from him again.
Ask for an Operator's manual for the machine. The information you seek is in the manual.
IP: 209.244.86.64 |
Anxiety
unregistered
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posted 01-24-2003 06:41 PM
We are here to help and discuss issues...someone must draw the line on this. Reading this on going post, suggests this patient has sevre anxiety issues. A "few minutes" worth of alarms will not dramatically affect the K/tv or appetite. This patient should be discussing his issues with the physician not a "Tech" message board. My suggestion is not to discourage patients from asking "machine related" questions...but to put them at ease...no need for fear and increased anxiety...this leads to "mixed messages" by carrying on like this. Be more responsible and use common sense.
IP: 12.91.36.27 |
What ?
unregistered
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posted 01-25-2003 07:34 AM
quote:
Originally posted by Anxiety:
We are here to help and discuss issues...someone must draw the line on this. Reading this on going post, suggests this patient has sevre anxiety issues. A "few minutes" worth of alarms will not dramatically affect the K/tv or appetite. This patient should be discussing his issues with the physician not a "Tech" message board. My suggestion is not to discourage patients from asking "machine related" questions...but to put them at ease...no need for fear and increased anxiety...this leads to "mixed messages" by carrying on like this. Be more responsible and use common sense.
What ??
SEVERAL reply posts have implored "Greg" to speak with his nephrologist while attemping to provide answers based on the information "patient"posts here. The folks who have responded ARE trying to help "Greg". You are correct only in that this forum could provide insight, not resolution to problems presented by posters.
IP: 209.244.87.101 |
mgunsolus
Member
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posted 01-25-2003 08:36 AM
Greg,
What is the specific gravity of your acid and bicarb solution? When we have conductivity problems this is the first thing my boss has me check.This can have a big change in the conductivity on the machine. I would guess to say that one of them is at the high end of the limits. Just a thought.
IP: 208.46.13.226 |
independent technician
unregistered
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posted 01-26-2003 03:20 PM
Greg,
I read this for more then three months, and I am sure you will not get any help from this forum, you can only become more confused.
What I do not understand is this conversation about conductivity. In one thing only I can be sure: If your machine can not maintain steady conductivity, it really does not matter who was on the machine before you. If your standard Sodium is set to 140 then it must be 140 without alarms, end of discussion. The same is if standard is 145 for instance.
So, change your machine or change your maintenance technician (person who is responsible for the machines)
Your service technician is the only one who can verify if the problem is inside or outside of the machine, so ask him.
Finally, machine is either working good or not.
It seems to me, as an independent spectator, that nobody has really tried to get into the heart of the problem yet.
Wish you luck
IP: 213.191.150.46 |
Greg
unregistered
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posted 01-26-2003 04:32 PM
Anxiety,
What makes you think I haven't dicussed this problem with my doctor? He was the first person I discussed it with. I have never seen him touch my machine so I don't think he knows how to operate it. He seems to be expecting someone else to take care of the problem. I also think, in his opinion which he has expressed to me, he feels that as long as I get "adequate" passing dialysis, it doesn't matter if the tx is compromised. Before my machine became problematic, I had steady kt/vs of close to 2.0. Then they became eratic going down as low as 1.3. Each month now the kt/v is up and down depending on how much the cond alarm goes off. Why would you not want me to get info here to solve the problem? I wouldn't have to be here at all if my doctor and staff would solve the problem. I shouldn't even have to be the one to solve the problem..that is their job.Independent,
Yes, its obvious to me there's a problem. I don't ask for the machine to be changed, because despite the cond. problem, I feel well on this machine. When I have had a machine with conductvity lower than 14.2, in almost all instances, I have become very symptomatic the last hour. And if you've read the previous posts, I have requested to meet with the machine tech so I can hear what he has to say and present the suggested repair solutions to him, but the head nurse has told me at leaste 3 times now that he will call me and then I don't hear from him. I'm sure there is a simple explanation for what's wrong with the machine, but won't know until I have the opportunity to talk with the tech. I would of liked the problem solved 3 months ago, but as you can see, through no fault of my own, I have not gotten service yet.
IP: 209.240.198.61 |
independent technician
unregistered
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posted 01-26-2003 06:50 PM
Well, Greg I must admit that I do not understand what does it mean: machine with 14,2 or machine with 14,5?
There is no machine which specifically has "14,2" It is the operators duty to set machine ( acid, bic, conductivity, temp, profil etc ) according to patient needs and prescription by doctor. If anybody says: this is machine which runs with 14,2, it is simply a lie, or machine with failure. Machines are designed with possibility of changing parameters, even when treatment is in progress. So, there is no "14,2" machines or "14,5" machines.
IP: 213.191.135.199 |
Greg
unregistered
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posted 01-26-2003 10:30 PM
Independent tech,
I have the same machine each tx. The operator sets the parameters according to my doctors prescription. That done, the screen will display a conductivity of 14.2-14.5 throughout the tx. The problem is, the cond. will rise to 14.6 and at that point the high cond alarm goes off.
IP: 209.240.198.61 |
Greg
unregistered
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posted 01-26-2003 10:42 PM
mgunsoius,
By specific gravity of the acid and bicarb, do you mean density? What do you do in order to check it?
IP: 209.240.198.61 |
jtech.
unregistered
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posted 01-26-2003 10:49 PM
Greg,
AS I read your complaints regarding High conductivity on the H machine, theree are a few things that I need to question.
1. What is the proportioning of the dialyis machines in your unit. eg. 45X
2. All dialysis machines' parameters are supposed to be pre-set according to the bath (1k, 2k, 3k)
3. when time comes for your treatment, the machine should be set according to prescribed concentrate. (for a 2k the range should be 13.5 - 14.5)
4. ask what is the proportioning, when the techs. make the bicarb. or have them give you factory mixed gallons of bicarb.
IP: 172.139.158.134 |
mgunsolus
Member
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posted 01-27-2003 11:36 AM
Greg,
All they will have to have is a hydrometer to measure the specific gravity. Example: When we make our bicarb one of the test we do is a specific gravity reading on it.We use Rockwell Medical Technologies bicarb powder and our specific graviy parameters are 1.062-1.065. If the solution does not meet this requirement the batch is dumped and new is made. The same applies for our acid. We make our on acid on site.Cost Effective so they say.
IP: 208.46.13.226 |
Anxiety
unregistered
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posted 02-01-2003 03:35 PM
Greg, your K/tv going up and down, could also be related to your renal failure progressing or perhaps diet. Plus, your staff should run your entire treatment regardless of alarms. Your machine has two "clocks/timers", subtract the two equals how long the machine has been in bypass, which equals potentially lost dialysis time. Your staff should realize this and run your whole treatment. But again, if the alarm span is only a few minutes once a week..than I would look at your diet...and perhaps have the Dr. order a 24hour urine clearance test and this will show how your disease is progressing. It is easy to blame a machine or a person.....lets get the whole story here.
IP: 12.91.37.84 |
Greg
unregistered
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posted 02-01-2003 11:02 PM
jtech,
I asked the techs and RNs what the proportioning of the machine is and none of them could answer the question. I also asked about the proportioning of the bicarb and no luck there either. I won't be able to answer these questions until I can talk to the machine tech. I would prefer using factory mixed solutions as I think they're safer, but I doubt that I could request it as it wouldn't be cost effective.mgunsoius,
Likewise, unable to find out about the hydrometer measurement of specific gravity until I can talk to the machine tech. Anxiety,
I follow the diet very carefully and have excellant labs each month. I have never skipped or shortened a tx in years of dialysis. I understand about the clocks and I am the one who insists the techs not end the tx until the RTD clock has elapsed. No other patient's machine has high cond. alarms. The problem is with my machine, alone. My RNs and techs can tell you that, because it makes their job a whole lot harder as they always have to stop what they are doing to silence the alarms on my machine.
IP: 209.240.198.61 |
m micone
Member
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posted 02-02-2003 10:42 AM
I'm a patient, on a fresenius 2008h. I commisserate, but you may be blaming symptoms on the wrong culprit. Cramping is a fluid removal question. Appetite can relate to many things, but it's most often an adequcy of dialysis question.
I've been having a problem with low co2 due to using renagel. We tried riasing the bicarb proportioning on the machine settings to compensate. The highest we can et is 37, due to the bicarb mix used on all the machines. If you set it higher, you get no result. The only time our machines alarm for high conductivity is when the techs change to a full bicarb jug in mid tx and the machine needs a moment to adjust to the fresh batch. For cramping, if you are taking off more than two litres, ask about sodium modeling scripts. Hope this helps.
IP: 216.189.175.16 |
Topic Closed
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