Technical Assistance Services

PHOENIX® Simulated Treatment

LAB 1

This LAB describes the procedures to perform a Simulated Patient Treatment needed for
preventive maintenance (PM) or troubleshooting purposes, and includes activities involving:
POWER UP; TOOLS; SETUP; SIMULATED TREATMENT; ENDING TREATMENT; RINSE

POWER UP SEQUENCE:

1. Locate the power switch and turn on the machine. Observe the boot-up messages that
occur:

System start up in Progress…

Boot from ATAP1 CD ROM:
Boot from ATAP1 CD-ROM: FAILURE…
Vxld 1 2
Loading OS 842
IP Adress <021.4xxxxxxx

2. Observe and record the numerical version of software that the Phoenix system is using
when it is displayed following the “Loading Modules” message and accompanied by an
advancing “progress bar” ______________________________.

3. When the boot-up is complete, the IDLE screen will be displayed. Service Manual - Section
1.3 describes each IDLE screen area and the different types of information that are, or can
be, displayed. In general, following a successful power up sequence of the machine, three
Action Keys should appear on the right side of the screen: Rx MGMT; SETUP; ADR.

Rx MGMT – Customer tailored Dialysis Treatment prescription options

SETUP – Initiates self tests and dialysate preparation prior to a new patient treatment
ADR – Automatic Disinfection and Rinse options

Note: The Rx MGMT key will appear first, and the other two keys a few seconds later.

SETUP: REQUIRED TOOLS / EQUIPMENT / SUPPLIES

4. Acid Concentrate

5. Bicarbonate (BiCart or liquid bicarbonate solution mixed in jug)

6. A/V Pressure Test Tool

7. Approx. 10 inch fluid-filled length of blood tubing for Air Bubble Detector (ABD) and Venous
Clamp

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PHOENIX® Simulated Treatment

LAB 1

8. P2 Pump Calibration Tool

9. 1000 cc (or larger) Graduated Cylinder (simulates patient)

10. 20 cc Syringe (or larger)

SETUP: MOUNTING TOOLS and SUPPLIES

11. ACID: Connect a jug of acid concentrate to the machine using the red, male Acid
Concentrate Connector and a white Suction Rod.

12. BiCart: Install a BiCart cartridge or connect the jug of liquid bicarbonate

13. A/V PRESSURE TEST TOOL:

13.1. Open the Blood Pump door and install the Arterial/Venous Pressure Test Cartridge
and close the door securely. The two pressure transducer access lines should be open
to atmospheric pressure.

13.2. NOTE: Simulates arterial / venous patient blood pressures in the Blood Tubing Set.

13.3. NOTE: The Blood Pump Rotor will automatically position itself to the horizontal
position when the Blood Pump Cover is opened.

14. TUBING SEGMENT:

14.1. Install a fluid-filled length of blood tubing in the ABD and the Venous Clamp.

14.2. NOTE: Simulates the presence of a Blood Tubing Set.

15. P2 PUMP CAL TOOL:

15.1. Hang the P2 Cal Tool in the Dialyzer Holder on the L side of the machine (red & blue
dialysate connectors up). Do not connect the dialysate lines to the P2 Test Tool at
this time. (Connect the dialysate lines only after the “Dialysate Prep Complete”
message appears on the display, later in this setup procedure.)

15.2. NOTE: Simulates the Dialyzer.

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PHOENIX® Simulated Treatment

LAB 1

16. GRADUATE:

16.1. Fill the graduated cylinder with 1000 ml of tap water and place it on an inverted
bucket on the left side of the machine.

16.2. NOTE: Simulates the Patient. During Dialysis, the system pulls fluid from the patient
through the dialyzer. During a Simulated Run, the system pulls fluid from the
graduated cylinder (patient) through the P2 Cal Tool (dialyzer).

SETUP: BEGIN DIALYSATE PREPARATION PROCESS

17. Press the SETUP key.

18. Press the BICART key. (or LIQUID BICARB if applicable)

SETUP: ENTER TREATMENT PARAMETERS

19. Press the SET mode button and change the following parameters:

19.1. TREATMENT TIME is highlighted yellow. Use the +/– keys to set it to 30 minutes,
then press ().
19.2. TARGET LOSS is now highlighted yellow. Use the +/– keys to set it to 0.8 Kg, then
press ().
19.3. UFR is now highlighted yellow. Observe that the displayed value has been
recalculated to 1.60 Kg/hr, then press ().
19.4. Press the SET mode button again to return to the home screen.

19.5. NOTE: Messages will appear in white boxes at the top of the screen indicating the
system self tests (T1 Tests) that are being performed. These self tests will be
discussed later in the course.

SETUP: PRIME KEY & SIMULATE SALINE PRIME

20. When it appears, press the PRIME key and then press the PRIME W/O UF key. The Blood
Pump will begin to run in the reverse direction (CW). (This simulates priming the blood
tubing set with saline to purge it and the dialyzer of air.)

21. When the “Prime Volume Complete” message appears, press the OVERRIDE button to
clear the message.

22. NOTE: While waiting, identify the screen icons and pictogram, and their meanings.

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PHOENIX® Simulated Treatment

LAB 1

SETUP: SET ARTERIAL & VENOUS BLOOD PRESSURES

23. Apply simulated patient pressures to the A/V Pressure Test Tool with a small syringe:

23.1. Set the venous pressure between +50 and +200 mmHg and clamp.
23.2. Set the arterial pressure between –50 and –200 mmHg and clamp.

SETUP: DIALYSATE PREP COMPLETE & CONNECT DIALYZER LINES

(DIALYSATE PRIME)

24. When the “Dialysate Prep Complete” message is displayed at the top of the screen (and/or
yellow BYPASS key appears indicating machine is in bypass), perform the following steps:

24.1. Attach the dialysate lines to the P2 Cal Tool, matching the connector colors.
24.2. Hold the Tool in the filling position. (SEE FIGURE 1a).
24.3. Place the long narrow tube of the P2 Tool into the water-filled graduated cylinder and
open the Tool clamps. Clamp off the short unused “Y” section of the Tool. (SEE
FIGURE 1b).
24.4. Press the yellow BYPASS key to take it out of bypass (BYPASS turns gray and P2 Tool
will begin to fill)
24.5. When the Tool is about 75% full, invert the Tool so the dialysate connectors are at
bottom and place in dialyzer holder. (See Figures 1a and 1b.)
24.6. (Water drawn from the cylinder during Dialysis will simulate fluid removed from the
patient.)

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PHOENIX® Simulated Treatment

LAB 1

Figure 1a – FILLING POSITION Figure 1b – TESTING POSITION

Connect and fill to 75%, then invert. Clamp the short tube from the “Y”. Add
an extension to the open tube or elevate
the graduated cylinder, so that the tube
reaches to the bottom.

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PHOENIX® Simulated Treatment

LAB 1

SETUP: PATIENT CONNECT

25. Within two minutes, the PATIENT CONNECT and RECIRC keys will appear.

26. Press the PATIENT CONNECT key, and then press the () button to confirm.

27. Press the Blood Pump ON/OFF button to start the blood pump at the default speed. (Pump
turns in the CCW direction.)

SETUP: SIMULATE PATIENT’S BLOOD

28. In order to simulate blood in the tubing in the Patient Sensor (a necessary condition for the
machine to continue toward Dialysis), follow these steps:

28.1. Select Status Screen #2 to view the Patient Sensor signal (PAT SENSOR) in the
Protection Module column about ¾ of the way down. Record here _________.
28.2. To prevent triggering an AIR IN BLOOD alarm, GENTLY open the air bubble detector
(ABD) door.
28.3. Using a thick business card or thin credit card, SLOWLY block the patient sensor’s
signal at the bottom of the ABD assembly by GENTLY sliding the card up from the
bottom of the ABD, on the right side of the fluid-filled tubing, between the tubing and
the patient sensor.

NOTE: An AIR IN BLOOD alarm will be triggered if the tubing is disturbed in the top
1/3 of the ABD (or if too much vibration of the blood tubing occurs).

NOTE: If an AIR IN BLOOD alarm occurs, see the procedure in the next section.

28.4. The patient sensor value should slowly decrease to ≈ 20 and the BLOOD IN VENOUS
LINE alarm should then occur (this is good), turning the blood drop icon red and
stopping the blood pump. Press the OVERRIDE button, which will clear the alarm
message and restart the blood pump.

28.5. GENTLY slide the card down and out of the ABD and GENTLY close the ABD door.
Press the HOME key to return to the home screen.

NOTE: An alternate method of making the patient sensor sense blood (blood drop
icon turns red) is to simply remove and then replace the tubing in the ABD, then clear
the AIR IN BLOOD alarm as described the next section.

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PHOENIX® Simulated Treatment

LAB 1

SETUP: AIR IN BLOOD ALARM

29. If an AIR IN BLOOD alarm occurs, ensure that the ABD door is securely closed and follow
these 4 steps to clear the alarm:

29.1. NEGATIVE - Connect a syringe to the venous line on the A/V Pressure Test Tool and
decrease the displayed venous pressure to a negative value of about - 40 mmHg.
NOTE: Opening the venous pressure to atmosphere is usually sufficient during a
Simulated Treatment.

29.2. OVERRIDE – Press the yellow OVERRIDE button on the Main Keyboard (override
symbol will then appear at the left side of the alarm message and the Venous Clamp
will open).

29.3. RESUME – Press the RESUME button (on the Blood Pump Keyboard) to restart the
Blood Pump.

29.4. POSITIVE – After the alarm clears and the Blood Pump resumes, reapply positive
venous pressure.

SIMULATED TREATMENT: START DIALYSIS

30. Remove the P2 Tool line from the graduated cylinder and record the fluid level: _________.
Insure that the level in the cylinder is still greater than 900 ml.

31. Replace the line and verify that the end of the tube reaches to the bottom of the cylinder.
The short section of tubing at the “Y” should remain clamped.

32. Press the DIALYSIS key on the display. After the Blood Pump ramps to the default speed
(green light stops blinking), set the Blood Pump speed to about 400 ml/min.

33. If a “HEPARINIZATION NOT STARTED” alarm occurs, clear it by pressing the OVERIDE
button. It can also be cleared by pressing the HEPARIN tab and then pressing LINEAR
(turns yellow - ON). Press the HOME tab to return. The Heparin Pump can be left on or it
can be turned off (touch LINEAR again - turns white - OFF) during the simulated treatment.

34. Connect the blood pressure cuff quick connector to the (BPM) port on the rear panel. Put
the blood pressure cuff on your arm. Press the ♥ key on the Main Keyboard. Verify that the
cuff inflates and when the BP measurement is complete, confirm blood pressure and pulse
values are displayed.

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PHOENIX® Simulated Treatment

LAB 1

SIMULATED TREATMENT: END DIALYSIS

35. When the Treatment Time display has counted down to 00:00, the message “Treatment
Time Complete” will be displayed. Remove the P2 Cal Tool line and record the amount of
fluid that remains in the graduated cylinder: ____________

36. Subtract the remaining fluid amount from the starting amount to determine the Fluid
Removed ____________. (This value should be 800 ±25 ml. This is the fluid removed from
the simulated “patient”.)

37. Record the TOT FLUID REMOVED display value ____________. (This value should also be
800 ±25 ml.)

NOTE: This ends the Simulated Treatment.

RINSEBACK: RETURNS PATIENTS BLOOD FROM BLOODTUBING

38. Press the RINSEBACK key and press the () button.

NOTE: In an actual dialysis treatment, the arterial patient line is attached to a saline bag and
the Blood Pump returns the blood from the Blood Tubing Set and Dialyzer back to the
patient.

EMPTYING: DIALYSATE EMPTIED FROM DIALYZER (P2 TOOL)

39. Press the EMPTYING key and press the () button. This will begin the process of empting
the dialysate from the P2 Test Tool.

40. Follow the directions in the screen. After returning the blue dialysate line connector to the
bypass port, elevate the P2 Test Tool holding it with the red dialysate connector on the
bottom and allow the machine to drain the Test Tool.

41. Do not remove the BiCart cartridge and the acid concentrate connector at this time.

NOTE: Waiting until IDLE to remove the Bicart allows the BiCart cartridge to depressurize,
which prevents splatters of bicarbonate solution.

42. When the “DIALYZER EMPTY” message appears, return the red dialysate line to its bypass
port.

43. Remove the A/V Test Tool and the short tubing segment from the ABD assembly and Venous
Clamp.

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PHOENIX® Simulated Treatment

LAB 1

DESCALING: CLEANING THE HYDRAULIC FLOW PATH (ACID or VINEGAR)

44. Press the DESCALING key. (Acid concentrate is drawn up while the descaling timer counts
down. The optional VINEGAR DESCAL key can be used with a jug of vinegar substituted for
the acid jug. The Phoenix system will perform a brief 3-minute final rinse to flush out the
acid or vinegar used during Descaling.)

RETURN TO IDLE:

45. When the Final Rinse is complete, the system will perform a few self tests and return to the
IDLE mode and the Rx MGMT, SETUP, NEW SESSION, and ADR keys will appear.

46. Connect the Acid Concentrate Connector to its rinse port. Remove and cap the unused
portion of the BiCart cartridge for later use. Close the BiCart Holder arms to the rinse
position.

47. Press the ADR key and press the RINSE key to initiate a full system rinse.

48. This concludes LAB #1.

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 ®

Alarms and Procedures Quick Reference

AIR IN BLOOD TOTAL FLUID

• Press MUTE button.
• Clamp venous line (below any visible air). REMOVAL ERROR
• Clamp venous dialyzer line. If UF Profiling is activated:
• Attach syringe to venous access line.
• Open venous access line clamp. • Press PROFILE Navigation Key.
• Aspirate until venous pressure is • Press COMPENSATION Action
at least - 40 to -50 mmHg. Key.
• Close the venous access line clamp.
• Press CONFIRM.
NOTE: Venous pressure>-150mmHg will not
allow the venous line clamp to open. • Verify new UF RATE is
NOTE: Perform the following steps within 30 appropriate, adjust if necessary.
seconds.
• Press OVERRIDE button. Venous Line Clamp
opens. IF UF Profiling is not activated:
• Open clamp on venous blood line, air is drawn
into venous chamber. • From HOME, press SET button.
• Verify air is removed and aspirate additional • Press UFR parameter box.
air, if necessary, with syringe on venous
access line. • Press CONFIRM.
• Remove clamp on venous dialyzer line. • Verify new UF RATE is
• Press RESUME button to start blood pump. appropriate, adjust if necessary.
• Adjust level of blood in Cartridge chambers.
• Press SET button.

MANUAL PRIME
PROCEDURE
NOTE: DIALYSATE PREPARATION must
be completed before proceeding with
Manual Prime.
• Press PRIME Selection Key.
• Press MANUAL PRIME Action Key.
• Press Blood Pump ON/OFF button.
NOTE: Blood Pump will continue to
operate until turned off
• Connect the dialysate lines to the
dialyzer and press BYPASS to prime
dialysate.
• After >120 ml of saline is infused, Blood
Pump may be stopped.
• Deselect PRIME Action Key on Home
View when “NOW MANUAL PRIME CAN
BE STOPPED” message appears.
• When RECIRCULATE Action Key
appears, press to proceed with
RECIRCULATION.
• Press Blood Pump ON/OFF button.
 FAST RECOVERY
Note:The Patient Sensor must detect blood in the
venous line to allow initiation of the Fast Recovery
Procedure
• Record treatment parameters from Home,
Heparin, BPM, and Profiling Views.
Note: Treatment information will be lost when
machine is turned OFF. Profiling and Diascan will
not be reactivated.
• Turn machine OFF. Wait 5 seconds.
• Turn machine back ON. Software will
reload.
• Press SETUP Selection Key.
• Follow the Operator Message:
“Press + and hold, press – and hold,
release + then release – to restart
interrupted treatment”
• Machine enters PATIENT CONNECT.
• Press OVERRIDE button to override any
alarms.
• Press Blood Pump ON/OFF button.
• SET and CONFIRM patient treatment
parameters (Time Remaining, Target Loss,
UFR, BPM, Heparin).
• Press DIALYSIS Action Key.
• Increase blood flow to prescribed rate.
T1 TEST FAILED
If alarm occurs during Dialysate Preparation:
• Note T1 Test that failed.
• Turn machine OFF.
• Verify dialysate connectors are
tightly fitted to bypass ports.
• Verify blood pump segment is
properly placed on blood pump rotor.
• Adjust rotor to horizontal position.
• Press blood pump rotor fully onto
shaft.
• Turn Machine ON.
• Verify arterial and venous pressures
remain at zero.
• If alarm recurs, note test that failed.
If alarm occurs during Fast Recovery:
• Insert venous line in Air Bubble
Detector.
• Repeat the Fast Recovery procedure.
For more specific instructions refer to the Phoenix® Operator’s Manual
10810 West Collins Avenue
Lakewood, CO 80215-4439
800-525-2623 or 303-232-6800
visit us at www.usa-gambro.com
GENERAL SAFE STATE
If during Dialysis:
• Record treatment parameters from
Home, Heparin, BPM, and Profiling
Views.
Note: Treatment information will be lost
when machine is turned OFF. Profiling
and Diascan will not be reactivated
Turn machine OFF.
• Perform a Fast Recovery procedure.
If during Dialysate Preparation:
• Verify dialysate connectors are tightly
fitted to bypass ports.
• Verify blood pump segment is
properly placed in blood pump rotor.
• Adjust rotor to horizontal position.
• Press blood pump rotor fully onto
shaft.
• Turn Machine OFF and then back ON.
DIAPHRAGM
NEUTRALIZATION
NOTE: Before performing this procedure,
ensure the fluid level in Cartridge
Chambers is no greater than half full.
• Press Blood Pump ON/OFF button.
• Clamp all four Cartridge Access Lines.
• Clamp arterial and venous lines below
Cartridge.
• Open Blood Pump Door.
• Open clamps on arterial and venous
access lines. Remove white end caps,
opening chambers to atmosphere.
• Loosen Cartridge from pressure
couplings.
• Observe arterial and venous pressures
at zero.
• Reseat Cartridge, close Blood Pump
Door.
• Close Cartridge access Line Clamps
and replace white end caps.
• Unclamp arterial and venous blood
lines.
• Press Blood Pump ON/OFF button,
increase blood flow to prescribed rate.
Caution: Federal Law (USA) restricts this device to sale, by or on the order of a physician.
Read Instruction for Use prior to patient application.
Trademarks used herein are owned by or licensed to Gambro, Inc.
©2004 Gambro Renal Products, Inc. Printed in USA 306050304 Rev G
 Responding to
Arterial & Venous Pressure Alarms
Overridden Arterial or Venous Alarms must be cleared before
leaving the machine.

When an Arterial or Venous Pressure Alarm occurs

1 2 3

Press the MUTE button Assess the alarm Press the OVERRIDE
to mute the audible condition and identify its button.
alarm. cause. Correct the
cause of the alarm.
4 5 6

2 min

Reassess the Arterial To end the Override If its LED is illuminated,

and Venous Pressures
and adjust parameters if
necessary.
condition, wait until the
Override period has
elapsed or press the
OVERRIDE button until
its LED is turned off.
press the MUTE button
to end the Mute
condition. The machine
is now in a normal
operating condition.

Remember
• An Override condition lasts for 2 minutes.
• A Mute condition lasts for 2 minutes.
• During Override condition, Arterial and Venous Pressure Alarm messages and
audible alarms can occur but with no effect (the blood pump will not stop). The
Override LED will remain illuminated, and every 10 seconds an audible and a
flashing red visual alarm will occur. The Arterial and Venous Pressure Alarm
Limits will be visually spread only during the initial 30 seconds.
• The operator is responsible for monitoring pressures during the Override
period.

Refer to the Phoenix Operator’s Manual for complete instructions. © 2007 GAMBRO LUNDIA AB. All rights reserved.
Code 306050430 Rev B Questions? Visit us at www.gambro.com
 Fast Recovery
Note: there must be blood in the venous line to allow initiation of the Fast
Recovery procedure.

1 2 3
5s

Record treatment Turn the machine off. Clamp the venous line
parameters from HOME, Wait for 5 seconds. below the ABD. Turn the
BPM, PROFILE and machine back on.
HEPARIN views.
4 5 6

Press the SETUP action Follow the operator Machine enters

key on the machine message: PATIENT CONNECT
screen when it is “Press + and hold, press - mode. Unclamp the
and hold, release + then
available. venous line.
release - to restart
interrupted treatment”

7 8 9

Press the blood pump Press the SET button. Press the DIALYSIS
ON/OFF button to start Set and confirm patient action key on the
the pump. treatment parameters machine screen.
(treatment time, target
loss, UFR, BPM,
heparin).
Refer to the Phoenix Operator’s Manual for complete instructions. © 2007 GAMBRO LUNDIA AB. All rights reserved.
Code 306050433 Rev B Questions? Visit us at www.gambro.com
 Diaphragm Neutral Position
Before performing this procedure, ensure the fluid level in the cartridge chambers
is no greater than half full.
GOOD BAD

1 2 3

Press the blood pump Clamp the 4-position Open the blood pump
ON/OFF button to stop line clamps, the arterial cover.
the pump. line and the venous line
below the cartridge.

4 5 6
5s

Open the arterial and Gently loosen the Leave open for 5
venous access line cartridge from the seconds, and observe
clamps and remove the pressure sensors. the arterial and venous
end caps. pressures at zero.
7 8 9

Reseat the cartridge Close the arterial and Unclamp the arterial and
and close the blood venous access line venous lines. Press the
pump cover. clamps and replace the blood pump ON/OFF
end caps. button to start the pump.

Refer to the Phoenix Operator’s Manual for complete instructions. © 2007 GAMBRO LUNDIA AB. All rights reserved.
Code 306050431 Rev B Questions? Visit us at www.gambro.com
 General Safe State
If during Dialysis
If the General Safe State occurs during dialysis, perform a Fast Recovery
procedure (as described on other card).

If during Dialysate Preparation

If the General Safe State occurs during dialysate preparation, perform the 7 steps
described below.
1 2 3
5s

Turn the machine off. Verify that the dialysate Verify that the cartridge
Wait for 5 seconds. connectors are tightly pump segment is
fitted to the bypass properly placed on the
ports. blood pump rotor.

4 5 6

Adjust the blood pump Turn the machine back Press the SETUP action
rotor to horizontal on. key on the machine
position and press the screen when it is
rotor fully onto shaft. available.

Press the OVERRIDE

button.
Refer to the Phoenix Operator’s Manual for complete instructions. © 2007 GAMBRO LUNDIA AB. All rights reserved.
Code 306050432 Rev B Questions? Visit us at www.gambro.com
Status Screen - Intro

• A way to view from the outside what’s going on inside the machine
in order to compare actual behavior to expected behavior.
• Data from devices as interpreted by Slave Boards
• Real-time screen updates (~1/sec.)
• Navigate from home screen: Machine/Status tabs
• Accessible after bootup in IDLE, Treatment, and Calibration & Test
• Documented in Service Manual Ch. 10
• (More details to follow after learning all the devices and boards)

© 2012 Gambro, Inc. 1

Serv. Man. Ch10 view vs. 3 Status Screens view

Column #

Documents use page, row, column to specify location, e.g.:

Row # SS1-6A&B for DIAL FLOW (= D1 flowmeter reading)
© 2012 Gambro, Inc. 2
Part 1

© 2012 Gambro, Inc. 1

Inlet Water Circuit

EVH20 SS1-16C

All Electrovalves
EVxx SS1-xC

PRE Switch SS2-21A

© 2012 Gambro, Inc. 2

Deaeration
PC Freq SS1-27A
PC ACTIV SS1-28A

TEMPERAT SS1-3A LP Sensor SS2-6A

Only opens during

ADR Processes
(mainly for Heat)

DEG Flow SS2-23A

Flow = OFF No Flow = ON

© 2012 Gambro, Inc. 3

Conductivity Circuit
CONDO B SS1-2A & 2B CONDO A SS1-1A & 1B

PB FREQ SS1-16A
PB% SS1-17B
PA FREQ SS1-12A
PB AUTOCAL SS1-18B
PA% SS1-13B
PB ACTIV SS1-19A
PA AUTOCAL SS1-14B
PA ACTIV SS1-15A

A SWITCH SS2-14A

Central Concentrate Switches

CENTR PRES SS2-15E
B SWITCH SS2-15A
CENTRAL A SS2-16E
(SWA1C & SWA2C)
CENTRAL B SS2-17E
BCT SWITCH SS2-16A
(SWBC)

© 2012 Gambro, Inc. 4

Deaeration / Temperature / pH

LD1 Sensor SS2-7A

TEMPERAT SS1-3B

pH VALUE SS2-31D

© 2012 Gambro, Inc. 5

Hydraulic Flowpath Lab Part 1

• Purpose: To gain experience locating and

identifying components and understand how to
relate those components to the hydraulic
flowpath diagram.

• Using the flowpath diagram identify the

numbered hydraulic component.
• Fill in each table with the name of the
component
• The numbered components follow the hydraulic
flowpath diagram.

© 2012 Gambro, Inc. 1

Inlet Regulation
1
5
2
3
4
2 4
5 7

6
7
3

© 2012 Gambro, Inc. 2

Degassing 11 14

12
13

10
12

Inside Rear Panel

8
10A
9
10
9
10A
8
15 11
9 12
13
14
15

© 2012 Gambro, Inc. 3

Degassing
16

13
17
16
17
13

© 2012 Gambro, Inc. 4

Conductivity Control 18
19
20
21
22
22 23 23

20
19 21
18

Inside Rear Panel

Inside Rear Compartment, Door Open

© 2012 Gambro, Inc. 5

Conductivity Control

27 26

25

24

24
25
26
Back Side of Front Panel 27

© 2012 Gambro, Inc. 6

Air Removal

30

29

31

28
28
29
28 30
31

Inside Rear Compartment

© 2012 Gambro, Inc. 7
Air Removal 32
33
34
35
34
32

33

35

34

© 2012 Gambro, Inc. 8

Disinfection, Cleaning & Rinse Overview
• Rinse/Disinfection methods available:
– Rinse (RO water)
– Chemical Disinfection (bleach, Actril, Renalin)
optional end with Rinse, Bacteriostatic (dwell), or None (dwell)
– Heat Disinfection (RO water, ~97°C)
– Heat Citric disinfection & descaling/cleaning (50% Citric Acid, ~97°C)
• CCK lines optional at end of Chem or Rinse (if using Phoenix connector)
• Descaling/Cleaning methods available
– At End of Treatment using Acid Concentrate
– At least 2x/week (assumes Bicarbonate Dialysis 2x/day) using Acetic Acid in
Chemical process (far less effective than Heat Citric)
• Initiated manually or programmed in Config/ADR/AUTO ON
• See Specifications Chapter regarding chemicals
• See Operator’s Manual regarding procedures
• Define parameters in Config/ADR

© 2012 Gambro, Inc. 1

Disinfectant Input Sources Available
1. Inlet water hose (RO loop or manual connection)
2. Front jug
3. Rear jugs section missed via mixing location
2&3 via 2 & 3

HYDRAULIC FLOW PATH

Rebuilding Order 16 w/Single Drain
GAMBRO
Technical Training Service

Dialysis Water Inlet Water Heating Deaeration, Temp. UF Mass Balance,

& Pressure Control & Deaeration Ph & Flow Deaeration,BLD & Diascan
B
1 R1 OW1
EVP

LP
OW 3
OW4
OR2
EVBP EVBP2 TO DRAIN
BTP
EVD 1
STH Pc OW12 OW5 EVD 2
H
BT1 LD 1
SWFS BT2 LD 2 PD EV 2 F7 D2 Tc CD
FH O SWP EVH2O TP 1500 TPS
2 m l/m in
EVDeg
CDF EV 1 P2
Chemical Intake OR 1 BLD
SWBY F5
A B
2 SWD
Tc

CB
Tp

PB
Tc

CA
Tp

PA
F4 Ph

PFS Pi
OR3 PO
EVUfo PUF
EVHE OW11

HE
HE R2 LFP
EVC PB PA D1 HLUF

SV EVDS1 F6 LLUF OW10 SWP 1

EVS
EVD SWB SWA P1
BICART

DRAIN

F3 DC S-out UFT EVUF

CHEMICAL
CLEANER

HLS OW18
ST LFD
BH
LLS SWBK
3 Waste Handling Option
ACID

EVR1 DC S-in
F2
DISINFECTANT
CHEMICAL

PS
Concentrate A & B Proportioning EVW 1 W-C ON
F1 OW 17
A
EV1S EVW 2 VENTURI

Rev 07 31 2008

© 2012 Gambro, Inc. 2

Integrated Chem or Heat

RO
System
loop

chem Phoenix
Phoenix …
Phoenix Phoenix

•Disinfect RO & all machines on loop in same session

•On demand, or scheduled unattended
•Includes Phoenix inlet section & full flowpath

© 2012 Gambro, Inc. 3

Manual Inlet Hose Disinfection

• Water Inlet Disinfect Tool (6979298) in Calibration kit

• Manually pump chemical into inlet hose, dwell,
• re-connect inlet hose to water source to rinse
• Convenient for just one system (e.g. after if fails culture tests)

Inlet tool

© 2012 Gambro, Inc. 4

Optional: CCK lines during Chem & Rinse
• See Operator’s Manual page 3-18
• Enable in Calibration/OPERATIONS/MAIN SETTING/VIRTUAL DIP
• Execute in ADR/CCK LINES RINSE, ADR/CHEM DISINFECT/CHEM + CENTR BICARB LINE
• Manually connect, automatically performed

Acid Rinse Port CCK port

CCK line and Phoenix connector

disconnected from wall and brought
around to the front of Phoenix and
inserted into Rinse Port

Concentrate line inserted into

CCK port
(one of several configurations
shown in Operator’s Manual)

© 2012 Gambro, Inc. 5

Disinfection miscellaneous

• Gambro recommends you alternate types of disinfectants

• Machine forces Rinse after Chem before Setup/Treatment
• Monitor disinfection effectiveness via cultures
• Don’t forget inlet section
• Develop & Use Clinic Policies based on industry standards
• Optional pH monitoring with alarms during disinfections

© 2012 Gambro, Inc. 6

Part 2

© 2012 Gambro, Inc. 1

Chemical Disinfection DIS Switch SS2-17A

Dis Lev HI SS2-12A

Dis Lev LOW SS2-13A

Rear 1 Rear 2

PS FREQ SS1-29A
PS ACTIV SS1-30A

© 2012 Gambro, Inc. 2

Dialysate Flow Control

P1 FREQ SS1-22C
P1 ACTIV SS1-23C

Bottom

Top

In drawing valve is inverted,

DIAL FLOW SS1-6A & 6B All vales are mounted coil up

© 2012 Gambro, Inc. 3

Clean Dialysate Option

CD1 Switch SS2-18A

With Bypass Block installed

CD2 Switch SS2-19A PRESS In SS1-7A & 7B

PRESS FS SS1-10A

© 2012 Gambro, Inc. 4

Dialysate Line Connection

OUT Dial Pos SS2-26A

IN Dial Pos SS2-25A

CONN Flow SS2-24A

Flow = ON No Flow = OFF

© 2012 Gambro, Inc. 5

Ultrafiltration Control / Dialyzer Circuit

BLD VALUE SS2-30D

LD2 Sensor SS2-8A PRESS DR SS1-9B

P2 SETVALUE SS1-24C
P2 FLOW SS1-25D
P2 FREQ SS1-26D
P2 ACTIV SS1-27C D2 FLOW SS1-34D

PRESS Out SS1-8A & 8B UF VALUE SS1-4A & B

PUF ACTIV SS1-21A
PUF AUTOCAL SS1-20A &B
PRESS In SS1-7A & 7B

© 2012 Gambro, Inc. 6

Flow Balance • Safety method that the Phoenix hemodialysis
system uses to confirm that the UF circuit
components are within operation specifications

• Protection System:
– Performs monitoring
– Verifies D1,D2 flows
 +/-5% Dialysis
 +/-3% in Taration (Flow meter calibration)
– Verifies P2 pump speed verses the delta P
of PD- PO (P2 pump calibration coefficient)
• P2 pump flow = (dialysate flow + UF rate) +/- 8%
• Anything outside of specification generates a
Flow Balance error.
© 2012 Gambro, Inc. 7
UF Accuracy PUF Pump speed monitored/adjusted during the
filling phase of the UF Vessel
When the UF Vessel is empting, the PUF speed
remains constant until it is checked/adjusted again
during the next filling phase of the Vessel
The PUF Pump does not stop during Dialysis

UF VALUE UF VESSEL
SS1-4A & 4B SS1-23B

PUF ACTIV
SS1-21A UF Lev HI SS1-25A & 25B

UF Lev LOW SS1-26A & 26B

© 2012 Gambro, Inc. 8

Light Feedback During UF Vessel calibration the
coefficient for the exact volume of the UF
Vessel between the sensors was
calculated
During the treatment the control system
calculates the UF rate as a ratio between
the Vessel’s volume and Vessel fill time
Measured value is compared to the set UF
rate
Measured Value / Set Value = LFB
compensation (ideal = 1.0)
LFB value must be ± 8.5% (1.085 – 0.915)
Pump speed adjusted to correct fill time
LFEEDBACK SS1-22A
LFB low - the PUF Pump speeds up
EMPTY TIME SS1-24B
LFB high - the PUF Pump slows down

© 2012 Gambro, Inc. 9

Flow Balance during Treatment
a closed circuit model (2 inputs & 2 outputs)

Dialyzer

D1 P1 P2 D2
10 500
500 10 500+10
UF PUF

PUF

Patient

1. D1 controls P1 to achieve Dialysate Flow Rate (D1)

2. User selected UF Rate = Target Weight Loss / Treatment Time (Kg/hr)
3. System sets PUF speed to desired UF Rate (ml/min)
4. D2 controls P2 to make two equations true:
D1 = D2
P2 = D2 + PUF
5. Result is UF = PUF

© 2012 Gambro, Inc. 10

Taration / Flow Meter Calibration
• During the treatment, the flow meters are verified for
congruency every 15 minutes.
INTER CALIB 900
• During this time the UF circuit is bypassed SS2-34D

Bypass Flow EV2 OFF

SS1-2C

EVDS1 OFF
SS1-5C

© 2012 Gambro, Inc. 11

Taration / Flow Meter Calibration
• The output flow from D1 goes
KAPPA FM 1.000 directly into the input of D2
SS1-29C
• During the calibration, a
coefficient (K) is calculated
D1-KD2 0
SS1-30C • This coefficient is used to
compensate the D2 flow meter
reading
MBAL_DEV SS1-31D • The calibration takes place in
MBAL LONG SS1-32D
MBAL SHORT SS1-33D
phase 18
• It is 40 seconds in duration*
• The K factor ideal is close to 1
• Example:
– D1 = 500 ml, D2 = 495, * If discrepancies in D2 flow are
K=D1/D2 = 500 /495 = 1.01 (phase 18) detected, additional flushing of D2
can take more time.
– During the treatment (phase 19)
D2 flow = K x D2 = 1.01 x 495 = 499.95

© 2012 Gambro, Inc. 12

Dialysate Flow during Taration and Bypass
PDR-PO SS1-28D

EVUFO ON SS1-4C

• BLD remains active

• PUF continues to run and
draws fluid from patient
• P2 controlled by PD-PO

© 2012 Gambro, Inc. 13

Flow Balance during Taration
a closed circuit model (2 inputs & 2 outputs)
bypass 500

Dialyzer 10 + loop

D1 P1 P2 D2

Po Pd 500
500
10 loop
UF 10
PUF PUF
Patient

1. D1 controls P1 to stay the same as D1 before

2. PUF stays the same as before
3. Po & Pd control P2.
4. equations:
D1 = D2 (to calibrate D2 against D1)
P2 in = P2 out
UF + “loop” = “loop” + PUF
5. Result is UF = PUF

© 2012 Gambro, Inc. 14

WHO

EVR1 and EVW1 only used

during disinfection and rinse

WHO Switch SS2-20A

EVS and EVW2 energize for 10 seconds when

WHO Door is opened during prime.

© 2012 Gambro, Inc. 15

Flow to Drain

from OR2 from

EVBP2

Post Flow
from
SS2-22A
EVUF

from Air Gap required

WHO at the drain

© 2012 Gambro, Inc. 16

Diascan

Diascan: a biosensor (conductivity probe) that allows for real time, non-
invasive and automatic follow up of the patients parameters.
• Function:
– At preset intervals, system automatically performs a step of the inlet
conductivity.
– The analysis of the outlet conductivity response allows for the computation of
the dialysance (post-dialyzer dialysate)

© 2012 Gambro, Inc. 17

Review

© 2012 Gambro, Inc. 18

 Technical Assistance Services

Review Questions for Day 1

1. What are the 3 Action Keys displayed on the IDLE screen?

________________________________________________________________

2. What are the minimum requirements (equipment / tools and supplies) to allow
completion of a Simulated Treatment?
________________________________________________________________

3. What calibration tool replaces the Dialyzer during a Simulated Treatment?

____________________

4. What on-screen icon lets us know that blood has been detected in the patient’s
venous line? ____________________

5. To clear an AIR IN BLOOD alarm, one of the steps is to lower the arterial pressure
to -40 to -50 mmHg. (T/F) ______

6. Air bubbles are vented from BT1 through check valve OW3. (T/F) ______

7. The Hydraulic Flow Path is described in detail in Service Manual Section #_____

8. The signal name of the switch that monitors the BiCart mounting arms is ______ ,
and in Status Screen # it is called ____________.

9. In the Deaeration (degassing) circuit of the hydraulic flow path, the level sensor at
the top of the bubble trap BTP is named ____________.

10. The temperature probes at the top and bottom of each conductivity cell are used
to help regulate the final temperature of the dialysate. (T/F) ______

May 2012