Transonic

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HD03In-serviceTraining
Part I HD03 Monitor Operation
Rev. A 1-08
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• Purpose
• To train/re-train personnel on how to use the
  HD03 Hemodialysis Monitoring System.
• Included in this training presentation
• A review of
• HD03 System and components
• HD03 Operation including measurement protocols
• Frequently Asked Questions
• Troubleshooting Tips
• Monitor and Flow/Dilution Sensor Maintenance

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HD03 System How It Works

• Measurements are made during hemodialysis with
  the HD03 monitor and flow/dilution sensors
  clipped onto arterial and venous blood lines.
• 2. The HD03 monitors computer captures and
  writes data to the Data Transfer Module (DTM).
  The DTM can then be transferred to the USB port
  on a PC computer loaded with the HD03
  Administrators software program. There the data
  can be accessed to be reviewed, organized and
  analyzed.

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Caution

• After measurements are completed, wait at
• least 20 seconds before turning off the HD03
• monitor or removing the DTM.
• Data can be lost with hasty monitor shut-down
• or DTM removal.

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HD03 System Schematic
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1. HD03 System Components
HD03 Monitor
Removable Data Transfer Module (DTM)
Handle
USB Accessory port
Flow/dilution sensors in cradle
Battery pack compartment
Sensor connection
Power supply connection
Pole adapter mount site
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1. HD03 System Components cont.
Data Transfer Module
Pole Mount Adapter
Battery
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1. HD03 System Components cont.
HD03 Mounted On IV Pole
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Setup H4FX Sensors

• Plug H4FX sensors into monitor.
• Open sensor door and add petroleum jelly into the
  sensing cavity of the sensors.
• Place sensors on bloodlines 2-4 inches from the
  needle connection.
• Clip red sensor on arterial line in direction of
  flow.
• Clip blue sensor on venous line in direction of
  flow.

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2. HD03 Operation
 
Note All monitor functions can be accessed by
pressing the touch screen with your finger or a
blunt stylus.
Figure 7 Initializing screen
Turn on the power switch on the right side on
the back of the monitor.  
Initializing Screen
 
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2. HD03 Operation cont.
 
After the initialization process is completed, a
Select Patient screen will appear. 
Figure 7 Initializing screen
Menu
 
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2. HD03 Operation cont.
 

• Find/Select Patients
• to Measure

Figure 7 Initializing screen
Press Todays Patients button. Scroll through
patient list with scroll arrows and highlight a
patient by pressing the name. An empty blue box
to left of patient icon indicates that this
patient is scheduled for this particular day but
has yet to be measured.
Pediatric patient icon
Adult patient icon
 
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2. HD03 Operation cont.
 
Find Patient icon
Another option Select a patient by pressing
Find Patient. On the Select Patient screen, a
keypad will appear. Press the first letter of
the patients last name. A list of patients will
appear. Highlight the patients name and press
Measure Patient.
Figure 7 Initializing screen
 
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2. HD03 Operation cont.
 
Add Patient icon
A third option To enter a new patient, press
Add Patient. A screen with an on-screen keyboard
will prompt for new patient information    
Figure 7 Initializing screen
 
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2. HD03 Operation cont.
Measure patient icon
 
B. Measure Patients Start a measurement protocol
by pressing the Measure Patient icon. 
Select tubing icon

• Select Tubing
• being used for the patient from on-screen
  choices.

When using the tubing library option, press the
first letter of the tubing manufacturer and
select the appropriate tubing from the list.
Press the OK button.
 
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2. HD03 Operation cont.

• 2. Choose Protocol
• from one of the following
• Delivered Blood Flow,
• Recirculation,
• Access Flow.

Figure 7 Initializing screen
Note The Cardiac Output Protocol can be
activated only if a CO Data Transfer Module
(DTM-CO) is inserted into the system.
 
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2. HD03 Operation cont.
 
Delivered blood flow icon
Delivered Blood Flow Measurement Press
Delivered Blood Flow Enter and compare the
machine (pump) setting with the measured
delivered flow on the screen. The reading should
be within 10 of the machine setting (see next
slide).
If the reading is gt than 10, the green bar
(bottom of screen) will turn red. When bar is
red, check for correct tubing selection, sensor
placement, and/or kinking of lines.
 
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Difference Between Delivered and Prescribed Blood
Flow Should be 10

• If gt 10, check
• Needle size
• Needle placement
• Condition of access
• Roller pump tubing segment occlusion or kinked
  dialysis tubing
• Change in blood line type
• Calibration of dialysis machine
• Calibration of sensors

(refer to Troubleshooting Section)
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2. HD03 Operation cont.
Optional Parameters Screen For Recirculation,
Access Flow, or Cardiac Output measure-ments, an
Optional Parameters screen will appear. Press to
highlight the field in which you want to enter a
value. Key in numbers for the highlighted
field. Once information is entered, press OK to
proceed.
Figure 7 Initializing screen
Entering values on this screen is optional,
unless you have selected Cardiac Output or the
patient is a pediatric patient
 
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2. HD03 Operation cont.
Access Recirculation icon
 
Recirculation Measurement Press the
Recirculation button on the Choose Protocol
screen follow on-screen directions. After
saline release, the HD03 initiates a countdown.
At its conclusion, a dilution curve with
Recirculation will display.
Figure 7 Initializing screen
On-screen directions When the traffic light
turns green. 1.Open venous pressure limits to
avoid pump stop. 2. Release saline from infusion
bag for 5-6 sec. OR inject 10 mL saline
into or before venous bubble trap. Inject
smoothly over 3-5 sec.
 
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2. HD03 Operation cont.
 
Vascular Access Flow icon
Vascular Access Flow Measurement Press the
Access Flow button on the Choose Protocol
screen. Stop the blood pump, REVERSE BLOOD LINES
and set the dialysis pump at 250-300 ml/min.
Figure 7 Initializing screen
 
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2. HD03 Operation cont. 
Vascular Access Flow icon
Vascular Access Flow Measurement cont. Follow
the on-screen directions. At the end of the
countdown, a dilution curve and calculated Access
Flow will display on the screen.
On-screen directions When the traffic light
turns green. 1.Open venous pressure limits to
avoid pump stop. 2. Release saline from infusion
bag for 5-6 sec. OR inject 10 mL saline
into or before venous bubble trap. Inject
smoothly over 3-5 sec. Note If Qb lt 200
mL/min, use saline bolus injection.
 
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2. HD03 Operation cont.  
Vascular Access Flow icon
Vascular Access Flow Measurement cont. If
vascular access flow is your final measurement,
return to the Select Patient screen before
shutting down the system or removing the
DTM. This allows sufficient time for the data to
be written to the DTM.
Select Patient screen
 
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2. HD03 Operation cont  
Optional Cardiac Output Measurement When a
Cardiac Output Data Transfer Module (DTM-CO) is
inserted into your HD03 Monitor, you can also
measure Cardiac Output. Cardiac Output
measurement capability is indicated by the heart
icon that appears on the screen shown on the
right.
Cardiac Output icon
 
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2. HD03 Operation cont  
Cardiac Output icon
Cardiac Output Setup

• Before performing a measurement, insert Flow-QC
  tubing set into the
• hemodialysis circuit as described
• Remove both tubing segments from package and caps
  from segments.
• Attach the red-banded end of the arterial segment
  to the male end of
• the arterial bloodline.
• Attach the blue-banded branch of the Y end to the
  male luer-lock
• connector on the venous bloodline.

 
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2. HD03 Operation cont  
Cardiac Output Setup cont
Cardiac Output icon

• Prime the Flow-QC tubing. Take care to remove
  all air bubbles from the tubing.
• Attach the arterial and venous Flow-QC Set lines
  to the fistula needles of the patient as usual.

 
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2. HD03 Operation cont. 
Cardiac Output icon
Cardiac Output Measurement cont. Select a
Patient, Press the Measure Patient button
Choose Transonic Flow-QC Tubing. Select the
Cardiac Output protocol. At the prompt, enter
data in the active fields highlighted in yellow.
If data is not entered in all the required
fields, you will be prompted to do so. Note All
units are metric, except for height which has
user-selectable units.
 
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2. HD03 Operation cont  
Cardiac Output icon
Cardiac Output Measurement cont Follow on-screen
directions as shown below. After a countdown, a
Cardiac Output dilution curve, calculated Cardiac
Output, and calculated Cardiac Index values are
displayed. If Access Flow is measured during
the same session, the monitor will also display
an AF/CO ratio.
When the traffic light turns green. 1. Open
venous pressure limits 2. Inject 30 ml saline
quickly into venous port on Transonic
Flow-QC tubing. Saline must be warmed to BODY
TEMPERATE (37 C).
 
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2. HD03 Operation cont.
 
C. Patient Information 1. Patient Record
Displayed at the top of the Patient Record
screen is the Patient name, ID number and patient
trend graphs. The buttons access the various
parameters. Clicking on each button reveals a
graph with corresponding variables
Patient record icon
 
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2. HD03 Operation cont.
 
C. Patient Information cont. 2. Access Flow
Trend
Vascular Access Flow icon
All access flow measurements values for a
patient are graphed. Yellow triangles at the top
of the graph indicate interventions.
 
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2. HD03 Operation cont.
 
C. Patient Information cont. 3. Cardiac
Output To view a patients complete Cardiac
Output history, press the gold heart icon. To
view the Cardiac Output results from the last
dialysis treatment, press one of the buttons with
the gold heart and clock shown.  
Cardiac Output icon
 
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2. HD03 Operation cont.
 
C. Patient Information cont. 4. Patient
Measurements Table Tabulated measurements for
a patient include includes Date, Time, Mode, Mean
Arterial Pressure (MAP) and Result. Under the
mode column, DLVFLW Delivered Flow, AXSFLW
Access Flow, REC Recirculation, CO Cardiac
Output and IVT Intervention .
 
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2. HD03 Operation cont.
 
D. System Information The system information
button displays specifications and details about
the HD03 Monitor and the H4FX sensor. The date
indicates the recommended due date for service.
Tubing indicates the version of the tubing
library uploaded. .
 
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2. HD03 Operation cont.
 
D. System Information cont. 1. Set Clock
Locale Use Set Clock Locale screen to set
clock locale. Time is entered in a 24-hour
format. Make sure to select the appropriate time
zone    Locale selection controls the language
translation and date time format.
 
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3. HD03 Frequently Asked Questions

• 1. How do I assign a patient to a clinic other
  than the clinic named No Assigned Clinic?
• Patients can only be assigned to a clinic from
  the HD03 Administrator Program. Only the patient
  name and I.D. number can be entered when adding a
  patient on the HD03 Monitor.
• 2. When I add a patient into the Monitor there
  are only a limited number of fields that I can
  fill in. Why is that?
• The HD03 Add Patient function is provided only
  to enter basic patient information. If possible,
  patients should be added using the HD03
  Administrators detailed Add Patient function and
  then synchronized to your Data Transfer Module.

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3. HD03 FAQs cont.

• 3. Where is the signal strength indicator? How do
  I interpret it?
• The signal strength indicator is located in the
  upper left corner of the Delivered Flow and
  Dilution Measurement screens and at the upper
  right corner of the dilution measurement protocol
  reminder screens.
• The signal strength indicator has five ascending
  bars.  
• Blank No Signal No measurement can be
  performed, contact Transonic.
• Red Poor Signal No measurements can be
  performed, contact Transonic.
• Yellow Marginal Signal Verify correct sensor
  placement, tubing selection,
• and adequate couplant. Proceed to
  measure.
• Green Good Signal Proceed to measure.

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3. HD03 FAQs cont.

• 4. How do I use the Delivered Flow measurement?
• Delivered flow measurement calculates the
  percent difference between the pump setting and
  the actual delivered pump flow. The result is
  displayed color-coded green for pump is
  delivering flow within 10 of the setting or red
  pump is not delivering flow as prescribed.
• 5. What happens if I lose my Data Transfer
  Module?
• You will lose any unsynchronized new patients
  and/or new measurements. Synchronize often and
  regularly. Patient confidentiality will not be
  compromised because all sensitive patient data is
  encrypted.

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3. HD03 FAQs cont.

• 6. My HD03 display changed to show Please insert
  Data Transfer Module. What should I do? 
• Shut off your system and reboot in order to
  regain normal functionality.  The AC power supply
  had a /- 1 kV line power spike.  This caused the
  Data Transfer Module to reset to protect the
  data.  This should not happen often at all in a
  Clinical or Hospital setting because the line
  power in these settings is quite controlled.  If
  it happens frequently, bring it to the attention
  of your building maintenance department.  This
  should not occur if the system is running off the
  battery and not plugged in.  If this occurs while
  the system is running on the battery contact your
  Transonic Customer Service Representative.

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3. HD03 FAQs cont. Cardiac Output

• 7.  What is the AF/CO value and will I get an
  AF/CO value every time I do an AXSFLW measurement
  and CO measurement?
• The AF/CO value is the percentage ratio of the
  patients access flow to the patients cardiac
  output. For example, an AF/CO value of 22 would
  mean that 22 of the patients cardiac output is
  being shunted through the patients access. This
  value will be calculated as long as an Access
  Flow measurement and a Cardiac Output measurement
  are performed within the same session. The order
  of the dilution measurements does not matter
  Access Flow then Cardiac Output or Cardiac Output
  then Access Flow.

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4. Troubleshooting Tips
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Saline Release
4. Troubleshooting Tips cont.
Release saline for 5-6 seconds from infusion bag.
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Bolus Injection
4. Troubleshooting Tips cont.

• Use saline injection method when-
• ever the pump flow is below 200
• ml/min or no result is obtained with
• saline release method.
• Draw 10 ml of saline from patients
• saline bag and inject at a steady
• pace before or into the venous
• bubble trap

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Venous Pressure Alarms
4. Troubleshooting Tips cont.
When releasing saline, open the venous pressure
limits to avoid pump stoppage.
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Low Flow
4. Troubleshooting Tips cont
An access with LOW ACCESS FLOW NO
RECIRCULATION could indicate a stenosis between
the needles.
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Incorrect Sensor Placement
4. Troubleshooting Tips cont.

• Problem
• Ultrasound signal quality indicator is not full
  or there is a negative delivered flow reading on
  the HD03 monitor.
• Possible Solutions
• Check that the sensors are on the blood line
  tubing, not on the needle tubing.
• Check that the arterial sensor is on the arterial
  blood line and the venous sensor is on the venous
  blood line.
• Check that the arrows on the sensors are pointing
  in the direction of flow.
• Apply a small amount of Vaseline in sensors
  sensing cavities.

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10 Difference Between Delivered and Prescribed
Blood Flow
4. Troubleshooting Tips cont

• Possible Causes
• Mis-calibration of dialysis machine and/or
  Transonic H4FX Sensors.
• Flow limited by needle size or needle placement.
• Not adequate roller pump tubing segment occlusion
  or dialysis tubing kinked.

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10 Difference Between Delivered and Prescribed
Blood Flow cont.

• Possible Solutions
• Check for occluded or kinked tubing.
• Make sure the selected tubing in the software
  program matches the tubing used on the patient.
• Set dialysis machine pump flow at 200 mL/min and
  compare it to the delivered pump flow
• If difference is lt6, then calibration of
  dialysis machine and sensors are OK. Check the
  following
• Make sure that the tips of the needles are not
  pressed against the wall of the access.
• Consider needle size.
• If difference gt6, check calibration of dialysis
  machine and/or Transonic H4FX Sensors.

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Catheters
4. Troubleshooting Tips cont
Dialysis adequacy can be tested in catheters by
measuring Delivered Blood Flow Recirculation.
Access Flow and Cardiac Output cannot be
measured in catheters.
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5. HD03 Maintenance
HD03 System Exterior surfaces of the HD03 can be
cleaned with a damp cloth. The touch screen can
be cleaned with a 1 bleach solution. Do not drop
liquids onto the monitor. Keep the HD03 monitor
in a dry environment and do not operate in wet
conditions. H4FX Flow/Dilution Sensors The
flow/dilution sensor, cable, and outer shell of
the connector should be cleaned by wiping with a
1 bleach solution, an alcohol wipe, or a mild
disinfectant soap solution. Do not immerse sensor
or connector. Regular cleaning is important to
prevent the possibility of patient
cross-contamination.
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Additional questions??? Please refer to the
HD03 Operators Manual or Quick Reference Guides
or contact Transonic Customer Service Hotline at
800-353-3569 or your local Transonic
representative.www.transonic.com