Aquarius Troubleshooting Game Cards Reference text may be found in this section PM-0129-02/2017-1 Produced in Partnership with Edinburgh Royal Infirmary 2016 Copyright © 2017 NIKKISO Co., LTD. All rights reserved. | Confidential

Aquarius Troubleshooting Game Cards Start with six Alarm Cards Pair a Troubleshooting Circuit Card to each Alarm Card Finally, match each one with a Cause and Action Card Trainer notes: print and laminate cards, typical use after Study day, Troubleshooting or Train-the-Trainer activities. Duration 10-30 min dependent on group, sequence may choose to follow Note: Image shown low resolution Produced in Partnership with Edinburgh Royal Infirmary 2016 Copyright © 2017 NIKKISO Co., LTD. All rights reserved. | Confidential

Low Access Pressure Alarm Card Produced in Partnership with Edinburgh Royal Infirmary 2016 Copyright © 2017 NIKKISO Co., LTD. All rights reserved. | Confidential

Cause and Action Card1 Cause: Patient could be hypovolemic Line could be kinked or clamped Line could be occluded or clotted Access could be against the vessel wall Action: Check patient’s fluid status Correct any kinks or clamps on the line Check the correct size of catheter, correct site and placement Consider catheter troubleshooting 2 Further Aquarius information may be found in: Pressure Monitoring, Alarms & Troubleshooting. Nikkiso CARE Module 2, Lesson 4, Page 67 of 76. Alarms, messages, system errors, and removal options. IFU Aquarius System with RCA SW 6.02, Rev. 4.1 (07/2014), Section 6.2. Pages 136 to 152. Produced in Partnership with Edinburgh Royal Infirmary 2016 Copyright © 2017 NIKKISO Co., LTD. All rights reserved. | Confidential

Troubleshooting Circuit Card Produced in Partnership with Edinburgh Royal Infirmary 2016 Copyright © 2017 NIKKISO Co., LTD. All rights reserved. | Confidential

High Return Pressure Alarm Card Produced in Partnership with Edinburgh Royal Infirmary 2016 Copyright © 2017 NIKKISO Co., LTD. All rights reserved. | Confidential

Cause and Action Card2 Cause Line could be kinked or clamped Line could be occluded or clotted Inadequate anticoagulation – partial clot in return drip chamber Running treatment with No Anticoagulation Low level of blood in return drip chamber Action Correct any kinks or clamps on the line Consider Catheter Troubleshooting Check anticoagulant and predilution Program a small volume of post-dilution Correct blood level in return drip chamber 2: Overview taken from Joannidis et al. Clinical review: Patency of the circuit in continuous renal replacement therapy. 2007, Critical Care, 11:218 (doi:10.1186/cc5937) accessed 12020802017 at http://ccforum.biomedcentral.com/articles/10.1186/cc5937 Produced in Partnership with Edinburgh Royal Infirmary 2016 Copyright © 2017 NIKKISO Co., LTD. All rights reserved. | Confidential

Troubleshooting Circuit Card Produced in Partnership with Edinburgh Royal Infirmary 2016 Copyright © 2017 NIKKISO Co., LTD. All rights reserved. | Confidential

Balance Alarm (max. 5 in 20 minutes) Alarm Card Balance Alarm (max. 5 in 20 minutes) Produced in Partnership with Edinburgh Royal Infirmary 2016 Copyright © 2017 NIKKISO Co., LTD. All rights reserved. | Confidential

Cause and Action Card Cause Kink or clamp on filtrate line or bag Bag positioning Kink or clamp on manifold for multiple bags Action Remove kink or clamp on filtrate line, bag or manifold Check bag positioning If problem persists, return to using one bag per scale Produced in Partnership with Edinburgh Royal Infirmary 2016 Copyright © 2017 NIKKISO Co., LTD. All rights reserved. | Confidential

Troubleshooting Circuit Card Remove clamp on filtrate line Remove kink on manifold Remove clamp on filtrate bag If persists or can’t find kink/clamp return to one bag per scale Produced in Partnership with Edinburgh Royal Infirmary 2016 Copyright © 2017 NIKKISO Co., LTD. All rights reserved. | Confidential

Alarm Card Blood Leak Produced in Partnership with Edinburgh Royal Infirmary 2016 Copyright © 2017 NIKKISO Co., LTD. All rights reserved. | Confidential

Cause and Action Card Cause Discoloured filtrate Damage to membrane Dust or dirt on detector Action Urinalysis ‘dipstick’ test effluent. If positive for blood; stop treatment, do not return blood Consider haemolysis test Ensure detector pot is in situ and clean Ensure detector mirror in situ and clean Do not use cleaning wipes. A clean cloth or paper towel is sufficient. Produced in Partnership with Edinburgh Royal Infirmary 2016 Copyright © 2017 NIKKISO Co., LTD. All rights reserved. | Confidential

Troubleshooting Circuit Card Produced in Partnership with Edinburgh Royal Infirmary 2016 Copyright © 2017 NIKKISO Co., LTD. All rights reserved. | Confidential

Check Substitution / Dialysate line Alarm Card Check Substitution / Dialysate line Produced in Partnership with Edinburgh Royal Infirmary 2016 Copyright © 2017 NIKKISO Co., LTD. All rights reserved. | Confidential

Cause and Action Card Cause Insufficient flow to degassing chamber Incorrect positioning of degassing chamber Action Is chamber level low? Check: the bag has both long and short seals broken, is pierced correctly, there is not a clamp on, there is no kink in the line, the lines are not trapped in the heater door Is chamber level high? Check: the short line with green clamp attached to pot is sitting in the groove of housing door Produced in Partnership with Edinburgh Royal Infirmary 2016 Copyright © 2017 NIKKISO Co., LTD. All rights reserved. | Confidential

Troubleshooting Circuit Card Produced in Partnership with Edinburgh Royal Infirmary 2016 Copyright © 2017 NIKKISO Co., LTD. All rights reserved. | Confidential

No Fluid Chamber Detected Degassing Chamber Missing Alarm Card No Fluid Chamber Detected Degassing Chamber Missing Produced in Partnership with Edinburgh Royal Infirmary 2016 Copyright © 2017 NIKKISO Co., LTD. All rights reserved. | Confidential

Cause and Action Card Cause The degassing chamber is not correctly installed Action Lift the degassing chamber out of the holder and replace back down firmly Ensure the short tubing with green clamp at rear of chamber is in the groove of housing door Press pot down firmly so the underside of the pot is flush with machine Produced in Partnership with Edinburgh Royal Infirmary 2016 Copyright © 2017 NIKKISO Co., LTD. All rights reserved. | Confidential

Troubleshooting Circuit Card Produced in Partnership with Edinburgh Royal Infirmary 2016 Copyright © 2017 NIKKISO Co., LTD. All rights reserved. | Confidential

Copyright © 2017 NIKKISO Co., LTD. All rights reserved. | Confidential AQUARIUS system NIKKISO Europe GmbH Desbrocksriede 1 30855 Langenhagen Germany ACCUSOL solution* Nikkiso Belgium bvba Industriepark 6 3300 Tienen Belgium * Registered as a drug and/or a medical device AQUAMAX hemofilter Nikkiso Belgium bvba Industriepark 6 3300 Tienen Belgium AQUALINE tubing Haemotronic S.p.A. Via Carreri, 16 41037 Mirandola Italy AQUASET and CITRASETRCA Haemotronic S.p.A. Via Carreri, 16 41037 Mirandola Italy AquariusTM, AccusolTM, AquamaxTM and AquasetTM are trademarks of Nikkiso Co., Ltd. Copyright © 2017 NIKKISO Co., LTD. All rights reserved. | Confidential