Red Cycler 5C Operating instructions

HomeChoice
HomeChoice PRO
APD Systems
Patient At-Home Guide
Creating a Better World of Care for Renal Patients
PATIENT GUIDE COVERS_Update121109.indd 1
12/11/2009 2:26:51 PM
The HomeChoice
and HomeChoice PRO
APD Systems
Patient At-Home Guide
Document Number 07-19-61-244
October 2, 2009
Baxter, HomeChoice, UltraBag, MiniCap, FlexiCap, OptiChoice, Dianeal, and Extraneal are
trademarks of Baxter International Inc.
Copyright 2009 Baxter Healthcare Corporation. All rights reserved.
HomeChoice APD Systems Patient At-Home Guide October 2, 2009 07-19-61-244
Table of Contents
1
Glossary
1.1
1.2
2
User Assistance Information
2.1
2.2
3
3.3
3.4
Side Effects and Contraindications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-1
Warnings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-1
3.2.1
Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-1
3.2.2
Treatment - Overfill / IIPV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-3
3.2.3
Supplies – General . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-6
3.2.4
Supplies – Solutions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-7
3.2.5
Supplies – Disposable Set . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-10
3.2.6
General . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-11
Cautions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-14
Battery Precautions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-16
Indications for Use
4.1
5
Personal and Cycler Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-1
Numbers to Call for Assistance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-1
Warnings and Cautions
3.1
3.2
4
Terms Used in This Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-1
Symbols Used on the HomeChoice and HomeChoice PRO APD Systems . . . . . . . . 1-12
About This Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-1
Description
5.1
5.2
5.3
5.4
5.5
Introduction to HomeChoice APD Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Introduction to Peritoneal Dialysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5.2.1
Continuous Ambulatory Peritoneal Dialysis (CAPD) . . . . . . . . . . . . . .
5.2.2
Automated Peritoneal Dialysis (APD) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
HomeChoice APD Systems Functions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5.3.1
Fluid Pathways: Drain, Fill, and Dwell . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5.3.2
Fluid Flow During Power Failure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5.3.3
Situations When Fluid Lines are Not Controlled . . . . . . . . . . . . . . . . . .
HomeChoice APD Systems Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
HomeChoice APD Systems Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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5-1
5-2
5-3
5-3
5-4
5-5
5-6
5-6
5-7
5-8
i
Table of Contents
5.6
5.7
6
Environmental Conditions
6.1
6.2
7
Check-out . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-1
Set Up the HomeChoice APD System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-2
Grounding Instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-4
Operating Instructions – PRO Card and Modem
8.1
8.2
8.3
8.4
8.5
ii
Operating Conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-1
Use While Traveling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-1
Setup and Check-out
7.1
7.2
7.3
8
5.5.1
The HomeChoice PRO APD System Cycler . . . . . . . . . . . . . . . . . . . . . . . . 5-8
5.5.2
The HomeChoice APD System Cycler . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-10
5.5.3
Control Panel Buttons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-12
Disposable Sets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-13
5.6.1
Luer Disposable Set . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-14
5.6.2
Spike Disposable Set . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-15
HomeChoice APD System and HomeChoice PRO APD System Differences . . . . . . 5-16
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-1
Using the PRO Card . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-3
8.2.1
Care and Handling of the PRO Card . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-3
8.2.2
Confirm Your PRO Card . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-4
8.2.3
Confirm a New Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-5
8.2.4
HomeChoice PRO APD System Prompts . . . . . . . . . . . . . . . . . . . . . . . . . . 8-7
8.2.5
Definitions of Data Entry Prompts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-8
8.2.6
Remove Your PRO Card . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-10
Display Messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-11
8.3.1
No PRO Card . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-11
8.3.2
Card Reader Disabled . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-12
8.3.3
PRO Card Full . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-12
8.3.4
Invalid PRO Card, Program Not Valid . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-13
8.3.5
Card Reader Error . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-13
Install the Modem Option . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-14
8.4.1
Test the Modem Installation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-16
If You Require a New System or “Swap” . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-17
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Table of Contents
9
Operating Instructions – Change Program
9.1
9.2
9.3
9.4
9.5
9.6
9.7
9.8
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-1
About Your System’s Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-1
9.2.1
Nurse’s Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-1
The Nurse’s Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-2
If You Receive a New System or “Swap” . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-3
Manual Programming . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-4
9.5.1
Basic Steps for Manual Programming . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-4
Therapy Type . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-8
Standard Mode (Standard Fill Mode) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-9
9.7.1
CCPD/IPD Therapy Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-9
9.7.2
CCPD/IPD Calculated Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-12
9.7.3
Hi-Dose CCPD Therapy Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-13
9.7.4
Hi-Dose CCPD Calculated Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-17
9.7.5
Tidal Therapy Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-18
9.7.6
Tidal Calculated Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-24
9.7.7
Hi-Dose Tidal Therapy Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-25
9.7.8
Hi-Dose Tidal Calculated Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-33
Low Fill Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-34
9.8.1
CCPD/IPD Therapy Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-35
9.8.2
CCPD/IPD Calculated Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-38
9.8.3
Hi-Dose CCPD Therapy Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-39
9.8.4
Hi-Dose CCPD Calculated Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-44
9.8.5
Tidal Therapy Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-45
9.8.6
Tidal Calculated Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-53
9.8.7
Hi-Dose Tidal Therapy Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-54
9.8.8
Hi-Dose Tidal Calculated Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-62
10 Operating Instructions – Make Adjustments
10.1
10.2
Make Adjustments Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-1
10.1.1
Changing Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-1
Option Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-3
10.2.1
Adjust Brightness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-3
10.2.2
Adjust Loudness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-4
10.2.3
Auto Dim . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-5
10.2.4
Set Clock . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-6
10.2.5
Set Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-7
10.2.6
I-Drain Time . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-8
10.2.7
I-Drain Alarm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-9
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Table of Contents
10.2.8
10.2.9
10.2.10
Comfort Control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-13
Last Manual Drain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-14
UF Target and Alarm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-15
11 Operating Instructions – Prepare for Therapy
11.1
11.2
11.3
11.4
11.5
11.6
11.7
11.8
11.9
Gather Your Supplies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-1
Prepare Your Solution Bags . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-3
Turn On Your HomeChoice APD System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-5
Menu Options at Startup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-7
Load the Disposable Set . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-10
Attach the Drain Option . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-14
Connect the Solution Bags . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-15
Prime the Disposable Set . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-18
11.8.1
Reprime the Patient Line . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-23
Connect Yourself to the Disposable Set . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-24
12 Operating Instructions – Perform Therapy
12.1
12.2
12.3
12.4
12.5
12.6
12.7
Initial Drain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-1
12.1.1
Menu Options During Initial Drain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-4
Fill . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-5
12.2.1
Menu Options During Fill . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-5
Dwell Phase . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-7
12.3.1
Menu Options During Dwell . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-7
Drain Phase . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-9
12.4.1
Menu Options During Drain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-9
Pause Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-11
12.5.1
Menu Options When STOP is Pressed . . . . . . . . . . . . . . . . . . . . . . . . . 12-11
Hi-Dose Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-13
12.6.1
Day Dwell Options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-15
Perform a Hi-Dose Day Exchange . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-16
12.7.1
Disconnect Yourself During Hi-Dose Dwell . . . . . . . . . . . . . . . . . . . . 12-18
12.7.2
Reconnect and Continue Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . 12-20
13 Operating Instructions – End Therapy
13.1
13.2
13.3
iv
Ending Your Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-1
Disconnect Yourself . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-6
Shut Down . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-8
13.3.1
Menu Options During End of Therapy . . . . . . . . . . . . . . . . . . . . . . . . 13-10
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14 Operating Instructions – Effluent Sampling
14.1
14.2
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-1
Take an Effluent Sample . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-2
15 Cleaning
15.1
15.2
15.3
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-1
Cleaning the Cycler . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-2
Preparing the Cycler for Return to Baxter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-3
16 Maintenance
17 Storage
17.1
17.2
17.3
Cycler . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-1
Battery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-1
Dialysis Solution and Disposables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-1
18 Troubleshooting
18.1
18.2
18.3
List of Alarms and Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-1
Correcting Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-3
18.2.1
Types of Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-4
Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-5
18.3.1
Check Lines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-5
18.3.2
Check Lines and Bags . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-9
18.3.3
Check Therapy Setting Value . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-10
18.3.4
Phase Not Finished . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-11
18.3.5
Load a New Set . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-12
18.3.6
Low Ultrafiltration (UF) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-13
18.3.7
Low Drain Volume . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-15
18.3.8
Slow Flow Rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-19
18.3.9
Machine Tilted . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-20
18.3.10 Warming Solution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-21
18.3.11 Caution: Negative UF . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-22
18.3.12 Check Your Position . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-24
18.3.13 Reload the Set . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-26
18.3.14 Caution: Positive UF . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-29
18.3.15 Verify I-Drain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-30
18.3.16 System Errors 2240 or 2267 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-31
18.3.17 System Error nnnn . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-33
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18.4
18.5
18.6
18.7
18.8
18.9
18.10
18.3.18 Temp Stabilizing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Bypass Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
18.4.1
Bypass Initial Drain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
18.4.2
Bypass Low Drain Volume Alarm During Initial Drain . . . . . . . . .
18.4.3
Bypass Drain Phase . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
18.4.4
Bypass Drain Not Finished Alarm . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
18.4.5
Bypass Low Drain Volume Alarm . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
18.4.6
Bypass Caution: Negative UF Alarm . . . . . . . . . . . . . . . . . . . . . . . . . .
18.4.7
Check Supply Line Alarm During Replenish . . . . . . . . . . . . . . . . . . .
Manual Drain Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
End Therapy Early Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Reprime Patient Line Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Increased Intraperitoneal Volume (IIPV) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Power Failure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Emergency Disconnect Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
18.10.1 Disconnect from the System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
18.10.2 Return to Therapy After an Emergency Disconnect . . . . . . . . . . . .
18-35
18-37
18-37
18-39
18-41
18-43
18-45
18-49
18-52
18-53
18-55
18-57
18-58
18-62
18-65
18-66
18-67
19 Technical Data
19.1
19.2
19.3
19.4
19.5
19.6
19.7
19.8
19.9
19.10
19.11
19.12
19.13
19.14
19.15
vi
Physical Specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19-1
Electrical Power Requirements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19-1
19.2.1
Extension Cords . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19-2
System Performance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19-2
Environmental Requirements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19-2
Battery Backup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19-3
Electromagnetic Compatibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19-3
Solution Temperature Protective System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19-9
Audible Alarm Silence Period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19-9
Range of Sound Pressure Levels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19-9
Maximum Pressures Used to Transfer Solution To and From the Patient . . . . . . 19-9
Protective System Preventing Air Infusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19-10
Protective System Preventing IIPV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19-10
Drain Logic Options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19-11
19.13.1 Standard Fill Mode Drain Logic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19-11
19.13.2 Low Fill Mode Drain Logic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19-12
Replenish Logic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19-13
19.14.1 Scheduled Replenish . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19-13
19.14.2 Unscheduled Replenish . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19-14
Determining Maximum Fill Volume . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19-14
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19.16
19.17
Determining Initial Drain Alarm Volume Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . 19-16
Determining Tidal Total UF and Last Manual Drain UF Target
Volume Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19-18
20 Quick Reference
20.1
20.2
20.3
Prepare for Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20-2
Perform a Hi-Dose Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20-13
End Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20-19
Index
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Glossary
1
1. Glossary
Section
Glossary
1.1
Terms Used in This Guide
# of Day Exchanges
The number of CAPD manual exchanges performed using an UltraBag system.
If no manual exchanges are performed on a given day, enter a zero (0). The
maximum number of manual exchanges allowed is five (5).
Abdomen
The area of your body that includes your stomach.
Abdominal Fullness
A patient’s feeling of fullness, sometimes referred to as “overfill” or “overfull.”
This feeling can come from Increased Intraperitoneal Volume (IIPV), or can
come from eating a large meal, constipation, or abdominal masses. See also
IPV and IIPV.
Air Infusion
Air in the patient line delivered to the peritoneal cavity. Air infusion can cause
pain in the abdomen and/or shoulder. An incomplete prime can cause air
infusion.
Aseptic Technique
The practice of cleanliness in handling items associated with your therapy. It
means you should put on a face mask and thoroughly wash and dry your
hands every time you connect or disconnect.
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1. Glossary
Automated Peritoneal Dialysis (APD)
APD is any form of peritoneal dialysis that is performed by a mechanical
device, known as a cycler. Treatment settings are programmed on the cycler
and are performed automatically, generally while you sleep.
Before you go to sleep, you attach the tubing and solution bags to the cycler.
You then connect the tubing to your transfer set attached to your catheter.
The cycler then performs the peritoneal dialysis by automatically delivering
the prescribed Fills, Dwells, and Drains of each therapy cycle throughout the
night.
Blood Pressure, Diastolic
The lowest number of your daily blood pressure (mmHg) when your heart
relaxes.
Blood Pressure, Systolic
The highest number of your daily blood pressure (mmHg) when your heart
pumps blood.
Bypass
An option you can select to go on to the next therapy phase if the therapy or
an alarm has been stopped. Some therapy or alarm conditions can not be
bypassed.
Cassette
The clear rectangular plastic piece of the disposable set that is inserted behind
the door of the HomeChoice/HomeChoice PRO APD System.
Catheter (PD Catheter)
In peritoneal dialysis, a catheter is used to deliver dialysis solution into the
peritoneal cavity and drain it out.
Contamination
The presence of foreign material that makes a substance impure or harmful.
1-2
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1. Glossary
Continuous Ambulatory Peritoneal Dialysis (CAPD)
With CAPD, the blood is being cleaned continuously, both day and night. The
dialysis solution passes from a plastic bag through the catheter and into the
peritoneal cavity. The solution stays in the peritoneal cavity with the transfer
set closed. After several hours, the solution is drained into a disposable bag.
Then the peritoneal cavity is refilled with fresh solution through the catheter
to begin the cleaning process again. This is a manual type of peritoneal
dialysis (PD) and does not use a cycler.
Continuous Cycling Peritoneal Dialysis (CCPD)
CCPD is a form of APD. It is a continuous therapy in which a cycler performs
exchanges while you sleep. Dialysis solution can be left in the peritoneal cavity
during the daytime, or it can be completely drained before ending the
treatment (referred to as Nocturnal Intermittent Peritoneal Dialysis, or NIPD).
Cycle (Exchange)
In peritoneal dialysis, a cycle consists of three phases: a Fill phase, a Dwell
phase, and a Drain phase. Every APD therapy contains one or more cycles.
Cycler
A mechanical device that performs peritoneal dialysis solution exchanges in
regular cycles. Your HomeChoice/HomeChoice PRO APD System device is a
cycler.
Day Fills
The amount of solution the system delivers to your peritoneal cavity for a
daytime exchange. During the Dwell phase of a daytime exchange, you can
disconnect from the system and have the freedom to conduct your normal
daytime activities. The daytime exchanges are a part of Hi-Dose therapy. See
also Hi-Dose CCPD/Hi-Dose Tidal.
Day Fill Volume
The volume of solution for each daytime exchange. This volume is based on
your prescription.
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1. Glossary
Dextrose
A form of sugar that is an ingredient in most of the solutions used for
peritoneal dialysis. The dextrose draws extra fluid from the body into the
dialysis solution.
Dialysis
The process of cleaning waste from the blood artificially. This job is normally
done by the kidneys. If the kidneys fail, the blood must be artificially cleaned
with special equipment. The two major forms of dialysis are hemodialysis and
peritoneal dialysis. See also Peritoneal Dialysis (PD).
Dialysis Solution
A special liquid used in both hemodialysis and peritoneal dialysis to clean the
blood. Dialysis solution contains dextrose (a sugar) and other compounds
similar to those in the body.
Disconnect Cap
A povidone-iodine solution-filled cap that is placed over the connectors on the
transfer set or the connector on the patient line of the disposable set.
FlexiCap and MiniCap are disconnect caps.
Disposable Set
The organizer and attached tubing lines that connect a patient to the solution
and drain bags. The disposable set is used to deliver dialysis solution to the
peritoneal cavity during therapy. The disposable set is used only once.
Drain/Full Drain
The removal of the dialysis solution from your peritoneal cavity. Depending
on the time of day and type of therapy, the amount of fluid drained may be a
complete Drain or a partial Drain (Tidal therapy).
The volume of fluid is measured in milliliters (mL). One liter is equal to
1000 milliliters.
Drain Bag
The optional bag into which fluid from your peritoneal cavity drains.
1-4
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1. Glossary
Drain Line Extension
An optional extension line that attaches to the drain line of the disposable set.
This extra length allows you to drain into a shower, tub, or toilet.
Drain Volume
The volume of a Drain after a Dwell cycle.
Dry Weight
Your weight after a dialysis session when all of the extra fluid in your body has
been removed.
Dwell and Dwell Time
The amount of time the fluid remains in your body during each cycle. Dwell
Time or Dwell is part of the therapy cycle.
Effluent
The used dialysis solution drained from the body as part of an exchange.
End-Stage Kidney Disease (ESKD)
Kidney failure. Requires dialysis or a kidney transplant.
End-Stage Renal Disease (ESRD)
Kidney failure. Requires dialysis or a kidney transplant.
Exchange
The draining of used dialysis solution from the abdomen, followed by refilling
with a fresh bag of solution.
Face Mask
A mask covering the mouth and nose. A face mask is used to prevent bacteria
from contaminating the sterile components of the disposable set, lines, and
solution bags.
Fill Volume
The volume of fluid to be delivered to your peritoneal cavity during each cycle.
The appropriate volume of fluid is determined by your physician.
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1. Glossary
First Fill
The first Fill cycle of your therapy following an Initial Drain (I-Drain).
Fluid Overload
Too much fluid in the body. This is caused by more fluid going into your body
than is coming out. Fluid overload can be dangerous to your heart.
Flush
The process by which the system pumps a small amount of dialysis solution
from the supply bags to the drain line after the supply line connections have
been made. This helps reduce infection from supply line contamination.
Hi-Dose CCPD / Hi-Dose Tidal
The goal of Hi-Dose therapy is to provide a 24-hour therapy that combines
conventional nighttime therapies, such as CCPD or Tidal, with additional
daytime exchanges. This may help improve the outcome of your dialysis
treatment.
During the Dwell phase of each Hi-Dose exchange, you can disconnect from
the system and have the freedom to conduct your normal daytime activities.
Hypothermia
A body temperature that is too far below normal.
Increased Intraperitoneal Volume (IIPV)
This condition is when there is more fluid in your abdomen than was
prescribed. This condition is sometimes called “overfill.” IIPV could result in a
feeling of abdominal discomfort, serious injury, or death. See 18.8, Increased
Intraperitoneal Volume (IIPV), on page 18-58.
Initial Drain (I-Drain)
The Drain that occurs at the beginning of each therapy, before the first regular
Fill.
I-Drain Volume
The volume of an Initial Drain.
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1. Glossary
Intermittent Peritoneal Dialysis (IPD)
A form of peritoneal dialysis in which dialysis sessions take place two to four
times a week, 12 to 20 hours per session. The dialysis solution is drained
completely at the end of the session and the peritoneal cavity remains empty
between the sessions.
Intraperitoneal Volume (IPV)
The amount of fluid in the peritoneal cavity at a given point in time.
Last Fill Concentration
This is the concentration strength of dialysis solution used for the Last Fill.
The Last Fill dialysis solution concentration may be different from the heater
bag and supply bag concentration.
Last Fill Volume
The Last Fill of solution that is delivered at the end of your therapy and left in
the peritoneal cavity during the day. This is also referred to as a Wet Day.
Low Fill Mode
This mode is available only to patients whose Fill volumes are less than
1000 mL. These patients typically weigh less than 44 lbs (20 kg).
In Low Fill Mode, the Drain logic has lower alarm limits for Slow Flow and No
Flow. A Minimum Drain Time must be set, in addition to a Minimum Drain
Volume. The Negative UF alarm and a Positive UF alarm can be set when in
this mode. Low Fill Mode must be used with the Low Recirculation Volume
Set.
Low Recirculation Volume APD Set with Cassette
(Low Recirculation Volume Set)
A disposable set with a 7.5-foot (2.9-meter) patient line made with a smaller
inside diameter tubing than the other lines in the set. This reduces the fluid
flow to patients using Low Fill Mode. The internal recirculation volume of this
set is 17 mL.
Nite (Night) Therapy Time
The total amount of time for the nighttime portion of Hi-Dose therapy. This
time is fixed and begins as soon as you complete your daytime exchanges.
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1. Glossary
Night Concentration 1
This is the concentration of the primary solution bag placed on the heater pan.
Night Concentration 2
This concentration is for the supply solutions that may be different from the
heater bag solution.
No Flow
This occurs when there is no measurable flow rate of solution. No Flow can
reduce the Dwell Time and decrease the amount of effective dialysis time. This
can be caused by a kink or closed clamp on one or more of the lines or by an
empty bag.
Occluder
The occluder clamps the solution lines if a power failure occurs or when the
system is off. This prevents any solution from being delivered to the patient.
The occluder is located inside the door on the front of the cycler.
Organizer
The blue plastic piece that holds the tubing lines and connectors of the
disposable set during preparation for therapy. The organizer hooks onto the
door of the cycler.
Overfill
A feeling of fullness in the abdomen. This feeling can come from IIPV, or can
come from eating a large meal, constipation, or abdominal masses. See also
Abdominal Fullness, Intraperitoneal Volume (IPV), and Increased
Intraperitoneal Volume (IIPV).
Patient Line Extension
An optional extension line that attaches to the patient line of the disposable
set. This extra length allows you to be up to an additional 12 feet (3.7 meters)
away from your system during therapy.
Peritoneal Cavity
The space around your internal organs inside the lower abdomen.
1-8
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1. Glossary
Peritoneal Dialysis (PD)
A form of dialysis that uses the lining of your abdomen, called the peritoneal
membrane, as a filter to remove waste products from your body.
A tube known as a catheter is surgically placed through the wall of your
abdomen. Dialysis solution flows from a bag through the catheter and into the
peritoneal cavity. Waste products and excess fluids from your body pass from
the blood through the peritoneal membrane and into the dialysis solution. The
dialysis solution, now filled with waste, is then drained from the peritoneal
cavity. This cycle may be performed multiple times.
Peritoneal dialysis can be performed with or without a mechanical device. See
also Automated Peritoneal Dialysis (APD).
Peritoneal Membrane
The layer of tissue that lines your abdominal cavity. A membrane can act as a
filter, allowing some particles to pass from one part of the body to another
while not allowing others to pass. The peritoneal membrane is used as a filter
during peritoneal dialysis.
Peritonitis
Inflammation of the peritoneal membrane, usually caused by infection.
Phase
A part of a cycle or an exchange. Each exchange is divided into three phases: a
Fill phase, a Dwell phase, and a Drain phase.
Positional Drainer
A patient who may increase Drain Volume by changing his/her position, or
who drains best in one position.
Priming
To prepare for therapy, priming is the process the system uses to fill all tubing
lines of the disposable set with solution. Priming removes air from the system.
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1. Glossary
PRO Card
The small electronic card that stores information about your treatment
sessions and your system settings. This is used only with a HomeChoice PRO
APD System.
Pushback
A small amount of fluid is pushed back from the cycler to the patient. This
verifies that the patient line is not occluded when a Drain ends due to No
Flow. The next Fill begins at this volume.
Recovered I-Drain Volume
The amount of solution that did not drain during Initial Drain. This amount
was drained by doing a Manual Drain during first Fill or early in the Dwell
phase of the first cycle. This amount is not part of your ultrafiltration (UF) for
this therapy.
Slow Flow
This occurs when the flow rate of solution is very slow. Slow Flow can reduce
the Dwell Time and decrease the amount of effective dialysis therapy. This can
be caused by a partial kink or closed clamp on one or more of the lines or by
an empty bag.
Solution Bags
Bags that contain the prescribed dialysis solution for your therapy. When
attaching these solution bags to your cycler and disposable set, make sure you
are using the correct solution.
Standard Fill Mode
The Standard Fill operating mode is typically prescribed for patients with Fill
volumes over 1000 mL. The Drain cycle Slow Flow alarm/move on threshold
is 50 mL/minute and the Drain cycle No Flow alarm/move on threshold is
12 mL/minute.
System
The HomeChoice and HomeChoice PRO APD Systems include the cycler,
disposable set, solution bags, drain lines, and Patient At-Home Guide. The
HomeChoice PRO APD System also includes the PRO Card.
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1. Glossary
Tidal Peritoneal Dialysis (TPD)
Tidal dialysis is a form of APD where only a portion of the solution in your
peritoneal cavity is drained and filled each cycle.
Tidal Volume
The volume of solution filled during each Tidal cycle.
Tidal Volume Percentage
The Tidal Volume expressed as a percent (%) of the Fill Volume.
Total UF
Total UF (ultrafiltration) is the sum of the UF for all of your cycles. The Initial
Drain and your Last Fill Volume are not included in your Total UF.
Total Volume
The Total Volume of dialysis solution for the entire course of therapy,
including the Last Fill Volume.
Transfer Set
Tubing that connects the patient line on the disposable set or UltraBag set to
the catheter.
Ultrafiltration (UF)
UF is the additional fluid removed from your body as part of your dialysis
therapy. It is the difference between the total amount of fluid filled and the
amount of fluid drained.
Universal Precautions
Universal precautions refers to the practice, in medicine, of avoiding contact
with patients’ bodily fluids, by means of wearing nonporous articles such as
medical gloves, goggles, and face shields.
Uremia
The condition in which a person gets sick from wastes (toxins) that build up in
the blood. Someone who has uremia may experience nausea, weakness,
weight loss, memory problems, and/or trouble sleeping.
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1-11
1. Glossary
1.2
Symbols Used on the HomeChoice and
HomeChoice PRO APD Systems
Alternating current
Type B applied part
Date of manufacture
SN
Serial number
Fuse – Replace only with same type and rating
Recovery / Recyclable
Crossed-out wheeled bin:
–
–
–
Do not dispose of this product as unsorted municipal
waste.
Collect this product separately.
Use collection and return systems available to you.
Bar below bin:
–
IPX1
Product brought to market after August 13, 2005.
Ingress protection:
–
–
Not protected against ingress of solid foreign objects.
Protected against ingress of vertical dripping water.
Contains rechargeable battery
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1. Glossary
NONSPILLABLE
BATTERY
Nonspillable lead-acid battery is recyclable
Pb
Canadian Standards Association –
Meets applicable requirements for the U.S. and Canada.
R
C
US
Manufacturer:
Baxter Healthcare Corporation
Renal Division
McGaw Park, IL 60085
U.S.A.
Baxter Healthcare SA
8010 Zurich
Switzerland
Mains Power (Off) / Mains Power (On)
Fragile
95
Humidity limitation for transport and storage
10
Keep dry
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1. Glossary
Stacking limit; do not stack more than 5 high
5
54°C
Temperature limitation for transport and storage
-32°C
This way up
ATTENTION:
Consult accompanying documents.
Read all instructions before using.
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User Assistance Information
2
2. User Assistance
Information
Section
User Assistance Information
This information is important. Keep this information available at all times.
2.1
Personal and Cycler Information
Name:
Patient ID Number:
Cycler Serial Number:
Cycler Model Number:
2.2
Numbers to Call for Assistance
For Baxter Technical
Assistance contact:
24-HOUR TECHNICAL ASSISTANCE
1-800-553-6898
Dialysis Center:
Name:
Phone:
Times Available:
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2. User Assistance Information
Other Important Information:
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Section
3. Warnings and
Cautions
Warnings and Cautions
3
Warnings and Cautions
3.1
Side Effects and Contraindications
Baxter’s HomeChoice and HomeChoice PRO APD Systems are not designed, sold, or
intended for use except as indicated. See Section 4, Indications for Use.
Baxter’s HomeChoice and HomeChoice PRO APD Systems are not intended to be a
substitute for monitoring the patient’s overall condition by trained and qualified
personnel.
3.2
Warnings
WARNING
Warnings are related to things that can cause harm to you.
READ ALL INSTRUCTIONS BEFORE USING THIS CYCLER!
3.2.1 Treatment
Use aseptic technique to reduce the chance of infection:
– When you connect yourself to the cycler
– When you disconnect yourself from the cycler
– Any time you handle fluid lines and solution bags
Contaminating any part of the fluid path can result in peritonitis.
Peritonitis is an inflammation of the peritoneal membrane, usually caused
by infection.
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3. Warnings and Cautions
Caregivers should use universal precautions when handling effluent
dialysis solution or contaminated disposables. Failure to use universal
precautions can result in infection or injury to the caregiver.
All therapies using the HomeChoice/HomeChoice PRO APD System must be
prescribed and performed under the responsibility of a physician who is
familiar and well-informed about peritoneal dialysis. Improper use of the
HomeChoice APD System can result in serious patient injury or death.
Do not change the settings for your therapy unless directed by your
physician or nurse. Using incorrect settings can cause symptoms and
signs of uremia, including fluid overload.
Contact your dialysis center if:
– You did not complete your treatment
– You skipped your prescribed Last Fill
– Other conditions occur, as instructed by your dialysis center
Too many incomplete or skipped treatments can cause reduced Dwell or
Therapy Time. This can lead to symptoms and signs of end-stage renal
disease (ESRD), including fluid overload.
Always look at your patient line after priming to make sure there is no air
in the line. An incomplete prime can cause air infusion. Air infusion can
cause abdominal and/or shoulder pain.
Conditions that can cause poor catheter drainage include:
– Constipation
– Fibrin accumulation due to a peritonitis infection
– Blockage of the catheter lumen or drainage holes with fibrin, blood
–
–
3-2
clots, or intestines
Kinking of the catheter
Movement of the catheter to the upper portion of the peritoneal cavity
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3. Warnings and Cautions
3.2.2 Treatment - Overfill / IIPV
Overfilling or not draining enough can result in excess fluid in the abdomen, also
known as Increased Intraperitoneal Volume (IIPV). While some people may not
exhibit symptoms, most commonly observed symptoms include:
Feeling full, bloated, or overfull
Abdominal pain or discomfort
Expanded or tense abdomen
Vomiting or spitting-up
Difficulties feeding
Localized swelling around the PD catheter exit site, belly button, groin
region, or genital area
Leakage of fluid from the PD catheter exit site
Difficulty breathing
A child complaining of a "funny feeling" in the abdomen
A child crying
Unexpected increase in blood pressure
IIPV can occur because of one or more of the following reasons:
Low Fill Mode is not programmed for patients whose fill volumes are less
than 1000 mL. These patients typically weigh less than 44 lbs (20 kg). The
Negative UF Limit should not be raised above 50% and the Minimum
Drain Volume % should not be lowered below 85% (the default values).
The Initial Drain Alarm is programmed too low. The system may move on
to the first Fill before you are completely drained if:
– Your last therapy left you with more than your normal Last Fill
–
–
Volume
You did not perform a manual drain
A slow flow condition occurs before you are completely drained
Temporarily increase your I-Drain Alarm setting or perform a Manual
Drain to make sure that your Initial Drain is complete.
The patient line length is greater than 12 feet (3.6 meters) and Initial
Drain Alarm is set below 30 mL. This can cause your Initial Drain to end
early.
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3. Warnings and Cautions
The Minimum Drain Volume % is programmed too low. This can cause
your Drain cycles to end early.
Day Fill Volume, Night Fill Volume, or Last Fill Volume is programmed too
high. This can cause you to be overfilled if the volume is not appropriate
for your body's size.
For Tidal therapies, Total UF volume is programmed too low. This can
cause a gradual buildup of UF volume during the therapy.
Last Manual Drain is programmed to No, or the UF Target for the Last
Manual Drain is programmed too low. This can cause an incomplete last
Drain.
Stop and Go are pressed during Tidal dwells over multiple dwell cycles.
This can reduce the volumetric accuracy of the device over the course of
successive Tidal Dwell cycles.
After a power failure during Prime, the Go button is pressed to start
therapy without closing all clamps first. This can cause a free flow of fluid
from one bag to another and/or to the patient during the time when LOAD
THE SET is displayed.
The door is opened during an alarm or System Error without closing all
clamps first. This can cause a free flow of fluid from one bag to another
and/or to the patient.
The transfer set is connected to the patient line before CONNECT
YOURSELF appears on the display screen. This can cause air to be
delivered to your peritoneal cavity, which can cause IIPV if you had fluid
in your peritoneal cavity prior to the Initial Drain.
At the start of Fill 1, the patient line clamp is opened after a Check Patient
Line alarm or Check Your Position alarm appears on the display screen
without first initiating a manual drain. This can cause air to be delivered
to your peritoneal cavity, which can cause IIPV if you had fluid in your
peritoneal cavity prior to the Initial Drain.
Go is pressed at the end of therapy before all clamps are closed when
CLOSE ALL CLAMPS appears on the display screen. This can cause a free
flow of fluid from one bag to another and/or to the patient.
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3. Warnings and Cautions
The door is opened at the end of therapy before all clamps are closed. This
can cause a free flow of fluid from one bag to another and/or to the
patient.
Any Drain phase is bypassed, including Initial Drain, Day Drain, or Night
Drain. This can cause the system to deliver a full Fill in addition to any
fluid left in the peritoneal cavity.
DRAIN NOT FINISHED, LOW UF, LOW DRAIN VOLUME, or CAUTION:
NEGATIVE UF alarms are bypassed. This can cause the system to deliver a
full Fill in addition to any fluid left in the peritoneal cavity.
A Manual Drain performed during Fill is stopped or bypassed. This can
cause the system to deliver a full Fill in addition to any fluid left in the
peritoneal cavity.
IIPV could result in a feeling of abdominal discomfort, serious injury, or death.
IF IIPV IS SUSPECTED, PLEASE DO THE FOLLOWING:
1.
Press STOP immediately, then press Vand initiate a Manual Drain. The
Manual Drain procedure is located on the next page. See 18.8, Increased
Intraperitoneal Volume (IIPV), on page 18-58 if IIPV is suspected.
2.
Once the fluid is completely drained from the abdomen, call your nephrologist.
3.
Call your nephrologist immediately if you have ANY complaints or symptoms
of IIPV including those listed above.
4.
For assistance in performing the above steps, call the Baxter Customer Service
line which is available 24 hours a day, 7 days a week at 1-800-553-6898
Prompt 1.
5.
If you are unable to reach your dialysis center, nephrologist, or the Baxter
Customer Service Line, and you or the patient are experiencing symptoms of
IIPV, call 911 immediately or go to the nearest Emergency Room.
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3-5
3. Warnings and Cautions
Steps to perform a Manual Drain
The current FILL phase appears on the display screen.
Display screen
FILL
3 OF 5
1.
Press STOP.
STOPPED:
2.
Press V.
FILL VOLUME:
3.
Press V.
BYPASS
4.
Press V.
CHANGE PROGRAM
5.
Press V.
MAKE ADJUSTMENTS
6.
Press V.
MANUAL DRAIN
7.
Press ENTER.
DRAINING:
FILL
ML
ML
The display screen shows the Drain volume. The
system continues to drain until flow is no longer
detected.
8.
Press GO to return to therapy.
9.
Reinitiate a Manual Drain if it is stopped during Fill.
3.2.3 Supplies – General
Use only Baxter Healthcare Corporation accessories, solutions, disposable
sets, and supplies with your HomeChoice/HomeChoice PRO APD System.
Baxter can not ensure that the dialysis products of other manufacturers,
when connected with Baxter’s products, will function in a safe and
satisfactory manner.
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3. Warnings and Cautions
Make sure that you are able to complete all of your treatments as
prescribed by your physician:
–
–
–
–
Order your supplies on time
Keep extra supplies on hand
Keep supplies for a manual exchange available
If your cycler can not begin or complete your treatment, or your APD
supplies are not available, perform a manual exchange as instructed
by your dialysis center.
Too many incomplete or skipped treatments can cause reduced Dwell or
Therapy Time. This can lead to symptoms and signs of end-stage renal
disease (ESRD), including fluid overload.
3.2.4 Supplies – Solutions
Add medication to the solution only as prescribed by a physician. Failure
to follow proper instructions can result in contamination. Adding the
wrong dosage of medication can make your condition worse.
Check each solution bag to ensure:
–
–
–
–
–
–
–
The solution is clear
The solution matches the prescribed type
The dextrose concentration is correct
The volume of solution in the bag is correct
The expiration date has not passed
The pull ring and medication port are in place
There are no leaks
If any problems are found, discard the bag and get a fresh dialysis solution
supply bag. Using wrong or damaged bags can result in inadequate
therapy or contamination of the fluid lines. Contamination of any portion
of the fluid or fluid path can result in peritonitis.
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3. Warnings and Cautions
The solution bag must be placed properly on the heater pan.
– Place the edge of the bag against the bag stops on the right side of the
–
–
heater pan.
Be sure that the bag completely covers the silver heater sensor button.
If the solution bag is not placed properly, overheated or underheated
dialysis fluid can be delivered.
Place the solution bags on a flat, stable surface. To prevent bags from
falling, do not stack bags on top of each other. Falling bags can result in a
disconnect or leak. Possible contamination of the fluid or fluid pathways
can result if a fluid leak occurs. Contamination of any portion of the fluid
or fluid path can result in peritonitis.
For storage and preparation of the dialysis solution, follow the labeling
instructions that come with the solution. Failure to follow the solution
labeling instructions can lead to insufficient therapy or patient injury.
Do not use the dialysis solution if you think you may be allergic to any
component of the solution. Check the labeling provided with your solution
for details to reduce the potential of an allergic reaction.
Make sure the solution bag placed on the heater pan is big enough to hold
the largest programmed Fill Volume plus a replenish buffer of at least
500 mL. Use of a smaller solution bag on the heater pan can cause the
heater bag to be filled in excess of its designed volume. These bags heat
slower and can burst.
Do not replace empty solution bags or reconnect disconnected solution
bags during your therapy. Possible contamination of the fluid or fluid
pathways can result. Contamination of any portion of the fluid or fluid
path can result in peritonitis.
If a bag becomes disconnected during your therapy, follow the
instructions in 18.6, End Therapy Early Procedure, on page 18-55. Notify
your dialysis center.
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3. Warnings and Cautions
When attaching your solution bags to your system and disposable set:
– Make sure the solution bags are connected to the proper lines on the
organizer.
If the solution bag connected to the line with the RED clamp is not
placed on the heater pan, room temperature solution can be
delivered. Room temperature solution is cooler than body
temperature. If a patient is unconscious or asleep and therapy
continues for many hours, hypothermia can develop.
– Make sure you use the correct dialysis solution.
If the concentration or type of solution is different from your
prescription, you may not receive the dialysis therapy you need. This
may lead to an increase or decrease in the amount of fluid
ultrafiltrated during the therapy. When performing a Tidal therapy,
your intraperitoneal volume can increase or decrease if the volume
ultrafiltrated does not equal the programmed Total UF.
– Make sure to connect enough bags of the right volume to deliver your
prescribed Fill Volume.
Multiple incomplete or skipped treatments can cause reduced Dwell
or Therapy Time. This can lead to symptoms and signs of end-stage
renal disease (ESRD), including fluid overload.
Discard the disposable set and all solution bags at the end of therapy.
Possible contamination of the fluid or fluid pathways can result if
disposables are reused. Contamination of any portion of the fluid or fluid
path can result in peritonitis.
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3. Warnings and Cautions
3.2.5 Supplies – Disposable Set
Do not apply alcohol, hydrogen peroxide, or antiseptic containing alcohol
to the disposable set or to the cassette interface inside the door of the
cycler. Using these products can cause the cassette to develop cracks.
Using damaged sets can result in contamination of the fluid or fluid
pathways. Contamination of any portion of the fluid or fluid path can
result in peritonitis.
Do not use the disposable set more than once. Discard after each use.
Reusing the disposable set can increase the risk of contamination, which
can result in peritonitis.
Be sure to use the correct disposable set for your prescribed therapy.
Using the wrong disposable set can result in an inadequate therapy.
Check all disposable set connections for a secure fit before beginning your
therapy. Make sure all clamps on unused fluid lines are closed securely.
Contamination of any portion of the fluid path can result in peritonitis.
Before loading the disposable set, inspect the cassette and tubing for
damage. Using damaged sets can result in contamination of the fluid or
fluid pathways. Contamination of any portion of the fluid or fluid path can
result in peritonitis.
– Inspect the flexible surfaces of the cassette for obvious signs of
damage, including cuts, tears, or punctures.
– Ensure the tip protectors on the ends of the tubing are on and
unbroken. If damage is found, obtain a new disposable set and repeat
the inspection procedure.
– Tubing indentations can be present on disposable sets due to the
flexible and supple nature of the tubing. Slight tubing indentations are
cosmetic and should have no impact on the functionality of the
product.
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3. Warnings and Cautions
3.2.6 General
Leave an air gap (space) between the end of the drain line and any fluid in
the drain or container when using a drain line extension. This prevents
non-sterile fluid from flowing backwards up the drain line. Non-sterile
fluid can contaminate the fluid path resulting in peritonitis.
Verify the operation of the display screen before starting your therapy. If
the display screen is not working correctly, it can display an inaccurate
number. This can lead to insufficient therapy or patient injury.
Verify the operation of the audible alarm. If the audible alarm is not
working, you will not be notified of an alarm situation. This can lead to
insufficient therapy or patient injury.
The modem must be Class II and approved to IEC/EN, CSA/UL 60950-1
with a TNV-1 circuit (accessible circuit is limited to 60Vrms). Using an
unapproved modem may increase the risk of electrical shock.
Do not open the HomeChoice/HomeChoice PRO APD System cycler.
Electrical circuitry inside can pose a shock hazard.
Unplug the HomeChoice/HomeChoice PRO APD System power cord from
the wall outlet, or other AC power source, before cleaning the system.
Failure to do so can cause an electric shock.
Do not use external heating sources, such as a microwave, to warm
solution bags. This can result in overheated solution delivered into your
peritoneal cavity. Dialysis solution should only be heated by the
HomeChoice/HomeChoice PRO APD System.
Do not attempt to operate the system in an explosive atmosphere (i.e.,
when gas is present). This is an explosion hazard and can cause personal
injury and damage to equipment.
Do not operate this product where the following are in use:
–
–
–
–
Aerosol spray products
Flammable anesthetic agents
Nitrous oxide
Oxygen-enriched environment (for example, oxygen tent)
Operating this device in these environments can cause an explosion or
fire.
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3-11
3. Warnings and Cautions
Do not use this product outdoors. Outdoor use can increase the risk of
shock or damage the device.
Do not use electrical nerve stimulation pain management devices while
performing your dialysis therapy. Some of these devices, when used at the
same time as the HomeChoice/HomeChoice PRO APD Systems, have been
shown to cause damage to the system and to the cassette. Baxter can not
ensure that the systems function in a safe and satisfactory manner when
the system is damaged. Damage to the cassette can lead to air infusion
into the peritoneal cavity. Air infusion can cause mild to moderate
abdominal pain.
Do not connect any devices to the HomeChoice/HomeChoice PRO APD
System other than those specified by Baxter as part of the system. Baxter
can not ensure that the dialysis products of other manufacturers, when
connected with Baxter’s products, function in a safe and satisfactory
manner.
The HomeChoice/HomeChoice PRO APD System should not be used near
other equipment. However, if it is necessary to use the cycler close to
other equipment, the cycler should be observed to verify normal
operation.
Do not turn on or use hand-held personal communications devices, such
as mobile two-way radios or cellular phones, near the cycler. Use of these
types of devices can cause the cycler to malfunction. However, cordless
phones up to 2.5 GHz are permitted. Follow the recommended separation
distance chart, Table 19-4 on page 19-8 in Section 19, Technical Data, if a
hand-held device must be used.
Do not operate this product if it:
–
–
–
–
Has a damaged cord or plug
Is not working properly
Has been dropped or damaged
Has been dropped into water
Baxter can not ensure that a cycler will function in a safe and satisfactory
manner under these conditions.
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3. Warnings and Cautions
Return the product to Baxter Technical Assistance for examination and
repair if damage occurs. Contact Technical Assistance at the number listed
in 2.2, Numbers to Call for Assistance, on page 2-1. Baxter Technical
Assistance is available 24 hours a day for HomeChoice/HomeChoice PRO
APD System users.
To reduce the risk of burns, electrocution, fire, or injury to persons:
– Close supervision is necessary when this product is used by, on, or
near children or those unable to care for themselves.
– Use this product only for its intended use as described in this guide.
– Do not use attachments, products, or supplies not recommended by
Baxter.
– Keep the power cord away from heated surfaces.
– Do not use while bathing.
– Do not place or store product where it can fall or be pulled into a tub
or sink.
– Do not place in or drop into water or other liquid.
– Do not reach for the system if it has fallen into water. Unplug it right
away.
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3-13
3. Warnings and Cautions
3.3
Cautions
CAUTION
Cautions are related to things that can damage the
HomeChoice and HomeChoice PRO APD Systems.
The cycler you are using may be the property of Baxter Healthcare
Corporation. Improper care or use may result in additional expense.
Wipe up any spills right away. This reduces the chance of moisture
entering the system and causing a malfunction. This also reduces the
chance of bacteria contamination or an unsanitary condition.
To prevent the cycler from falling, place it on a sturdy, stable nightstand
or table large enough to hold the cycler and the solution bags. Falling can
damage the cycler or cause personal injury.
If an extension cord is used, make sure the ampere rating of the
HomeChoice/HomeChoice PRO APD System does not exceed the extension
cord ampere rating.
– Use only heavy-duty extension cords rated at 1200 watts (10 amp for
110V systems).
– Use only extension cords less than 12 feet (3.5 meters) in length.
– The extension cord must have the third grounding wire that mates
with the grounding plug on the HomeChoice/HomeChoice PRO APD
System power cord.
Failure to follow this advice can result in excessive heating or fire.
Do not attempt to service the HomeChoice/HomeChoice PRO APD System
yourself. Doing so can result in fire, burns, electrocution, or other
personal injury. For servicing, contact Technical Assistance at the number
listed in 2.2, Numbers to Call for Assistance, on page 2-1. Baxter Technical
Assistance is available 24 hours a day for HomeChoice/HomeChoice PRO
APD System users. A service manual for this product is not available.
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3. Warnings and Cautions
Do not use chemical cleaning agents or aerosol spray cleaners. These
products might damage the plastics or surface finishes. Use a small
amount of mild soap and water on a damp cloth to wipe the exterior of the
system. Because the system uses a disposable set, it does not need to be
sterilized or disinfected between uses.
For product disposal (according to WEEE 2002/96/EC or other applicable
regulations), please do the following:
– For more information on return, recovery, or recycling of this product,
please contact Baxter Technical Assistance at the number listed in
2.2, Numbers to Call for Assistance, on page 2-1. Baxter Technical
Assistance is available 24 hours a day for HomeChoice and HomeChoice
PRO APD Systems users.
– Return this product to your dialysis center or to Baxter by calling
Baxter Technical Assistance.
– Do not dispose of this product as unsorted municipal waste.
– Use the collection and return systems available to you.
– Follow your local guidelines for disposal of dialysis waste materials.
Failure to follow disposal instructions can result in groundwater
contamination or a fine.
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3-15
3. Warnings and Cautions
3.4
Battery Precautions
The HomeChoice/HomeChoice PRO APD System contains both a lead-acid
and a lithium battery. The lead-acid battery is automatically checked and
recharged during the HomeChoice/HomeChoice PRO APD System
operation. The batteries require no periodic maintenance.
There is danger of explosion if either battery, located within the
HomeChoice/HomeChoice PRO APD System, is incorrectly replaced.
In case replacement of either battery is needed, contact technical
assistance at the number listed in 2.2, Numbers to Call for Assistance, on
page 2-1. Baxter Technical Assistance is available 24 hours a day for
HomeChoice/HomeChoice PRO APD System users.
Pb
3-16
Contains lead-acid and lithium batteries. Must
be recycled or disposed of properly.
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Section
4
Indications for Use
4. Indications for Use
Indications for Use
Baxter’s HomeChoice and HomeChoice PRO APD Systems are intended for
automatic control of dialysis solution exchanges in the treatment of pediatric and
adult renal failure patients undergoing peritoneal dialysis.
WARNING
Read all warnings, cautions and instructions carefully
before use. (Refer to Section 3, Warnings and Cautions.)
Improper use of the HomeChoice APD System can result in
serious patient injury or death.
CAUTION: Federal (U.S.A.) Law restricts this device to sale by or on order of a
physician.
4.1
About This Guide
This Patient At-Home Guide provides instructions necessary for the proper
operation of the HomeChoice and HomeChoice PRO APD Systems (the “system”).
This guide is meant to be used with and after your training on the system. It does
not provide instructions for the prescription or administration of peritoneal
dialysis.
This guide contains examples that show typical therapy values. The values for
your therapy may vary.
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4-1
4. Indications for Use
4-2
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Section
5
Description
5. Description
Description
This section describes the functions, components, and features of the HomeChoice
and HomeChoice PRO APD Systems (the “system”) and the basics of Peritoneal
Dialysis (PD).
You should learn the names of the system components, where they are located,
and how they function before beginning to use the procedures in this guide.
5.1
Introduction to HomeChoice APD Systems
Baxter's HomeChoice and HomeChoice PRO APD Systems are designed to provide
Automated Peritoneal Dialysis (APD) therapy for pediatric and adult renal
patients. Their Fill volumes can range from 60 mL to 3000 mL.
HomeChoice and HomeChoice PRO APD Systems are intended to be operated by:
Home patients whose physicians have prescribed this system. Patients, or
their caregivers, must have received adequate training to use the system.
Clinicians who are using the system for patients under their care and
under a prescription. Clinicians must have received adequate training to
use the system.
Since Drain and volume requirements vary among patients, both the HomeChoice
and HomeChoice PRO APD Systems software have a choice of modes, either
Standard Mode or Low Fill Mode. The dialysis center selects the Fill mode for the
patient before therapy begins.
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5. Description
5.2
Introduction to Peritoneal Dialysis
Peritoneal Dialysis (PD) is a procedure that cleans and filters the blood. Peritoneal
dialysis rids the body of unwanted waste and excess fluid, helps to control blood
pressure, and maintains the proper balance of chemicals such as potassium,
sodium, and bicarbonate in the body. This process of cleansing the blood uses the
body’s own peritoneal membrane as a filter. See Figure 5-1.
1
2
3
1. Peritoneal Cavity
2. Catheter
3. Peritoneal Membrane
Figure 5-1. Peritoneal Cavity
The basic steps of PD are the following:
1.
Peritoneal dialysis usually begins with an initial drain to remove existing fluid
from the peritoneal cavity.
2.
The peritoneal cavity is filled with fresh dialysis solution. Solution enters
through a catheter that has been surgically placed through the wall of the
abdomen and into the peritoneal cavity.
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5. Description
3.
The solution is allowed to remain (dwell) in the cavity for a period of time.
During this time, waste products pass from the bloodstream through the
peritoneal membrane and into the dialysis solution.
4.
The used dialysis solution containing waste products and excess fluids, called
effluent, is then drained from the peritoneal cavity.
5.
The peritoneal cavity is then refilled with fresh solution to remain (dwell) for
another period of time.
The draining of used dialysis solution from the abdomen, followed by refilling with
a fresh bag of solution, is known as a dialysis exchange.
5.2.1 Continuous Ambulatory Peritoneal Dialysis (CAPD)
With CAPD, the blood is always being cleaned. Dialysis exchanges are done
manually three to five times a day. This type of peritoneal dialysis does not use an
automatic cycler. This method can be used to continue your treatments if you are
unable to use your cycler; for example, during a power failure.
Dialysis solution flows by gravity from a plastic bag through the catheter and into
the peritoneal cavity. The solution stays in the peritoneal cavity with the transfer
set closed. Dwell periods typically last four to six hours during the daytime, and up
to eight hours overnight. After the Dwell period, the used solution is drained into a
disposable bag. Then the peritoneal cavity is refilled with fresh solution to begin
the cleaning process again.
5.2.2 Automated Peritoneal Dialysis (APD)
All peritoneal dialysis techniques that use a cycler to perform exchanges are
referred to as Automated Peritoneal Dialysis (APD).
APD exchanges are usually referred to as cycles. Each cycle consists of three (3)
phases:
Fill phase
Dwell phase
Drain phase
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5. Description
Treatment settings, such as the amount of solution to be infused and the length of
time the solution remains in the peritoneal cavity, are programmed on the cycler.
The cycler then automatically performs the treatment. In APD, the treatment
settings can be modified to meet the needs of each patient.
There are four (4) types of APD therapy:
Continuous Cycling Peritoneal Dialysis/Intermittent Peritoneal Dialysis
(CCPD/IPD)
Tidal Peritoneal Dialysis (TPD)
Hi-Dose Continuous Cycling Peritoneal Dialysis (Hi-Dose CCPD)
Hi-Dose Tidal Peritoneal Dialysis (Hi-Dose TPD)
See Section 1, Glossary for definitions of each of these therapies.
5.3
HomeChoice APD Systems Functions
The HomeChoice and HomeChoice PRO APD Systems perform peritoneal dialysis by
directing the flow of fluid between the solution bags, the cassette, your peritoneal
cavity, and your drain option.
Once you have connected all solution bags and your drain option, and have
connected yourself to the disposable set, you have created a fluid circuit. The
system manages your PD by the following methods:
With the cassette loaded in the cycler, the system is able to draw fluid into
the cassette chambers by opening and closing the correct combination of
valves on the cassette.
The system measures the fluid in the cassette chambers. It then opens and
closes the required valves on the cassette to move fluid to the correct
destination. This allows the system to deliver the programmed Fill
Volume to your peritoneal cavity with high accuracy.
The measurements taken during the Drain cycle allow the system to
calculate how much ultrafiltrate (UF) was removed from your peritoneal
cavity during each Drain cycle. These values are stored in the system so
that you can view them at the end of your therapy.
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5. Description
5.3.1 Fluid Pathways: Drain, Fill, and Dwell
Fluid pathways change during the therapy. They are pictured below for the
three (3) main phases of therapy.
1. DRAIN
During the Drain phase, the
system pulls fluid from
your peritoneal cavity to
the disposable cassette
where it is measured. The
fluid is then sent to the
drain option. This process
is repeated until the system
determines you are empty.
The system calculates the
UF volume for each Drain
cycle.
2. FILL
During the Fill phase, the
system pulls fluid from the
heater bag to the
disposable cassette where
it is measured. The fluid is
then delivered to your
peritoneal cavity. This
process is repeated until
the programmed Fill
Volume has been delivered
to your peritoneal cavity.
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5. Description
3. DWELL
During the Dwell phase, the
system pulls fluid from the
supply bags to the
disposable cassette where
it is measured. This fluid is
then delivered to the heater
bag to replenish the
solution that was used
during the previous Fill
phase. This is done to warm
the fluid in the heater bag
to prepare for the next Fill
phase.
5.3.2 Fluid Flow During Power Failure
If there is a power failure, all valves on the cassette close so there is no fluid flow.
Valves remain closed as long as the door remains locked. See 18.9, Power Failure,
on page 18-62 for complete instructions.
5.3.3 Situations When Fluid Lines are Not Controlled
There are three (3) situations during the use of the system when the fluid lines are
not clamped by the internal occluder (behind the door of the cycler) or not closed
by the valves in the cassette.
All lines should be clamped when any of the following situations take place:
When the door is open.
During treatment setup when LOAD THE SET appears on the display
screen.
At the end of treatment when REMOVE THE SET appears on the display
screen.
During these three situations, the system does not have control of the valves and
fluid pathways. Therefore, solution can move freely between pathways. This can
result in an increased intraperitoneal volume (IIPV) situation.
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5. Description
5.4
HomeChoice APD Systems Features
Features of the HomeChoice/HomeChoice PRO APD System cycler include:
The controls: an On/Off switch, and buttons for GO, STOP, ENTER, up
arrow (U), and down arrow (V).
Prompts and directions lead you step-by-step through each setting,
assuring you that each setting is correct.
Audible alarms and signals alert you to check the display screen.
The cassette, with attached fluid lines, fits into the system only one way so
you always insert it correctly. Connections are color coded.
Settings are changed or adjusted by following the prompts on the display
screen and pressing the appropriate button.
In the event that there is a problem, an alarm sounds and a message
appears on the screen. Most situations can be corrected. If you can not
correct the problem, call the phone number located in Section 2, User
Assistance Information, for assistance.
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5. Description
5.5
HomeChoice APD Systems Description
There are two models of Baxter HomeChoice APD System cyclers described in this
guide:
HomeChoice PRO APD System cycler
HomeChoice APD System cycler
5.5.1 The HomeChoice PRO APD System Cycler
2
1
3
4
00000000
GO
STOP
ENTER
9
5
8
6
7
1. Heater Pan
6. Door
2. Silver Heater Sensor Button
7. Handle (shown in
locked position)
3. Bag Stops
4. Serial Number
8. Control Panel
5. Occluder (behind Door)
9. PRO Card Port
Figure 5-2. Front and Top of the HomeChoice PRO APD System Cycler
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5. Description
1
2
3
5
4
1. Power Entry
4. Power Cord
2. J1 – Service Port
5. On/Off Switch
3. J2 – Modem Port
Figure 5-3. HomeChoice PRO APD System Back Panel
1
2
3
4
5
6
1. Display Screen
4. STOP Button
2. Control Panel
5. ENTER Button
3. GO Button
6. UP/DOWN Buttons
Figure 5-4. HomeChoice PRO APD System
Display Screen and Control Panel
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5. Description
5.5.2 The HomeChoice APD System Cycler
2
1
3
4
GO
STOP
5
ENTER
8
6
7
1. Heater Pan
6. Door
2. Silver Heater Sensor Button
7. Handle (shown in
locked position)
3. Bag Stops
4. Serial Number
8. Control Panel
5. Occluder (behind Door)
Figure 5-5. Front and Top of the HomeChoice APD System Cycler
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5. Description
2
1
4
3
1. Power Entry
3. Power Cord
2. Service Ports
4. On/Off Switch
Figure 5-6. HomeChoice APD System Back Panel
1
2
STOP
GO
3
4
ENTER
5
6
1. Display Screen
4. STOP Button
2. Control Panel
5. ENTER Button
3. GO Button
6. UP/DOWN Buttons
Figure 5-7. HomeChoice APD System
Display Screen and Control Panel
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5. Description
5.5.3 Control Panel Buttons
The general functions of the control panel buttons are described below.
GO Button
GO
(Green)
Press the GO button to:
Start or continue therapy
Continue therapy after an alarm sounds
Continue therapy after a daytime Dwell
STOP Button
(Red)
STOP
Press the STOP button to:
Return to the previous menu
Cancel a setting change
Stop therapy
Mute to silence an audible alarm
ENTER Button
(Blue)
ENTER
Press the ENTER button to:
View a secondary menu
Edit a setting
Accept an edited setting
Move to the next field when editing the date or time
Up/Down Buttons
(Blue)
Press the up and down buttons to navigate menu items.
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5. Description
5.6
Disposable Sets
Disposable sets have one of two types of connections:
Luer
Spike
The following disposable sets are available with either connection type:
Automated PD Set with Cassette – 4 Prong
Integrated APD Set
Low Recirculation Volume APD Set with Cassette
Your dialysis center determines which type of disposable set and connection you
use.
Figure 5-8 and Figure 5-9 show a 4-prong Luer disposable set. Figure 5-10 and
Figure 5-11 show a 4-prong spike disposable set. Your disposable set may look
different.
The instructions in this manual apply to all disposable sets approved for use with
the HomeChoice and HomeChoice PRO APD Systems.
For instructions specific to the type of set you are using, refer to the package insert
for your disposable set.
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5. Description
5.6.1 Luer Disposable Set
3
2
1
4
1. Organizer
3. Cassette
2. Effluent Sampling Site
4. Lines
Figure 5-8. Luer 4-Prong Disposable Set
6
1
2
3
4
5
1. Patient Line
4. Heater Line (Red Clamp)
2. Final Line (Blue Clamp)
5. Drain Line
3. Supply Lines (White Clamps) 6. Luer Connectors
Figure 5-9. Luer 4-Prong Lines and Connectors
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5. Description
5.6.2 Spike Disposable Set
3
2
1
4
1. Organizer
3. Cassette
2. Effluent Sampling Site
4. Lines
Figure 5-10. Spike 4-Prong Disposable Set
6
1
2
3
4
5
1. Patient Line
4. Heater Line (Red Clamp)
2. Final Line (Blue Clamp)
5. Drain Line
3. Supply Lines (White Clamps)
6. Spike Connectors
Figure 5-11. Spike 4-Prong Lines and Connectors
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5. Description
5.7
HomeChoice APD System and HomeChoice
PRO APD System Differences
The HomeChoice APD System and HomeChoice PRO APD System are the same in
operation, except for the PRO Card feature. The PRO Card feature stores
prescription and therapy data. The data can be transferred between your cycler
and your clinician. The two systems use the same disposable sets and solutions.
They perform the same therapies the same way.
Section 8, Operating Instructions – PRO Card and Modem, of this guide describes
the PRO Card and modem features of the HomeChoice PRO APD System. All other
sections apply to both the HomeChoice APD System and the HomeChoice PRO APD
System.
Illustrations shown in the rest of this guide are of the HomeChoice PRO APD
System; however, the instructions apply to both systems.
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Environmental Conditions
6
6. Environmental
Conditions
Section
Environmental Conditions
6.1
Operating Conditions
The HomeChoice and HomeChoice PRO APD Systems are designed for use in these
conditions:
Temperature between 59°F to 96.8°F (15°C to 36°C)
Humidity between 15% and 85%
Altitude of –1,100 ft to +10,000 ft (–340 m to +3,050 m)
6.2
Use While Traveling
The system is designed to be portable and to allow you to travel. To be sure that
your therapies continue smoothly, contact your dialysis center about the
following:
When you will not be taking your supplies with you, arrange with your
dialysis center well in advance of your trip. Your solution and disposable
sets can be delivered to you at your destination.
If you are traveling out of the region where you live, inquire about any
emergency contact information that you will need.
If you are traveling to another country, the solution bag connection
method may be different. Your dialysis center can provide you with
information about any differences in supplies and connection methods.
Some regions of the world use different voltage levels, frequencies, and
plug shapes. Ask your dialysis center about the use of approved plug
adaptors. Also ask about step-up or step-down isolation transformers
with a minimum rating of 500 watts (continuous). Use an isolation
transformer in countries with the same voltage as the U.S. if there is any
doubt about the proper grounding of an electrical outlet.
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6. Environmental Conditions
To avoid any interruption in your therapy during long trips, obtain the
needed supplies for at least a full day’s manual exchanges (CAPD).
Perform manual exchanges if your cycler is lost or damaged in transit, or
your supplies do not arrive on time.
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Setup and Check-out
7
7. Setup and
Check-out
Section
Setup and Check-out
Setup and check-out refers to installing the HomeChoice APD System or
HomeChoice PRO APD System (the “system”) in your home.
7.1
Check-out
1.
Check the cycler for external damage. See 5.5, HomeChoice APD Systems
Description, on page 5-8 for a description of the system and its components.
2.
Verify that a power cord was included in the box.
3.
If you see any damage on the cycler or the cord is missing, contact Baxter
Technical Assistance. See 2.2, Numbers to Call for Assistance, on page 2-1.
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7. Setup and Check-out
7.2
Set Up the HomeChoice APD System
Place the HomeChoice/HomeChoice PRO APD System cycler on a stable, clean, flat
surface (table or nightstand) in a well-lighted area. The table should be large
enough to hold the cycler and all of the solution bags. Make sure a three-prong
grounded outlet is nearby. See 7.3, Grounding Instructions, on page 7-4 for
warnings concerning the three-prong outlet.
Be sure the cycler is placed at the same height as you when you are lying in bed.
To decrease the flow rate during Drain, raise the cycler by approximately
6 inches (15 cm).
To increase the flow rate during Drain, lower the cycler by approximately
6 inches (15 cm).
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7. Setup and Check-out
WARNING
Do not place the cycler more than 12 inches (30 cm) higher
or lower than you when you are lying in bed.
Placing the cycler more than 12 inches (30 cm) above
your position can produce higher than normal flow
rates during Fill and lower than normal flow rates
during Drain. This can cause pain or discomfort during
Fill and extend the duration of the Drain phase. This
can result in a loss in Dwell Time or an increase in LOW
DRAIN VOLUME alarms.
Placing the cycler more than 12 inches (30 cm) below
your position can produce higher than normal negative
pressure during Drain if the peritoneal membrane is in
contact with the catheter. This can cause pain,
discomfort or, in extreme cases, peritoneal membrane
damage.
WARNING
Place the solution bags on a flat, stable surface. To prevent
bags from falling, do not stack bags on top of each other.
Falling bags can result in a disconnect or leak. Possible
contamination of the fluid or fluid pathways can result if a
fluid leak occurs. Contamination of any portion of the fluid
or fluid path can result in peritonitis.
WARNING
The HomeChoice/HomeChoice PRO APD System should not
be used next to, or stacked with, other electrical equipment.
Such equipment may cause the cycler to operate
incorrectly. However, if it is necessary to use the cycler
close to other equipment, the cycler should be monitored to
verify normal operation.
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7. Setup and Check-out
7.3
Grounding Instructions
This product must be grounded. In the event of an electrical short circuit,
grounding reduces the risk of electric shock by providing an escape wire for the
electric current. This product is equipped with a cord that has a grounding wire
with a grounding plug. The plug must be inserted into an outlet that is properly
installed with a verified ground. Please contact your dialysis center for any
questions concerning the outlet.
WARNING
If you do not understand these grounding instructions,
contact a qualified service person. Improper use of the
grounding plug can result in a risk of electric shock.
WARNING
If you can not insert the power cord plug into the wall
outlet, do not alter the plug. Contact an electrician to
modify or replace the wall outlet.
When the HomeChoice/HomeChoice PRO APD System
is used on a 120V circuit, make sure that the plug is as
shown at right.
1
2
1. Grounding Pin
2. Grounded Outlet Box
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Section
8. PRO Card and
Modem
Operating Instructions –
PRO Card and Modem
8
Operating Instructions –
PRO Card and Modem
8.1
Introduction
h NOTE:
If your dialysis center does not use the PRO Card feature, skip this
section and continue with Section 9, Operating Instructions – Change
Program. The PRO Card feature can only be used with the HomeChoice
PRO APD System.
Your HomeChoice PRO APD System has a computerized data transfer feature – the
PRO Card.
During your initial training, your dialysis nurse or physician showed you a small
electronic data card that fits into your system. The PRO Card holds treatment
information and is used by your dialysis center to automatically set up your
therapy. The PRO Card also records information about each treatment.
The PRO Card holds at least two months of treatment information. This feature
provides information to your dialysis center to help improve your therapy.
You might also use a modem and a phone line to transfer PRO Card information to
the dialysis center. See 8.4, Install the Modem Option, on page 8-14.
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8. Operating Instructions – PRO Card and Modem
2
GO
STOP
1
1. PRO Card Port
2. Indicator Light
Figure 8-1. PRO Card Port
1
2
3
5
4
1. Power Entry
4. Power Cord
2. J1 – Service Port
5. On/Off Switch
3. J2 – Modem Port
Figure 8-2. HomeChoice PRO APD System Back Panel
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8. Operating Instructions – PRO Card and Modem
8.2
Using the PRO Card
At the time of your initial training, your physician gave you a PRO Card. The
PRO Card contains your personal therapy settings prescribed for you by your
physician.
Just insert your PRO Card into your HomeChoice PRO APD System. Treatment
results from your therapy are recorded to the PRO Card. This data provides your
physician with important information about your therapy.
h NOTE:
8.2.1
The PRO Card must remain in the HomeChoice PRO APD System until
you bring it with you to your next dialysis center visit.
Care and Handling of the PRO Card
The PRO Card is compact and durable. It is designed to be carried to and from your
dialysis center visits. It must remain inserted in the HomeChoice PRO APD System
at all other times.
Please follow these guidelines for handling your PRO Card:
Make sure that the main power switch of the HomeChoice PRO APD
System is OFF before you insert or remove the PRO Card.
Do not use excessive force when you insert or remove the PRO Card from
the port. The PRO Card slides easily into the PRO Card port.
Do not insert anything other than your PRO Card into the PRO Card port.
Do not bend the PRO Card.
Always store the PRO Card in its case to transport it.
Keep the PRO Card away from magnets.
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8. Operating Instructions – PRO Card and Modem
8.2.2
Confirm Your PRO Card
When you return from a visit to your dialysis center with a new or reprogrammed
PRO Card, you must verify that you have the correct card.
The following steps help you to confirm your name and patient ID.
Steps to confirm your PRO Card
1.
With the cycler power OFF, insert the PRO Card into
the PRO Card port.
2.
Turn on the HomeChoice PRO APD System.
Display screen
CONFIRM CARD
Wait until the CONFIRM CARD message appears.
3.
Press ENTER.
(YOUR NAME)
Your name appears.
4.
Press ENTER.
(YOUR ID#)
Your patient identification number appears.
5.
8-4
Press ENTER.
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8. Operating Instructions – PRO Card and Modem
8.2.3
Confirm a New Therapy
CONFIRM NEW PROGRAM appears if the therapy settings on your PRO Card have
changed. Press ENTER if the setting is correct.
The steps below show an example of a CCPD/IPD therapy. The steps taken to
confirm HI-DOSE CCPD/IPD, TIDAL, or HI-DOSE TIDAL therapies are similar. Only
the settings that changed appear.
h NOTE:
Press STOP if a displayed item is not correct. PROGRAM REJECTED
appears. Keep the PRO Card in the device to collect treatment
information. You must report this to your dialysis center and verify
your therapy settings manually before proceeding with treatment.
Press GO to proceed to PRESS GO TO START.
Steps to confirm a New Therapy –
CCPD/IPD example
Display screen
CONFIRM NEW PROGRAM appears if the therapy
settings on your PRO Card have changed.
CONFIRM NEW PROGRAM
1.
Press ENTER.
THERAPY:
2.
Press ENTER.
TOTAL VOL:
3.
Press ENTER.
THERAPY TIME:
4.
Press ENTER.
FILL VOL:
CCPD/IPD
ML
HH:MM
ML
h NOTE: Your Fill Volume in milliliters (mL) should normally not exceed the
values shown in Table 19-7 on page 19-15. Contact your dialysis
center to confirm your Fill Volume if it exceeds the volume listed.
5.
Press ENTER.
LAST FILL VOL:
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8-5
8. Operating Instructions – PRO Card and Modem
Steps to confirm a New Therapy –
CCPD/IPD example (Continued)
6.
Press ENTER.
Display screen
DEXTROSE:
Skip this step if the LAST FILL VOLUME = 0
7.
Press ENTER.
MIN DRAIN VOL:
8.
Press ENTER.
MODE:
%
LOW FILL
(This setting appears in Low Fill Mode only.)
9.
Press ENTER.
NEG UF LIMIT:
%
POS UF LIMIT:
OFF%
(This setting appears in Low Fill Mode only.)
10. Press ENTER.
(This setting appears in Low Fill Mode only.)
11. Press ENTER.
PLEASE WAIT...
HomeChoice PRO APD System then calculates and
briefly displays CYCLES and DWELL TIME.
CYCLES:
PROGRAM ACCEPTED then appears.
DWELL TIME:
HH:MM
PROGRAM ACCEPTED
PRESS GO TO START appears when all information is confirmed, accepted, and
saved by the HomeChoice PRO APD System. The HomeChoice PRO APD System is
then ready for you to begin your therapy. See Section 11, Operating Instructions –
Prepare for Therapy.
h NOTE:
8-6
If you make manual programming changes on your system after you
confirm the program on your PRO Card, those changes are saved in a
“swap” file on your PRO Card. The changes are also written in your
treatment file. The cycler uses these new settings for your treatment.
The original prescription remains unchanged on your PRO Card.
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8. Operating Instructions – PRO Card and Modem
8.2.4
HomeChoice PRO APD System Prompts
The HomeChoice PRO APD System records information needed by your physician,
such as your weight, blood pressure, and day or manual exchanges. The system
displays daily messages to prompt you to enter this information.
Three buttons are used to enter data: ENTER, U (up arrow), and V (down
arrow). The data entry menu only appears when you turn on the HomeChoice PRO
APD System.
Shown below are the basic steps for entering data in the entry prompts. The
setting shown for each entry is zero (0) until you enter your data.
Basic steps for entering data
1.
Display screen
Press ENTER when the data entry prompt appears. WEIGHT:
The zero setting is replaced with the previous day’s
data. The digits blink.
000.0LB
(Digits blink)
2.
Press U and V to adjust the setting.
WEIGHT:
160.0LB
3.
Press ENTER to save the setting.
WEIGHT:
160.0LB
The digits stop blinking.
4.
Press V to display the next data entry prompt.
5.
Continue entering data for each of the prompts by
repeating Steps 2 through 4.
6.
Press STOP when all data is entered or to exit the
data entry menu.
(Blinking stops)
BLOOD PRES:
000/000
PRESS GO TO START
PRESS GO TO START appears. Data that was
entered is saved on the PRO Card along with data
from the upcoming treatment.
h NOTE:
To return to the HomeChoice PRO APD System data entry prompts, the
system must be turned OFF and then back ON before the therapy
begins.
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8. Operating Instructions – PRO Card and Modem
8.2.5
Definitions of Data Entry Prompts
Table 8-1 and Table 8-2 list all the prompts available on the HomeChoice PRO APD
System. See Basic steps for entering data on page 8-7.
h NOTE:
Only those prompts selected by your dialysis nurse appear on your
cycler.
Table 8-1.
Definitions of Data Entry Prompts
Prompt
Weight
Display and Definition
WEIGHT:
0.0LB
Your daily weight to the tenths place.
Blood Pressure
BLOOD PRES:
000/000
The systolic and diastolic numbers of your daily blood
pressure.
Night
Concentration 1
Night
Concentration 2
Last Fill
Concentration
8-8
NIGHT CONC. 1:
0.00
This is the concentration of the primary solution bag
placed on the heater pan. Available concentrations are:
4.25%, 2.5%, and 1.5%.
NIGHT CONC. 2:
0.00
The second night concentration is for the supply solutions
that may be different from the heater bag solution.
Available concentrations are: 4.25%, 2.5%, and 1.5%.
LAST FILL CONC: 0.00
The Last Fill Concentration is for the last solution bag. The
Last Fill Concentration may be different from the heater
bag and other supply bag concentrations. Available
concentrations are: Dianeal 4.25%, 2.5%, 1.5%, and
Extraneal.
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8. Operating Instructions – PRO Card and Modem
Table 8-2.
Definitions of Manual Daytime Exchanges Prompts
Prompt
# of Day Exchanges
Display and Definition
# OF DAY EXCHANGES:
The number of CAPD manual exchanges performed
using an UltraBag system. If no manual exchanges
were performed on a given day, a 0 (zero) is entered.
The following data items are repeated for each manual exchange. The n is a
number from one to five to indicate the manual exchange for the data entered.
Exchange Time n
EXCH TIME n: 00:00AM
This is the time of day (AM/PM format) that the nth
manual exchange was performed.
Day Drain n
DAY DRAIN n:
0000ML
This is the volume of solution that the patient drained
during the nth manual exchange. This volume must be
measured and entered in mL.
Day Fill n
DAY FILL n:
0000ML
This is the nth manual exchange Fill Volume in mL.
Day Concentration n
DAY CONC. n:
0.00
This is the concentration of the nth manual exchange
solution.
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8-9
8. Operating Instructions – PRO Card and Modem
8.2.6
Remove Your PRO Card
h NOTE:
The PRO Card must remain in the HomeChoice PRO APD System until
your next visit to your dialysis center.
When you visit your doctor or dialysis center, you are usually asked to bring the
PRO Card with you.
Follow the steps below to remove your PRO Card.
Steps to remove your PRO Card
1.
Turn off the HomeChoice PRO APD System.
2.
Slide the PRO Card gently out of the slot.
h NOTE: Do not bend the PRO Card.
3.
Place the PRO Card in its case.
8-10
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8. Operating Instructions – PRO Card and Modem
8.3
Display Messages
The PRO Card port has an indicator light located on the control panel directly
above the port. See Figure 8-1 on page 8-2. This light can be green or yellow.
Green means the card is fully inserted and working.
Yellow means there is a problem with the PRO Card or card reader inside
the cycler.
If there is a problem with the PRO Card or the card reader, the following messages
can appear.
8.3.1
No PRO Card
Display Message:
NO PRO CARD
Indicator Light:
Flashing Yellow
Cause:
The PRO Card is not inserted when you turn on the device, or
at the end of your therapy.
To Correct:
1.
Turn the power switch OFF.
2.
Insert the PRO Card and turn the power switch ON.
The indicator light turns Green if the PRO Card is
inserted correctly.
– OR –
1.
If you can not correct the problem, press GO to
continue.
No therapy information is recorded to the PRO Card.
You must report this to your dialysis center.
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8. Operating Instructions – PRO Card and Modem
8.3.2
Card Reader Disabled
Display Message: CARD READER DISABLED
Indicator Light:
Off
Cause:
Your dialysis center disabled the PRO Card functions on your
HomeChoice PRO APD System.
To Correct:
1.
Call your dialysis center to verify that your PRO Card is
disabled.
2.
Press GO to proceed to PRESS GO TO START.
8.3.3
PRO Card Full
Display Message:
PRO CARD FULL
Indicator Light:
Yellow
Cause:
The PRO Card is full of treatment information not read by
your dialysis center.
To Correct:
1.
Bring your PRO Card to your dialysis center.
– OR –
1.
Press GO to continue.
Information for your next treatment is recorded.
However, the oldest treatment record is deleted to
make room for the latest treatment.
8-12
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8. Operating Instructions – PRO Card and Modem
8.3.4
Invalid PRO Card, Program Not Valid
Display Message:
INVALID PRO CARD
PROGRAM NOT VALID
Indicator Light:
Yellow
Cause:
The system found a problem with the PRO Card. The card
may be blank, corrupted, or damaged.
To Correct:
1.
Call your dialysis center to obtain a new card.
2.
Press GO to proceed to PRESS GO TO START.
The program on your system is not changed. You must
verify your therapy settings manually with your dialysis
center before you proceed with treatment. Future
treatment information can be lost if this is not
corrected.
8.3.5
Card Reader Error
Display Message:
CARD READER ERROR
Indicator Light:
Yellow
Cause:
The system found a problem with the card reader inside the
HomeChoice PRO APD System.
To Correct:
1.
Call Baxter Technical Assistance. See 2.2, Numbers to
Call for Assistance, on page 2-1.
2.
Press GO to proceed with your treatment.
Future treatment information can be lost if the problem
is not corrected.
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8. Operating Instructions – PRO Card and Modem
8.4
Install the Modem Option
In addition to the PRO Card, your HomeChoice PRO APD System can also transfer
therapy information via a phone line using a modem. If your dialysis center uses
this option, you are given a modem to install with your HomeChoice PRO APD
System. Read the instructions that were provided with your modem for modem
operation.
h NOTE:
The modem must be Class II and approved to IEC/EN, CSA/UL
60950-1 with a TNV-1 circuit (accessible circuit is limited to 60Vrms).
h NOTE:
Maintenance of the external modem must only be performed by
qualified Baxter Service personnel. See 2.2, Numbers to Call for
Assistance, on page 2-1.
h NOTE:
The modem must be located at least 5 feet (1.5 meters) away from the
patient.
Follow the steps below to install your modem.
Steps to install your modem
1.
Unpack the modem.
2
1
1. Power Adapter
2. Data Cable
3. Modem
8-14
4. Telephone Line
with Double
Connector for
Wall Jack
3
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8. Operating Instructions – PRO Card and Modem
Steps to install your modem (Continued)
2.
Plug the data cable into the J2 Port, as shown.
3.
Unplug the telephone line from the wall jack.
4.
Plug the double connector into the wall jack.
5.
Plug the telephone line and modem line into the double
connector.
6.
Plug the modem power adapter into the wall outlet.
OEM
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8. Operating Instructions – PRO Card and Modem
Steps to install your modem (Continued)
7.
Turn modem power on.
8.4.1
Test the Modem Installation
After you install the modem, call your dialysis center to let them know you are
ready to test your modem connection. If possible, use a different phone line to call
the dialysis center, such as a cell phone.
A transfer of therapy information is initiated by the dialysis center. The center will
then request that you put the HomeChoice PRO APD System in the MODEM
CONNECT mode.
Follow the steps below to test your modem connection.
Steps to test your
modem connection
Display screen
1.
Be sure the modem is installed properly and the
modem power is turned on.
2.
Turn on the HomeChoice PRO APD System.
PRESS GO TO START
3.
Press V until you see MODEM CONNECT.
MODEM CONNECT
h NOTE: MODEM CONNECT can not occur while
your therapy is in progress.
4.
Press ENTER.
8-16
CONNECTING...
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8. Operating Instructions – PRO Card and Modem
Steps to test your
modem connection (Continued)
5.
Hang up the telephone, if necessary, and allow the
dialysis center to call back with their modem.
Display screen
TRANSFERRING...
The HomeChoice PRO APD System automatically
answers.
An error message, MODEM ERROR n appears if a
problem occurs. Call Baxter Technical Service and
report the Modem Error number. See 2.2, Numbers
to Call for Assistance, on page 2-1.
MODEM ERROR n
If an urgent need occurs to use the phone during
the transfer, press STOP. The transfer stops
immediately and the telephone can be used.
6.
When the transfer is complete, your telephone is
available for use. You do not need to unplug the
phone line.
8.5
PRESS GO TO START
If You Require a New System or “Swap”
If your HomeChoice PRO APD System must be returned (or swapped) for service,
remove the PRO Card from the old cycler. Insert the PRO Card into the new cycler
and turn on the power.
When the display prompts you to CONFIRM CARD, follow the procedures in
8.2.2, Confirm Your PRO Card, on page 8-4 and 8.2.3, Confirm a New Therapy, on
page 8-5. When the card is confirmed, the new system is updated to match the
therapy settings on your old system, including any manual changes you made.
h NOTE:
If you used a modem with your old system, detach the cable from your
old system and plug it into the new system. See 8.4, Install the Modem
Option, on page 8-14 for instructions.
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8. Operating Instructions – PRO Card and Modem
8-18
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Section
9
Operating Instructions –
Change Program
9. Change Program
Operating Instructions –
Change Program
9.1
Introduction
CHANGE PROGRAM
This section contains information about reviewing and changing your prescribed
treatment and system settings. This can be done at the CHANGE PROGRAM
prompt.
Even if you have a PRO Card, you still need to learn how to manually change the
settings on your HomeChoice PRO APD System. To program your system with your
PRO Card, see Section 8, Operating Instructions – PRO Card and Modem.
9.2
About Your System’s Settings
Your physician prescribes your treatment and system settings. You view your
prescription settings and other system settings on the display screen. Even though
you may not have to change your settings, you may be asked for their values by
your nurse or your physician.
9.2.1
Nurse’s Settings
There are some settings available only to your dialysis nurse. Your dialysis nurse
should refer to the HomeChoice APD Systems Trainer’s Guide for information
on programming those settings.
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9. Operating Instructions – Change Program
9.3
The Nurse’s Menu
NURSE'S MENU
The NURSE’S MENU allows your nurse to tailor the therapy to meet your special
needs.
Your dialysis nurse completes the information below to record the data
programmed in the Nurse’s Menu. Please keep this information available.
Instructions: Please have your dialysis nurse check the appropriate box below.
The Nurse’s Menu has not been changed and the factory default settings are
being used.
The Nurse’s Menu has been adjusted for this patient’s special needs. This
system is programmed as recorded in Table 9-1.
Table 9-1.
Nurse’s Menu Settings
Setting
Description
Mode
MODE:
STANDARD (default setting)
– or –
MODE:
LOW FILL
Minimum Drain
Volume
MIN DRAIN VOL:
Minimum Drain
Time
MIN DRAIN TIME:
(hh:mm)
Low Fill Mode only.
Negative
Ultrafiltration (UF)
Limit
9-2
%
NEG UF LIMIT:
%
Low Fill Mode only.
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9. Operating Instructions – Change Program
Table 9-1.
Nurse’s Menu Settings (Continued)
Setting
Description
Positive
Ultrafiltration (UF)
Limit
POS UF LIMIT:
ML
Low Fill Mode only.
Smart Dwells
SMART DWELLS:
YES or NO
Heater Bag Empty
HEATER BAG EMPTY:
YES or NO
Tidal Full Drains
TIDAL FULL DRNS:
YES or NO
Tidal Mode only.
Language
LANGUAGE:
Flush
FLUSH:
YES or NO
Program Locked
PROGRAM LOCKED:
YES or NO
9.4
If You Receive a New System or “Swap”
If your system must be returned for service, call your dialysis center, and then call
Baxter Technical Assistance for instructions. See 2.2, Numbers to Call for
Assistance, on page 2-1.
In most regions, when a replacement cycler (“swap”) is delivered by Baxter, it is
not programmed with your therapy settings. Your dialysis center is responsible for
knowing and entering your therapy settings.
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9. Operating Instructions – Change Program
9.5
Manual Programming
To manually program your HomeChoice APD System or HomeChoice PRO APD
System (the “system”), press V (down arrow) before you press GO to start your
therapy. You can also review or change your settings during your therapy by
pressing V.
WARNING
Do not change the settings for your therapy unless directed
by your physician. Using incorrect settings can cause
patient injury.
9.5.1
Basic Steps for Manual Programming
Three buttons are used to manually review or change your therapy settings:
ENTER, U (up arrow), and V (down arrow).
Your dialysis center determines if you can change your therapy settings.
If you are not allowed to change your settings, the display screen will say REVIEW
PROGRAM instead of CHANGE PROGRAM.
See 9.6, Therapy Type, on page 9-8, 9.7, Standard Mode (Standard Fill Mode), on
page 9-9, and 9.8, Low Fill Mode, on page 9-34 for definitions and the allowable
ranges for the available setting options.
If you are allowed to change your settings, follow the instructions in Basic steps to
change settings.
h NOTE:
9-4
The values used in the following steps are examples and not intended
as recommended values.
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9. Operating Instructions – Change Program
Basic steps to change settings
1.
Press V to change or review settings (before you
press GO to start your therapy).
Display screen
PRESS GO TO START
– OR –
Press V during your therapy.
2.
Press ENTER to access the CHANGE PROGRAM
menu.
CHANGE PROGRAM
THERAPY is the first setting that appears.
THERAPY:
3.
If you do not want to change this setting, press V
to see TOTAL VOL (Total Volume).
TOTAL VOL:
15000ML
4.
Press ENTER to change the setting, if needed.
TOTAL VOL:
15000ML
CCPD/IPD
(The option or value blinks)
5.
Press U and V to change the value.
TOTAL VOL:
14000ML
6.
Press ENTER to save the new value.
TOTAL VOL:
14000ML
(Blinking stops)
7.
Press V to display THERAPY TIME.
NITE THER TIME (Night Therapy Time) appears
for Hi-Dose therapies.
8.
Make changes, if needed, by following Steps 4–6.
9.
Press V to display FILL VOL (Fill Volume).
NITE FILL VOL (Night Fill Volume) appears for
Hi-Dose therapies.
THERAPY TIME:
8:00
NITE THER TIME: 8:00
FILL VOL:
ML
NITE FILL VOL:
ML
10. Make changes, if needed, by following Steps 4–6.
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9. Operating Instructions – Change Program
Basic steps to change settings (Continued)
11. Press V to display LAST FILL VOL (Last Fill
Volume).
Display screen
LAST FILL VOL:
ML
12. Make changes, if needed, by following Steps 4–6.
13. Press V to display DEXTROSE.
DEXTROSE:
SAME
This setting only appears if you use Last Fill.
14. Make changes, if needed, by following Steps 4–6.
15. Press V to display # OF DAY FILLS.
# OF DAY FILLS:
This setting only appears for Hi-Dose therapies.
16. Make changes, if needed, by following Steps 4–6.
17. Press V to display DAY FILL VOL (Day Fill Volume). DAY FILL VOL:
This setting only appears for Hi-Dose therapies.
ML
18. Make changes, if needed, by following Steps 4–6.
19. Press V to display TIDAL VOL (Tidal Volume).
TIDAL VOL:
%
TOTAL UF:
ML
This setting only appears for Tidal therapies.
20. Make changes, if needed, by following Steps 4–6.
21. Press V to display TOTAL UF.
This setting only appears for Tidal therapies.
22. Make changes, if needed, by following Steps 4–6.
23. Press STOP when the option or value is not
blinking to exit Change Program.
9-6
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9. Operating Instructions – Change Program
Basic steps to change settings (Continued)
Display screen
h NOTE: The following prompts appear if you do not change the value for
Last Fill Volume:
The system calculates the number of cycles.
CYCLES appears briefly on the display screen.
CYCLES:
Then the system calculates the Dwell Time.
DWELL TIME appears briefly on the display screen.
DWELL TIME:
HH:MM
In Tidal therapies, the system also calculates:
TIDAL VOLUME
TIDAL VOLUME:
UF (ultrafiltration) PER CYCLE
UF PER CYCLE:
24. PRESS GO TO START appears on the display screen
after the calculated settings.
ML
PRESS GO TO START
You are now ready to press GO to begin the setup
for your therapy.
– OR –
If you do change the value for Last Fill Volume:
CHECK I-DRAIN VOLUME appears on the display
screen.
25. Press STOP.
The I-DRAIN (Initial Drain) ALARM submenu from
the Make Adjustments menu is shown. This allows
you to update the I-Drain Alarm setting to be
consistent with the new Last Fill Volume. See
10.2.7, I-Drain Alarm, on page 10-9.
CHECK I-DRAIN VOLUME
I-DRAIN ALARM:
60ML
(The value blinks)
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9-7
9. Operating Instructions – Change Program
9.6
Therapy Type
The first setting on the Change Program menu is THERAPY type. There are four
Therapy types available, as shown in Table 9-2.
Table 9-2.
Therapy Type Options
Therapy Type
Display
CCPD/IPD
THERAPY:
Hi-Dose CCPD
THERAPY:HI-DOSE CCPD
Tidal
THERAPY:
Hi-Dose Tidal
THERAPY:HI-DOSE TIDL
CCPD/IPD (default setting)
TIDAL
See Terms Used in This Guide in Section 1, Glossary, for the definitions of APD,
CCPD, IPD, Tidal, Hi-Dose CCPD, and Hi-Dose Tidal.
9-8
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9. Operating Instructions – Change Program
9.7
Standard Mode (Standard Fill Mode)
The following sections define the therapy settings for Standard Fill Mode. For Low
Fill Mode settings, see 9.8, Low Fill Mode, on page 9-34.
9.7.1
CCPD/IPD Therapy Settings
THERAPY:
CCPD/IPD
Table 9-3 shows the settings programmed for CCPD/IPD therapy in the Standard
Fill Mode.
Table 9-3.
CCPD/IPD Settings – Standard Fill Mode
Setting
Total Volume
Description
TOTAL VOL:
ML
Total Volume of solution used for the therapy. Includes the
total Fill Volume for all cycles and the Last Fill Volume.
Minimum setting is 200 mL
Maximum setting is 80000 mL
Default setting is 200 mL
Setting increments:
– 50 in the 200 to 2000 mL range
– 100 in the 2000 to 5000 mL range
– 500 in the 5000 to 80000 mL range
Therapy Time
THERAPY TIME:
HH:MM
Total time for the nighttime portion of therapy. This time is
fixed and begins with Initial Drain.
Minimum setting is 10 minutes
Maximum setting is 48 hours
Default setting is 10 minutes
Setting increment is 10 minutes
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9. Operating Instructions – Change Program
Table 9-3.
CCPD/IPD Settings – Standard Fill Mode (Continued)
Setting
Description
WARNING
Your Fill Volume in milliliters (mL) should normally not exceed the
values shown in Table 19-7 on page 19-15. Contact your dialysis
center to confirm your Fill Volume if it exceeds this volume. Exceeding
this volume can result in an increased intraperitoneal volume (IIPV)
situation.
IIPV could result in a feeling of abdominal discomfort, serious injury,
or death. See page 18-58 for IIPV symptoms or if IIPV is suspected.
Additional care should be taken to monitor for IIPV symptoms for
those patients not able to communicate essential information to their
caregiver during treatment.
Fill Volume
FILL VOL:
ML
Volume of solution for each nighttime cycle based on your
prescription.
Minimum setting is 100 mL
Maximum setting is 3000 mL
Default setting is 250 mL
Setting increments:
– 10 in the 100 to 500 mL range
– 50 in the 500 to 1000 mL range
– 100 in the 1000 to 3000 mL range
9-10
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9. Operating Instructions – Change Program
Table 9-3.
Setting
Last Fill
Volume
CCPD/IPD Settings – Standard Fill Mode (Continued)
Description
LAST FILL VOL:
ML
Last Fill Volume delivered at the end of the therapy and left in
the peritoneal cavity during the day. Also called “Wet Day.”
Minimum setting is 0 or 100 mL
Maximum setting is 3000 mL
Default setting is 0 mL
Setting increments:
– 10 in the 100 to 500 mL range
– 50 in the 500 to 1000 mL range
– 100 in the 1000 to 3000 mL range
Dextrose
DEXTROSE:
SAME (default setting)
– or –
DEXTROSE:
DIFFERENT
The Last Fill Volume can be the same dextrose concentration
as the other Fills or it can be different.
This setting does not appear if LAST FILL VOL = 0.
This setting only appears if you use Last Fill.
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9-11
9. Operating Instructions – Change Program
9.7.2
CCPD/IPD Calculated Settings
HomeChoice/HomeChoice PRO APD System calculates the number of night cycles
and the Dwell Time. The calculated values are shown on the display screen when
you press STOP after you have completed reviewing your therapy settings.
Table 9-4.
Definitions for CCPD/IPD Calculated Settings
Setting
Description
Cycles
Total number of cycles at night, not including the Last Fill.
This parameter is calculated by the system.
Dwell Time
Calculated amount of time the dialysis solution remains in the
peritoneal cavity during each cycle. The system may
automatically adjust the Dwell Time based on your actual
flow rates during Fill and Drain, if your clinician chooses this
option.
9-12
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9. Operating Instructions – Change Program
9.7.3
Hi-Dose CCPD Therapy Settings
THERAPY:HI-DOSE CCPD
Table 9-5 shows the settings programmed for Hi-Dose CCPD therapy in the
Standard Fill Mode.
Table 9-5.
Hi-Dose CCPD Settings – Standard Fill Mode
Setting
Total Volume
Description
TOTAL VOL:
ML
Total Volume of solution used for the therapy. Includes the
total Day Fill Volume and Night Fill Volume for all cycles, and
the Last Fill Volume.
Minimum setting is 200 mL
Maximum setting is 80000 mL
Default setting is 200 mL
Setting increments:
– 50 in the 200 to 2000 mL range
– 100 in the 2000 to 5000 mL range
– 500 in the 5000 to 80000 mL range
# of Day Fills
# OF DAY FILLS:
Number of daytime exchanges. This setting only appears for a
Hi-Dose therapy.
Minimum setting is 0
Maximum setting is 9
Default setting is 0
Setting increment is 1
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9-13
9. Operating Instructions – Change Program
Table 9-5.
Setting
Hi-Dose CCPD Settings – Standard Fill Mode (Continued)
Description
WARNING
Your Day Fill Volume in milliliters (mL) should normally not exceed
the values shown in Table 19-7 on page 19-15. Contact your dialysis
center to confirm your Day Fill Volume if it exceeds this volume.
Exceeding this volume can result in an increased intraperitoneal
volume (IIPV) situation.
IIPV could result in a feeling of abdominal discomfort, serious injury,
or death. See page 18-58 for IIPV symptoms or if IIPV is suspected.
Additional care should be taken to monitor for IIPV symptoms for
those patients not able to communicate essential information to their
caregiver during treatment.
Day Fill
Volume
DAY FILL VOL:
ML
Volume of solution for each daytime exchange, based on your
prescription. This setting only appears for a Hi-Dose therapy.
Minimum setting is 100 mL
Maximum setting is 3000 mL
Default setting is 250 mL
Setting increments:
– 10 in the 100 to 500 mL range
– 50 in the 500 to 1000 mL range
– 100 in the 1000 to 3000 mL range
h NOTE: Day Fill Volume may be a different volume from
the Night Fill Volume.
9-14
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9. Operating Instructions – Change Program
Table 9-5.
Hi-Dose CCPD Settings – Standard Fill Mode (Continued)
Setting
Night Therapy
Time
Description
NITE THER TIME:HH:MM
Total time for the nighttime portion of therapy. This time is
fixed and begins as soon as you complete daytime exchanges.
Minimum setting is 10 minutes
Maximum setting is 48 hours
Default setting is 10 minutes
Setting increment is 10 minutes
WARNING
Your Night Fill Volume in milliliters (mL) should normally not exceed
the values shown in Table 19-7 on page 19-15. Contact your dialysis
center to confirm your Night Fill Volume if it exceeds this volume.
Exceeding this volume can result in an increased intraperitoneal
volume (IIPV) situation.
IIPV could result in a feeling of abdominal discomfort, serious injury,
or death. See page 18-58 for IIPV symptoms or if IIPV is suspected.
Additional care should be taken to monitor for IIPV symptoms for
those patients not able to communicate essential information to their
caregiver during treatment.
Night Fill
Volume
NITE FILL VOL:
ML
Volume of solution for each nighttime cycle based on your
prescription.
Minimum setting is 100 mL
Maximum setting is 3000 mL
Default setting is 250 mL
Setting increments:
– 10 in the 100 to 500 mL range
– 50 in the 500 to 1000 mL range
– 100 in the 1000 to 3000 mL range
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9-15
9. Operating Instructions – Change Program
Table 9-5.
Setting
Last Fill
Volume
Hi-Dose CCPD Settings – Standard Fill Mode (Continued)
Description
LAST FILL VOL:
ML
Last Fill Volume delivered at the end of the therapy and left in
the peritoneal cavity during the day. Also called “Wet Day.”
Minimum setting is 0 or 100 mL
Maximum setting is 3000 mL
Default setting is 0 mL
Setting increments:
– 10 in the 100 to 500 mL range
– 50 in the 500 to 1000 mL range
– 100 in the 1000 to 3000 mL range
Dextrose
DEXTROSE:
SAME (default setting)
– or –
DEXTROSE:
DIFFERENT
The Last Fill Volume can be the same dextrose concentration
as the other Fills or it can be different.
This setting does not appear if LAST FILL VOL = 0.
This setting only appears if you use Last Fill.
9-16
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9. Operating Instructions – Change Program
9.7.4
Hi-Dose CCPD Calculated Settings
HomeChoice/HomeChoice PRO APD System calculates the number of night cycles
and the Dwell Time. The calculated values are shown on the display screen when
you press STOP after you have completed reviewing your therapy settings.
Table 9-6.
Definitions for Hi-Dose CCPD Calculated Settings
Settings
Description
Cycles
Total number of cycles at night, not including the Last Fill.
This parameter is calculated by the system.
Dwell Time
Calculated amount of time the dialysis solution remains in the
peritoneal cavity during each cycle. The system may
automatically adjust the Dwell Time based on your actual
flow rates during Fill and Drain, if your clinician chooses this
option.
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9. Operating Instructions – Change Program
9.7.5
Tidal Therapy Settings
THERAPY:
TIDAL
With Tidal therapy, only a portion of the solution in your peritoneal cavity is
drained and replaced with new solution during each therapy cycle.
WARNING
Pressing the STOP and GO buttons during successive Tidal
Dwell cycles can lead to a gradual increase in
intraperitoneal volume (IPV). An increased intraperitoneal
volume (IIPV) situation can result for patients with a low
Fill Volume and a high number of cycles.
IIPV could result in a feeling of abdominal discomfort,
serious injury, or death. See page 18-58 for IIPV symptoms
or if IIPV is suspected.
Additional care should be taken to monitor for IIPV
symptoms for those patients not able to communicate
essential information to their caregiver during treatment.
h NOTE:
Changing from CCPD to Tidal mode will automatically reset the Tidal
Volume % and Total UF to the default settings (5% and 0 mL
respectively). If your cycler is programmed with these default
settings, contact your clinician to verify that they are correct for you.
h NOTE:
The Tidal Volume (Fill Volume x Tidal Volume %) must be at least
95 mL or a CHECK TIDAL VOL PCT alarm will occur. See 18.3.3, Check
Therapy Setting Value, on page 18-10.
h NOTE:
Prescription settings can not be adjusted during a Tidal therapy.
Table 9-7, on the following page, shows the settings programmed for Tidal therapy
in the Standard Fill Mode.
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9. Operating Instructions – Change Program
Table 9-7.
Tidal Settings – Standard Fill Mode
Setting
Total Volume
Description
TOTAL VOL:
ML
Total Volume of solution used for the therapy. Includes the
total Fill Volume for all cycles and the Last Fill Volume.
Minimum setting is 200 mL
Maximum setting is 80000 mL
Default setting is 200 mL
Setting increments:
– 50 in the 200 to 2000 mL range
– 100 in the 2000 to 5000 mL range
– 500 in the 5000 to 80000 mL range
Therapy Time
THERAPY TIME:
HH:MM
Total time for the nighttime portion of the therapy. This time
begins with Initial Drain.
Minimum setting is 10 minutes
Maximum setting is 48 hours
Default setting is 10 minutes
Setting increment is 10 minutes
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9. Operating Instructions – Change Program
Table 9-7.
Tidal Settings – Standard Fill Mode (Continued)
Setting
Description
WARNING
Your Fill Volume in milliliters (mL) should normally not exceed the
values shown in Table 19-7 on page 19-15. Contact your dialysis
center to confirm your Fill Volume if it exceeds this volume. Exceeding
this volume can result in an increased intraperitoneal volume (IIPV)
situation.
IIPV could result in a feeling of abdominal discomfort, serious injury,
or death. See page 18-58 for IIPV symptoms or if IIPV is suspected.
Additional care should be taken to monitor for IIPV symptoms for
those patients not able to communicate essential information to their
caregiver during treatment.
Fill Volume
FILL VOL:
ML
Volume of solution used for each cycle based on your
prescription.
Minimum setting is 100 mL
Maximum setting is 3000 mL
Default setting is 250 mL
Setting increments:
– 10 in the 100 to 500 mL range
– 50 in the 500 to 1000 mL range
– 100 in the 1000 to 3000 mL range
Tidal Volume %
TIDAL VOL:
%
Volume of fluid drained and refilled during each cycle. This is
expressed as a percentage of the initial Fill Volume.
Minimum setting is 5%
Maximum setting is 95%
Default setting is 5%
Setting increment is 5%
h NOTE: When the Therapy type is changed from CCPD to Tidal, the Tidal
Volume % reverts to the default setting of 5%.
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9. Operating Instructions – Change Program
Table 9-7.
Setting
Tidal Settings – Standard Fill Mode (Continued)
Description
WARNING
A Total UF volume set too low can result in a gradual buildup of UF
volume during the therapy. This can result in an increased
intraperitoneal volume (IIPV) situation.
IIPV could result in a feeling of abdominal discomfort, serious injury,
or death. See page 18-58 for IIPV symptoms or if IIPV is suspected.
Additional care should be taken to monitor for IIPV symptoms for
those patients not able to communicate essential information to their
caregiver during treatment.
Total UF
TOTAL UF:
ML
Total ultrafiltration (UF) expected for the therapy. The
system calculates the UF Per Cycle. The UF Per Cycle plus the
Tidal Volume is the amount of solution drained during each
Tidal Drain.
Minimum setting is 0 mL
Maximum setting is 10000 mL
Default setting is 0 mL
Setting increments:
– 10 in the 0 to 1000 mL range
– 100 in the 1000 to 10000 mL range
h NOTES:
When the Therapy type is changed from CCPD to
Tidal, the Total UF reverts to the default setting of
zero (0).
A Total UF volume set too high can result in an
increased number of LOW DRAIN VOLUME alarms.
NOTES continued on next page.
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9. Operating Instructions – Change Program
Table 9-7.
Setting
Tidal Settings – Standard Fill Mode (Continued)
Description
h NOTES: (Continued)
Seventy percent (70%) of your normal Night UF is a
good starting point for determining your optimum
Total UF. For help in converting 70% of your
expected total therapy UF into a value that can be
programmed as your Total UF for your Tidal
therapy, see 19.17, Determining Tidal Total UF and
Last Manual Drain UF Target Volume Settings, on
page 19-18.
If you use a solution for your Tidal therapy that is
different from the solution used in your previous
therapy, you may need to adjust your Total UF based
on the concentration of the new solution. Contact
your dialysis center for recommendations regarding
setting your Total UF in this situation.
Last Fill
Volume
LAST FILL VOL:
ML
Last Fill Volume delivered at the end of therapy and left in the
peritoneal cavity during the day. Also called “Wet Day.”
Minimum setting is 0 or 100 mL
Maximum setting is 3000 mL
Default setting is 0 mL
Setting increments:
– 10 in the 100 to 500 mL range
– 50 in the 500 to 1000 mL range
– 100 in the 1000 to 3000 mL range
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9. Operating Instructions – Change Program
Table 9-7.
Setting
Dextrose
Tidal Settings – Standard Fill Mode (Continued)
Description
DEXTROSE:
SAME (default setting)
– or –
DEXTROSE:
DIFFERENT
The Last Fill Volume can be the same dextrose concentration
as the other Fills or it can be different.
This setting does not appear if LAST FILL VOL = 0.
This setting only appears if you use Last Fill.
Full Drains
Every
FULL DRAINS EVERY:
The frequency of Full Drains during Tidal therapy. Only
appears if MODE: STANDARD and TIDL FULL DRNS: YES is set
in the Nurse’s Menu.
Minimum setting is 1
Maximum setting is 99
Default setting is 1
Setting increment is 1
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9. Operating Instructions – Change Program
9.7.6
Tidal Calculated Settings
The HomeChoice/HomeChoice PRO APD System calculates the number of night
cycles and the Dwell Time. For a Tidal therapy, the system also calculates Tidal
Volume and ultrafiltration (UF) per cycle. The calculated values are shown on the
display screen when you press STOP after you have completed reviewing your
therapy settings.
Table 9-8.
Definitions for Tidal Calculated Settings
Setting
Description
Cycles
Total number of cycles at night, not including the Last Fill.
This parameter is calculated by the system.
Dwell Time
Calculated amount of time the dialysis solution remains in
the peritoneal cavity during each cycle. The system may
automatically adjust the Dwell Time based on your actual
flow rates during Fill and Drain, if your clinician chooses this
option.
Tidal Volume
Actual Tidal Volume calculated based on the Tidal Volume %
programmed and the Fill Volume.
UF Per Cycle
Estimated UF Per Cycle based on Total UF programmed and
number of cycles calculated.
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9. Operating Instructions – Change Program
9.7.7
Hi-Dose Tidal Therapy Settings
THERAPY:HI-DOSE TIDL
With Tidal therapy, only a portion of the solution in your peritoneal cavity is
drained and replaced with new solution during each therapy cycle.
WARNING
Pressing the STOP and GO buttons during successive Tidal
Dwell cycles can lead to a gradual increase in
intraperitoneal volume (IPV). An increased intraperitoneal
volume (IIPV) situation can result for patients with a low
Fill Volume and a high number of cycles.
IIPV could result in a feeling of abdominal discomfort,
serious injury, or death. See page 18-58 for IIPV symptoms
or if IIPV is suspected.
Additional care should be taken to monitor for IIPV
symptoms for those patients not able to communicate
essential information to their caregiver during treatment.
h NOTE:
Changing from CCPD to Tidal mode will automatically reset the Tidal
Volume % and Total UF to the default settings (5% and 0 mL
respectively). If your cycler is programmed with these default
settings, contact your clinician to verify that they are correct for you.
h NOTE:
The Tidal Volume (Fill Volume x Tidal Volume %) must be at least
95 mL or a CHECK TIDAL VOL PCT alarm will occur. See 18.3.3, Check
Therapy Setting Value, on page 18-10.
h NOTE:
Prescription settings can not be adjusted during a Tidal therapy.
Table 9-9 shows the settings programmed for Hi-Dose Tidal therapy in the
Standard Fill Mode.
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9. Operating Instructions – Change Program
Table 9-9.
Hi-Dose Tidal Settings – Standard Fill Mode
Setting
Total Volume
Description
TOTAL VOL:
ML
Total Volume of solution used for the therapy. Includes the
total Day Fill Volume and Night Fill Volume for all cycles, and
the Last Fill Volume.
Minimum setting is 200 mL
Maximum setting is 80000 mL
Default setting is 200 mL
Setting increments:
– 50 in the 200 to 2000 mL range
– 100 in the 2000 to 5000 mL range
– 500 in the 5000 to 80000 mL range
# of Day Fills
# OF DAY FILLS:
Number of daytime exchanges. This setting only appears for a
Hi-Dose therapy.
Minimum setting is 0
Maximum setting is 9
Default setting is 0
Setting increment is 1
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9. Operating Instructions – Change Program
Table 9-9.
Hi-Dose Tidal Settings – Standard Fill Mode (Continued)
Setting
Description
WARNING
Your Day Fill Volume in milliliters (mL) should normally not exceed
the values shown in Table 19-7 on page 19-15. Contact your dialysis
center to confirm your Day Fill Volume if it exceeds this volume.
Exceeding this volume can result in an increased intraperitoneal
volume (IIPV) situation.
IIPV could result in a feeling of abdominal discomfort, serious injury,
or death. See page 18-58 for IIPV symptoms or if IIPV is suspected.
Additional care should be taken to monitor for IIPV symptoms for
those patients not able to communicate essential information to their
caregiver during treatment.
Day Fill Volume
DAY FILL VOL:
ML
Volume of solution for each daytime exchange, based on your
prescription. This setting only appears for a Hi-Dose therapy.
Minimum setting is 100 mL
Maximum setting is 3000 mL
Default setting is 250 mL
Setting increments:
– 10 in the 100 to 500 mL range
– 50 in the 500 to 1000 mL range
– 100 in the 1000 to 3000 mL range
Night Therapy
Time
NITE THER TIME:HH:MM
Total time for the nighttime portion of the therapy. This time
will begin as soon as you start the last Drain of the daytime
exchange.
Minimum setting is 10 minutes
Maximum setting is 48 hours
Default setting is 10 minutes
Setting increment is 10 minutes
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9. Operating Instructions – Change Program
Table 9-9.
Setting
Hi-Dose Tidal Settings – Standard Fill Mode (Continued)
Description
WARNING
Your Night Fill Volume in milliliters (mL) should normally not exceed
the values shown in Table 19-7 on page 19-15. Contact your dialysis
center to confirm your Night Fill Volume if it exceeds this volume.
Exceeding this volume can result in an increased intraperitoneal
volume (IIPV) situation.
IIPV could result in a feeling of abdominal discomfort, serious injury,
or death. See page 18-58 for IIPV symptoms or if IIPV is suspected.
Additional care should be taken to monitor for IIPV symptoms for
those patients not able to communicate essential information to their
caregiver during treatment.
Night Fill
Volume
NITE FILL VOL:
ML
Volume of solution used for each cycle based on your
prescription.
Minimum setting is 100 mL
Maximum setting is 3000 mL
Default setting is 250 mL
Setting increments:
– 10 in the 100 to 500 mL range
– 50 in the 500 to 1000 mL range
– 100 in the 1000 to 3000 mL range
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9. Operating Instructions – Change Program
Table 9-9.
Setting
Night Tidal
Volume %
Hi-Dose Tidal Settings – Standard Fill Mode (Continued)
Description
NITE TIDAL VOL:
%
Volume of fluid drained and refilled during each cycle. This is
expressed as a percentage of the initial Fill Volume.
Minimum setting is 5%
Maximum setting is 95%
Default setting is 5%
Setting increment is 5%
h NOTE: When the Therapy type is changed from CCPD to
Tidal, the Night Tidal Volume % reverts to the
default setting of 5%.
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9. Operating Instructions – Change Program
Table 9-9.
Setting
Hi-Dose Tidal Settings – Standard Fill Mode (Continued)
Description
WARNING
A Total UF volume set too low can result in a gradual buildup of UF
volume during the therapy. This can result in an increased
intraperitoneal volume (IIPV) situation.
IIPV could result in a feeling of abdominal discomfort, serious injury,
or death. See page 18-58 for IIPV symptoms or if IIPV is suspected.
Additional care should be taken to monitor for IIPV symptoms for
those patients not able to communicate essential information to their
caregiver during treatment.
Night UF
NITE UF:
ML
Total ultrafiltration (UF) expected for the therapy. The
system calculates the UF Per Cycle. The UF Per Cycle plus the
Tidal Volume is the amount of solution drained during each
Tidal Drain.
Minimum setting is 0 mL
Maximum setting is 10000 mL
Default setting is 0 mL
Setting increments:
– 10 in the 0 to 1000 mL range
– 100 in the 1000 to 10000 mL range
h NOTES:
When the Therapy type is changed from CCPD to
Tidal, the Night UF reverts to the default setting of
zero (0).
A Total UF volume set too high can result in an
increased number of LOW DRAIN VOLUME alarms.
NOTES continued on next page.
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9. Operating Instructions – Change Program
Table 9-9.
Setting
Hi-Dose Tidal Settings – Standard Fill Mode (Continued)
Description
h NOTES: (Continued)
Seventy percent (70%) of your normal Night UF is a
good starting point for determining your optimum
Total UF. For help in converting 70% of your
expected total therapy UF into a value that can be
programmed as your Total UF for your Tidal
therapy, see 19.17, Determining Tidal Total UF and
Last Manual Drain UF Target Volume Settings, on
page 19-18.
If you use a solution for your Tidal therapy that is
different from the solution used in your previous
therapy, you may need to adjust your Total UF based
on the concentration of the new solution. Contact
your dialysis center for recommendations regarding
setting your Total UF in this situation.
Last Fill
Volume
LAST FILL VOL:
ML
Last Fill Volume delivered at the end of therapy and left in the
peritoneal cavity during the day. Also called “Wet Day.”
Minimum setting is 0 or 100 mL
Maximum setting is 3000 mL
Default setting is 0 mL
Setting increments:
– 10 in the 100 to 500 mL range
– 50 in the 500 to 1000 mL range
– 100 in the 1000 to 3000 mL range
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9. Operating Instructions – Change Program
Table 9-9.
Setting
Dextrose
Hi-Dose Tidal Settings – Standard Fill Mode (Continued)
Description
DEXTROSE:
SAME (default setting)
– or –
DEXTROSE:
DIFFERENT
The Last Fill Volume can be the same dextrose concentration
as the other Fills or it can be different.
This setting does not appear if LAST FILL VOL = 0.
This setting only appears if you use Last Fill.
Full Drains
Every
FULL DRAINS EVERY:
The frequency of Full Drains during Tidal therapy. Only
appears if MODE: STANDARD and TIDL FULL DRNS: YES is set
in the Nurse’s Menu.
Minimum setting is 1
Maximum setting is 99
Default setting is 1
Setting increment is 1
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9. Operating Instructions – Change Program
9.7.8
Hi-Dose Tidal Calculated Settings
The HomeChoice/HomeChoice PRO APD System calculates the number of night
cycles and the Dwell Time. For a Tidal therapy, the system also calculates Tidal
Volume and ultrafiltration (UF) per cycle. The calculated values are shown on the
display screen when you press STOP after you have completed reviewing your
therapy settings.
Table 9-10. Definitions for Hi-Dose Tidal Calculated Settings
Setting
Description
Cycles
Total number of cycles at night, not including the Last Fill.
This parameter is calculated by the system.
Dwell Time
Calculated amount of time the dialysis solution remains in
the peritoneal cavity during each cycle. The system may
automatically adjust the Dwell Time based on your actual
flow rates during Fill and Drain, if your clinician chooses this
option.
Tidal Volume
Actual Tidal Volume calculated based on the Tidal Volume %
programmed and the Night Fill Volume.
UF Per Cycle
Estimated UF Per Cycle based on Total UF programmed and
number of cycles calculated.
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9. Operating Instructions – Change Program
9.8
Low Fill Mode
The following sections describe the therapy settings for Low Fill Mode. For
Standard Fill Mode settings, see 9.7, Standard Mode (Standard Fill Mode), on
page 9-9.
WARNING
Patients whose Fill volumes are less than 1000 mL may
normally drain slowly. These patients typically weigh less
than 44 lbs (20 kg). Use of the Low Fill Mode minimizes the
incidence of LOW DRAIN VOLUME and CAUTION: NEGATIVE
UF alarms. These alarms can not be bypassed to prevent an
increased intraperitoneal volume (IIPV) situation in Low
Fill Mode. The Negative UF Limit should not be raised
above 50% and the Minimum Drain Volume % should not
be lowered below 85%, (the default values). It is required
that the Low Recirculation Volume Set be used with Low
Fill Mode procedures.
IIPV could result in a feeling of abdominal discomfort,
serious injury, or death. See page 18-58 for IIPV symptoms
or if IIPV is suspected.
Additional care should be taken to monitor for IIPV
symptoms for those patients not able to communicate
essential information to their caregiver during treatment.
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9. Operating Instructions – Change Program
9.8.1
CCPD/IPD Therapy Settings
THERAPY:
CCPD/IPD (Low Fill Mode)
Table 9-11 shows the settings programmed for CCPD/IPD therapy in the Low Fill
Mode.
Table 9-11. CCPD/IPD Settings – Low Fill Mode
Setting
Total Volume
Description
TOTAL VOL:
ML
Total Volume of solution used for the therapy. Includes the
total Fill Volume for all cycles and the Last Fill Volume.
Minimum setting is 200 mL
Maximum setting is 80000 mL
Default setting is 200 mL
Setting increments:
– 50 in the 200 to 2000 mL range
– 100 in the 2000 to 20000 mL range
– 500 in the 20000 to 80000 mL range
Therapy Time
THERAPY TIME: HH:MM
Total time for the nighttime portion of therapy. This time is
fixed and starts with the Initial Drain.
Minimum setting is 10 minutes
Maximum setting is 48 hours
Default setting is 10 minutes
Setting increment is 10 minutes
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9. Operating Instructions – Change Program
Table 9-11. CCPD/IPD Settings – Low Fill Mode (Continued)
Setting
Description
WARNING
Your Fill Volume in milliliters (mL) should normally not exceed the
values shown in Table 19-7 on page 19-15. Contact your dialysis
center to confirm your Fill Volume if it exceeds this volume. Exceeding
this volume can result in an increased intraperitoneal volume (IIPV)
situation.
IIPV could result in a feeling of abdominal discomfort, serious injury,
or death. See page 18-58 for IIPV symptoms or if IIPV is suspected.
Additional care should be taken to monitor for IIPV symptoms for
those patients not able to communicate essential information to their
caregiver during treatment.
Fill Volume
FILL VOL:
ML
Volume of solution for each nighttime cycle based on your
prescription.
Minimum setting is 60 mL
Maximum setting is 1000 mL
Default setting is 250 mL
Setting increments:
– 1 in the 60 to 100 mL range
– 10 in the 100 to 500 mL range
– 50 in the 500 to 1000 mL range
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9. Operating Instructions – Change Program
Table 9-11. CCPD/IPD Settings – Low Fill Mode (Continued)
Setting
Last Fill
Volume
Description
LAST FILL VOL:
ML
Last Fill Volume delivered at the end of the therapy and left in
the peritoneal cavity during the day. Also called “Wet Day.”
Minimum setting is 0 or 60 mL
Maximum setting is 1000 mL
Default setting is 0 mL
Setting increments:
– 1 in the 60 to 100 mL range
– 10 in the 100 to 500 mL range
– 50 in the 500 to 1000 mL range
Dextrose
DEXTROSE:
SAME (default setting)
– or –
DEXTROSE:
DIFFERENT
The Last Fill Volume can be the same dextrose concentration
as the other Fills or it can be different.
This setting does not appear if LAST FILL VOL = 0.
This setting only appears if you use Last Fill.
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9. Operating Instructions – Change Program
9.8.2
CCPD/IPD Calculated Settings
HomeChoice/HomeChoice PRO APD System calculates the number of night cycles
and the Dwell Time. The calculated values are shown on the display screen when
you press STOP after you have completed reviewing your therapy settings.
Table 9-12. Definitions for CCPD/IPD Calculated Settings
Setting
Description
Cycles
Total number of cycles at night, not including the Last Fill.
This parameter is calculated by the system.
Dwell Time
Calculated amount of time the dialysis solution remains in
the peritoneal cavity during each cycle. The system may
automatically adjust the Dwell Time based on your actual
flow rates during Fill and Drain, if your clinician chooses this
option.
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9. Operating Instructions – Change Program
9.8.3
Hi-Dose CCPD Therapy Settings
THERAPY:HI-DOSE CCPD (Low Fill Mode)
WARNING
Patients whose Fill volumes are less than 1000 mL may
normally drain slowly. These patients typically weigh less
than 44 lbs (20 kg). Use of the Low Fill Mode minimizes the
incidence of LOW DRAIN VOLUME and CAUTION: NEGATIVE
UF alarms. These alarms can not be bypassed to prevent an
increased intraperitoneal volume (IIPV) situation in Low
Fill Mode. The Negative UF Limit should not be raised
above 50% and the Minimum Drain Volume % should not
be lowered below 85%, (the default values). It is required
that the Low Recirculation Volume Set be used with Low
Fill Mode procedures.
IIPV could result in a feeling of abdominal discomfort,
serious injury, or death. See page 18-58 for IIPV symptoms
or if IIPV is suspected.
Additional care should be taken to monitor for IIPV
symptoms for those patients not able to communicate
essential information to their caregiver during treatment.
Table 9-13 shows the settings programmed for Hi-Dose CCPD therapy in the Low
Fill Mode.
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9. Operating Instructions – Change Program
Table 9-13. Hi-Dose CCPD Settings – Low Fill Mode
Setting
Total Volume
Description
TOTAL VOL:
ML
Total Volume of solution used for the therapy. Includes the
total Day Fill Volume and Night Fill Volume for all cycles, and
the Last Fill Volume.
Minimum setting is 200 mL
Maximum setting is 80000 mL
Default setting is 200 mL
Setting increments:
– 50 in the 200 to 2000 mL range
– 100 in the 2000 to 20000 mL range
– 500 in the 20000 to 80000 mL range
# of Day Fills
# OF DAY FILLS:
Number of daytime exchanges. This setting only appears for a
Hi-Dose therapy.
Minimum setting is 0
Maximum setting is 9
Default setting is 0
Setting increment is 1
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9. Operating Instructions – Change Program
Table 9-13. Hi-Dose CCPD Settings – Low Fill Mode (Continued)
Setting
Description
WARNING
Your Day Fill Volume in milliliters (mL) should normally not exceed
the values shown in Table 19-7 on page 19-15. Contact your dialysis
center to confirm your Day Fill Volume if it exceeds this volume.
Exceeding this volume can result in an increased intraperitoneal
volume (IIPV) situation.
IIPV could result in a feeling of abdominal discomfort, serious injury,
or death. See page 18-58 for IIPV symptoms or if IIPV is suspected.
Additional care should be taken to monitor for IIPV symptoms for
those patients not able to communicate essential information to their
caregiver during treatment.
Day Fill
Volume
DAY FILL VOL:
ML
Volume of solution for each daytime exchange, based on your
prescription. This setting only appears for a Hi-Dose therapy.
Minimum setting is 60 mL
Maximum setting is 1000 mL
Default setting is 250 mL
Setting increments:
– 1 in the 60 to 100 mL range
– 10 in the 100 to 500 mL range
– 50 in the 500 to 1000 mL range
Night Therapy
Time
NITE THER TIME:HH:MM
Total time for the nighttime portion of therapy. This time is
fixed and begins as soon as you complete daytime exchanges.
Minimum setting is 10 minutes
Maximum setting is 48 hours
Default setting is 10 minutes
Setting increment is 10 minutes
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9. Operating Instructions – Change Program
Table 9-13. Hi-Dose CCPD Settings – Low Fill Mode (Continued)
Setting
Description
WARNING
Your Night Fill Volume in milliliters (mL) should normally not exceed
the values shown in Table 19-7 on page 19-15. Contact your dialysis
center to confirm your Night Fill Volume if it exceeds this volume.
Exceeding this volume can result in an increased intraperitoneal
volume (IIPV) situation.
IIPV could result in a feeling of abdominal discomfort, serious injury,
or death. See page 18-58 for IIPV symptoms or if IIPV is suspected.
Additional care should be taken to monitor for IIPV symptoms for
those patients not able to communicate essential information to their
caregiver during treatment.
Night Fill
Volume
NITE FILL VOL:
ML
Volume of solution for each nighttime cycle based on your
prescription.
Minimum setting is 60 mL
Maximum setting is 1000 mL
Default setting is 250 mL
Setting increments:
– 1 in the 60 to 100 mL range
– 10 in the 100 to 500 mL range
– 50 in the 500 to 1000 mL range
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9. Operating Instructions – Change Program
Table 9-13. Hi-Dose CCPD Settings – Low Fill Mode (Continued)
Setting
Last Fill
Volume
Description
LAST FILL VOL:
ML
Last Fill Volume delivered at the end of the therapy and left in
the peritoneal cavity during the day. Also called “Wet Day.”
Minimum setting is 0 or 60 mL
Maximum setting is 1000 mL
Default setting is 0 mL
Setting increments:
– 1 in the 60 to 100 mL range
– 10 in the 100 to 500 mL range
– 50 in the 500 to 1000 mL range
Dextrose
DEXTROSE:
SAME (default setting)
– or –
DEXTROSE:
DIFFERENT
The Last Fill Volume can be the same dextrose concentration
as the other Fills or it can be different.
This setting does not appear if LAST FILL VOL = 0.
This setting only appears if you use Last Fill.
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9. Operating Instructions – Change Program
9.8.4
Hi-Dose CCPD Calculated Settings
HomeChoice/HomeChoice PRO APD System calculates the number of night cycles
and the Dwell Time. The calculated values are shown on the display screen when
you press STOP after you have completed reviewing your therapy settings.
Table 9-14. Definitions for Hi-Dose CCPD Calculated Settings
Setting
Description
Cycles
Total number of cycles at night, not including the Last Fill.
This parameter is calculated by the system.
Dwell Time
Calculated amount of time the dialysis solution remains in the
peritoneal cavity during each cycle. The system may
automatically adjust the Dwell Time based on your actual
flow rates during Fill and Drain, if your clinician chooses this
option.
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9. Operating Instructions – Change Program
9.8.5
Tidal Therapy Settings
THERAPY:
TIDAL (Low Fill Mode)
With Tidal therapy, only a portion of the solution in your peritoneal cavity is
drained and replaced with new solution during each therapy cycle.
WARNING
Pressing the STOP and GO buttons during successive Tidal
Dwell cycles can lead to a gradual increase in
intraperitoneal volume (IPV). An increased intraperitoneal
volume (IIPV) situation can result for patients with a low
Fill Volume and a high number of cycles.
IIPV could result in a feeling of abdominal discomfort,
serious injury, or death. See page 18-58 for IIPV symptoms
or if IIPV is suspected.
Additional care should be taken to monitor for IIPV
symptoms for those patients not able to communicate
essential information to their caregiver during treatment.
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9. Operating Instructions – Change Program
WARNING
Patients whose Fill volumes are less than 1000 mL may
normally drain slowly. These patients typically weigh less
than 44 lbs (20 kg). Use of the Low Fill Mode minimizes the
incidence of LOW DRAIN VOLUME and CAUTION: NEGATIVE
UF alarms. These alarms can not be bypassed to prevent an
increased intraperitoneal volume (IIPV) situation in Low
Fill Mode. The Negative UF Limit should not be raised
above 50% and the Minimum Drain Volume % should not
be lowered below 85%, (the default values). It is required
that the Low Recirculation Volume Set be used with Low
Fill Mode procedures.
IIPV could result in a feeling of abdominal discomfort,
serious injury, or death. See page 18-58 for IIPV symptoms
or if IIPV is suspected.
Additional care should be taken to monitor for IIPV
symptoms for those patients not able to communicate
essential information to their caregiver during treatment.
h NOTE:
The Tidal Volume (Fill Volume x Tidal Volume %) must be at least
95 mL or a CHECK TIDAL VOL PCT alarm will occur. See 18.3.3, Check
Therapy Setting Value, on page 18-10.
h NOTE:
Prescription settings can not be adjusted during a Tidal therapy.
Table 9-15 shows the settings programmed for Tidal therapy in the Low Fill Mode.
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9. Operating Instructions – Change Program
Table 9-15. Tidal Settings – Low Fill Mode
Setting
Total Volume
Description
TOTAL VOL:
ML
Total Volume of solution used for the therapy. Includes the
total Fill Volume for all cycles and the Last Fill Volume.
Minimum setting is 200 mL
Maximum setting is 80000 mL
Default setting is 200 mL
Setting increments:
– 50 in the 200 to 2000 mL range
– 100 in the 2000 to 20000 mL range
– 500 in the 20000 to 80000 mL range
Therapy Time
THERAPY TIME:
HH:MM
Total time for the nighttime portion of therapy. This time
begins with Initial Drain.
Minimum setting is 10 minutes
Maximum setting is 48 hours
Default setting is 10 minutes
Setting increment is 10 minutes
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9. Operating Instructions – Change Program
Table 9-15. Tidal Settings – Low Fill Mode (Continued)
Setting
Description
WARNING
Your Fill Volume in milliliters (mL) should normally not exceed the
values shown in Table 19-7 on page 19-15. Contact your dialysis
center to confirm your Fill Volume if it exceeds this volume. Exceeding
this volume can result in an increased intraperitoneal volume (IIPV)
situation.
IIPV could result in a feeling of abdominal discomfort, serious injury,
or death. See page 18-58 for IIPV symptoms or if IIPV is suspected.
Additional care should be taken to monitor for IIPV symptoms for
those patients not able to communicate essential information to their
caregiver during treatment.
Fill Volume
FILL VOL:
ML
Volume of solution used for each cycle based on your
prescription.
Minimum setting is 60 mL
Maximum setting is 1000 mL
Default setting is 250 mL
Setting increments:
– 1 in the 60 to 100 mL range
– 10 in the 100 to 500 mL range
– 50 in the 500 to 1000 mL range
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9. Operating Instructions – Change Program
Table 9-15. Tidal Settings – Low Fill Mode (Continued)
Setting
Tidal Volume %
Description
TIDAL VOL:
%
Volume of fluid drained and refilled during each cycle. This is
expressed as a percentage of the initial Fill Volume.
Minimum setting is 5%
Maximum setting is 95%
Default setting is 5%
Setting increment is 5%
h NOTE: When the Therapy type is changed from CCPD to
Tidal, the Tidal Volume % reverts to the default
setting of 5%.
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9. Operating Instructions – Change Program
Table 9-15. Tidal Settings – Low Fill Mode (Continued)
Setting
Description
WARNING
A Total UF volume set too low can result in a gradual buildup of UF
volume during the therapy. This can result in an increased
intraperitoneal volume (IIPV) situation.
IIPV could result in a feeling of abdominal discomfort, serious injury,
or death. See page 18-58 for IIPV symptoms or if IIPV is suspected.
Additional care should be taken to monitor for IIPV symptoms for
those patients not able to communicate essential information to their
caregiver during treatment.
Total UF
TOTAL UF:
ML
Total ultrafiltration (UF) expected for the therapy. The
system calculates the UF Per Cycle. The UF Per Cycle plus the
Tidal Volume is the amount of solution drained during each
Tidal Drain.
Minimum setting is 0 mL
Maximum setting is 10000 mL
Default setting is 0 mL
Setting increments:
– 10 in the 0 to 1000 mL range
– 100 in the 1000 to 10000 mL range
h NOTES:
When the Therapy type is changed from CCPD to
Tidal, the Total UF reverts to the default setting of
zero (0).
A Total UF volume set too high can result in an
increased number of LOW DRAIN VOLUME alarms.
(NOTES continued on following page.)
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9. Operating Instructions – Change Program
Table 9-15. Tidal Settings – Low Fill Mode (Continued)
Setting
Description
h NOTES: (Continued)
Seventy percent (70%) of your normal Night UF is a
good starting point for determining your optimum
Total UF. For help in converting 70% of your
expected total therapy UF into a value that can be
programmed as your Total UF for your Tidal
therapy, see 19.17, Determining Tidal Total UF and
Last Manual Drain UF Target Volume Settings, on
page 19-18.
If you use a solution for your Tidal therapy that is
different from the solution used in your previous
therapy, you may need to adjust your Total UF based
on the concentration of the new solution. Contact
your dialysis center for recommendations regarding
setting your Total UF in this situation.
Last Fill
Volume
LAST FILL VOL:
ML
Last Fill Volume delivered at the end of therapy and left in the
peritoneal cavity during the day. Also called “Wet Day.”
Minimum setting is 0 or 60 mL
Maximum setting is 1000 mL
Default setting is 0 mL
Setting increments:
– 1 in the 60 to 100 mL range
– 10 in the 100 to 500 mL range
– 50 in the 500 to 1000 mL range
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9. Operating Instructions – Change Program
Table 9-15. Tidal Settings – Low Fill Mode (Continued)
Setting
Dextrose
Description
DEXTROSE:
SAME (default setting)
– or –
DEXTROSE:
DIFFERENT
The Last Fill Volume can be the same dextrose concentration
as the other Fills or it can be different.
This setting does not appear if LAST FILL VOL = 0.
This setting only appears if you use Last Fill.
Full Drains
Every
FULL DRAINS EVERY:
This setting appears when the therapy type is set to Tidal, and
Tidal Full Drains is enabled in the Nurse’s Menu by your
nurse.
Minimum setting is 1
Maximum setting is 99
Default setting is 1
Setting increment is 1
h NOTE: The Full Drains Every setting always defaults
to “1” when Tidal Full Drains is enabled. This
must be changed in the Therapy menu to prevent
full drains every cycle.
h NOTE: Use this setting to get a full Drain mid-therapy
when you have a large number of Tidal cycles.
This reduces over- (or under-) fills due to under(or over-) estimating the Total UF for the Tidal
therapy.
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9. Operating Instructions – Change Program
9.8.6
Tidal Calculated Settings
HomeChoice/HomeChoice PRO APD System calculates the number of night cycles
and the Dwell Time. For a Tidal therapy, the system also calculates Tidal Volume
and ultrafiltration (UF) per cycle. The calculated values are shown on the display
screen when you press STOP after you have completed reviewing your therapy
settings.
Table 9-16. Definitions for Tidal Calculated Settings
Setting
Description
Cycles
Total number of cycles at night, not including the Last Fill.
This parameter is calculated by the system.
Dwell Time
Calculated amount of time the dialysis solution remains in
the peritoneal cavity during each cycle. The system may
automatically adjust the Dwell Time based on your actual
flow rates during Fill and Drain, if your clinician chooses this
option.
Tidal Volume
Actual Tidal Volume calculated based on the Tidal Volume %
programmed and the Fill Volume.
UF Per Cycle
Estimated UF Per Cycle based on Total UF programmed and
number of cycles calculated.
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9. Operating Instructions – Change Program
9.8.7
Hi-Dose Tidal Therapy Settings
THERAPY:HI-DOSE TIDL (Low Fill Mode)
With Tidal therapy, only a portion of the solution in your peritoneal cavity is
drained and replaced with new solution during each therapy cycle.
WARNING
Pressing the STOP and GO buttons during successive Tidal
Dwell cycles can lead to a gradual increase in
intraperitoneal volume (IPV). An increased intraperitoneal
volume (IIPV) situation can result for patients with a low
Fill Volume and a high number of cycles.
IIPV could result in a feeling of abdominal discomfort,
serious injury, or death. See page 18-58 for IIPV symptoms
or if IIPV is suspected.
Additional care should be taken to monitor for IIPV
symptoms for those patients not able to communicate
essential information to their caregiver during treatment.
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9. Operating Instructions – Change Program
WARNING
Patients whose Fill volumes are less than 1000 mL may
normally drain slowly. These patients typically weigh less
than 44 lbs (20 kg). Use of the Low Fill Mode minimizes the
incidence of LOW DRAIN VOLUME and CAUTION: NEGATIVE
UF alarms. These alarms can not be bypassed to prevent an
increased intraperitoneal volume (IIPV) situation in Low
Fill Mode. The Negative UF Limit should not be raised
above 50% and the Minimum Drain Volume % should not
be lowered below 85%, (the default values). It is required
that the Low Recirculation Volume Set be used with Low
Fill Mode procedures.
IIPV could result in a feeling of abdominal discomfort,
serious injury, or death. See page 18-58 for IIPV symptoms
or if IIPV is suspected.
Additional care should be taken to monitor for IIPV
symptoms for those patients not able to communicate
essential information to their caregiver during treatment.
h NOTE:
The Tidal Volume (Fill Volume x Tidal Volume %) must be at least
95 mL or a CHECK TIDAL VOL PCT alarm will occur. See 18.3.3, Check
Therapy Setting Value, on page 18-10.
h NOTE:
Prescription settings can not be adjusted during a Tidal therapy.
Table 9-17 shows the settings programmed for Hi-Dose Tidal therapy in the Low
Fill Mode.
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9. Operating Instructions – Change Program
Table 9-17. Hi-Dose Tidal Settings – Low Fill Mode
Setting
Total Volume
Description
TOTAL VOL:
ML
Total Volume of solution used for the therapy. Includes the
total Day Fill Volume and Night Fill Volume for all cycles, and
the Last Fill Volume.
Minimum setting is 200 mL
Maximum setting is 80000 mL
Default setting is 200 mL
Setting increments:
– 50 in the 200 to 2000 mL range
– 100 in the 2000 to 20000 mL range
– 500 in the 20000 to 80000 mL range
# of Day Fills
# OF DAY FILLS:
Number of daytime exchanges. This setting only appears for a
Hi-Dose therapy.
Minimum setting is 0
Maximum setting is 9
Default setting is 0
Setting increment is 1
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9. Operating Instructions – Change Program
Table 9-17. Hi-Dose Tidal Settings – Low Fill Mode (Continued)
Setting
Description
WARNING
Your Day Fill Volume in milliliters (mL) should normally not exceed
the values shown in Table 19-7 on page 19-15. Contact your dialysis
center to confirm your Day Fill Volume if it exceeds this volume.
Exceeding this volume can result in an increased intraperitoneal
volume (IIPV) situation.
IIPV could result in a feeling of abdominal discomfort, serious injury,
or death. See page 18-58 for IIPV symptoms or if IIPV is suspected.
Additional care should be taken to monitor for IIPV symptoms for
those patients not able to communicate essential information to their
caregiver during treatment.
Day Fill Volume
DAY FILL VOL:
ML
Volume of solution for each daytime exchange. This
parameter appears only when the Number of Day Fills has
been set to greater than zero (0).
Minimum setting is 60 mL
Maximum setting is 1000 mL
Default setting is 250 mL
Setting increments:
– 1 in the 60 to 100 mL range
– 10 in the 100 to 500 mL range
– 50 in the 500 to 1000 mL range
Night Therapy
Time
NITE THER TIME:HH:MM
Total time for the nighttime portion of therapy. This time
begins as soon as you start the last Drain of the daytime
exchange.
Minimum setting is 10 minutes
Maximum setting is 48 hours
Default setting is 10 minutes
Setting increment is 10 minutes
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9. Operating Instructions – Change Program
Table 9-17. Hi-Dose Tidal Settings – Low Fill Mode (Continued)
Setting
Description
WARNING
Your Night Fill Volume in milliliters (mL) should normally not exceed
the values shown in Table 19-7 on page 19-15. Contact your dialysis
center to confirm your Night Fill Volume if it exceeds this volume.
Exceeding this volume can result in an increased intraperitoneal
volume (IIPV) situation.
IIPV could result in a feeling of abdominal discomfort, serious injury,
or death. See page 18-58 for IIPV symptoms or if IIPV is suspected.
Additional care should be taken to monitor for IIPV symptoms for
those patients not able to communicate essential information to their
caregiver during treatment.
Night Fill
Volume
NITE FILL VOL:
ML
Volume of solution used for each cycle based on your
prescription.
Minimum setting is 60 mL
Maximum setting is 1000 mL
Default setting is 250 mL
Setting increments:
– 1 in the 60 to 100 mL range
– 10 in the 100 to 500 mL range
– 50 in the 500 to 1000 mL range
Night Tidal
Volume %
NITE TIDAL VOL:
%
Volume of fluid drained and refilled during each cycle. This is
expressed as a percentage of the initial Fill Volume.
Minimum setting is 5%
Maximum setting is 95%
Default setting is 5%
Setting increment is 5%
h NOTE: When the Therapy type is changed from CCPD to Tidal, the Night
Tidal Volume % reverts to the default setting of 5%.
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9. Operating Instructions – Change Program
Table 9-17. Hi-Dose Tidal Settings – Low Fill Mode (Continued)
Setting
Description
WARNING
A Total UF volume set too low can result in a gradual buildup of UF
volume during the therapy. This can result in an increased
intraperitoneal volume (IIPV) situation.
IIPV could result in a feeling of abdominal discomfort, serious injury,
or death. See page 18-58 for IIPV symptoms or if IIPV is suspected.
Additional care should be taken to monitor for IIPV symptoms for
those patients not able to communicate essential information to their
caregiver during treatment.
Night UF
NITE UF:
ML
Total ultrafiltration (UF) expected for the therapy. The
system calculates the UF Per Cycle. The UF Per Cycle plus the
Tidal Volume is the amount of solution drained during each
Tidal Drain.
Minimum setting is 0 mL
Maximum setting is 10000 mL
Default setting is 0 mL
Setting increments:
– 10 in the 0 to 1000 mL range
– 100 in the 1000 to 10000 mL range
h NOTES:
When the Therapy type is changed from CCPD to
Tidal, the Night UF reverts to the default setting of
zero (0).
A Total UF volume set too high can result in an
increased number of LOW DRAIN VOLUME alarms.
(NOTES continued on following page.)
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9. Operating Instructions – Change Program
Table 9-17. Hi-Dose Tidal Settings – Low Fill Mode (Continued)
Setting
Description
h NOTES: (Continued)
Seventy percent (70%) of your normal Night UF is a
good starting point for determining your optimum
Total UF. For help in converting 70% of your
expected total therapy UF into a value that can be
programmed as your Total UF for your Tidal
therapy, see 19.17, Determining Tidal Total UF and
Last Manual Drain UF Target Volume Settings, on
page 19-18.
If you use a solution for your Tidal therapy that is
different from the solution used in your previous
therapy, you may need to adjust your Total UF based
on the concentration of the new solution. Contact
your dialysis center for recommendations regarding
setting your Total UF in this situation.
Last Fill
Volume
LAST FILL VOL:
ML
Last Fill Volume delivered at the end of therapy and left in the
peritoneal cavity during the day. Also called “Wet Day.”
Minimum setting is 0 or 60 mL
Maximum setting is 1000 mL
Default setting is 0 mL
Setting increments:
– 1 in the 60 to 100 mL range
– 10 in the 100 to 500 mL range
– 50 in the 500 to 1000 mL range
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9. Operating Instructions – Change Program
Table 9-17. Hi-Dose Tidal Settings – Low Fill Mode (Continued)
Setting
Dextrose
Description
DEXTROSE:
SAME (default setting)
– or –
DEXTROSE:
DIFFERENT
The Last Fill Volume can be the same dextrose concentration
as the other Fills or it can be different.
This setting does not appear if LAST FILL VOL = 0.
This setting only appears if you use Last Fill.
Full Drains
Every
FULL DRAINS EVERY:
This setting appears when the therapy type is set to Tidal, and
Tidal Full Drains is enabled in the Nurse’s Menu by your
nurse.
Minimum setting is 1
Maximum setting is 99
Default setting is 1
Setting increment is 1
h NOTE: The Full Drains Every setting always defaults
to “1” when Tidal Full Drains is enabled. This
must be changed in the Therapy menu to prevent
full Drains every cycle.
h NOTE: Use this setting to get a full Drain mid-therapy
when you have a large number of Tidal cycles.
This reduces over- (or under-) fills due to under(or over-) estimating the Total UF for the Tidal
therapy.
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9. Operating Instructions – Change Program
9.8.8
Hi-Dose Tidal Calculated Settings
The HomeChoice/HomeChoice PRO APD System calculates the number of night
cycles and the Dwell Time. For a Tidal therapy, the system also calculates Tidal
Volume and ultrafiltration (UF) per cycle. The calculated values are shown on the
display screen when you press STOP after you have completed reviewing your
therapy settings.
Table 9-18. Definitions for Hi-Dose Tidal Calculated Settings
Setting
Description
Cycles
Total number of cycles at night, not including the Last Fill.
This parameter is calculated by the system.
Dwell Time
Calculated amount of time the dialysis solution remains in
the peritoneal cavity during each cycle. The system may
automatically adjust the Dwell Time based on your actual
flow rates during Fill and Drain, if your clinician chooses this
option.
Tidal Volume
Actual Tidal Volume calculated based on the Tidal Volume %
programmed and the Night Fill Volume.
UF Per Cycle
Estimated UF Per Cycle based on Total UF programmed and
number of cycles calculated.
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Section
10
Operating Instructions –
Make Adjustments
10. Make Adjustments
Operating Instructions –
Make Adjustments
10.1 Make Adjustments Menu
MAKE ADJUSTMENTS
The following options are available from the MAKE ADJUSTMENTS menu.
Adjust Brightness
Adjust Loudness
Auto Dim
Set Clock
Set Date
I-Drain Time (Low Fill Mode only)
I-Drain Alarm
Comfort Control
Last Manual Drain
UF Target and Alarm
10.1.1 Changing Settings
The settings for these options can be changed by your dialysis nurse or physician
using your PRO Card, or you can adjust them manually. These settings are not part
of your prescription. They do not have to be reviewed or changed every treatment.
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10-1
10. Operating Instructions – Make Adjustments
Follow the basic steps below to make adjustments to your settings.
Basic steps to Make Adjustments
1.
Before you press GO to start your therapy,
press V.
CHANGE PROGRAM appears on the display screen.
2.
Press V again.
Display screen
PRESS GO TO START
CHANGE PROGRAM
MAKE ADJUSTMENTS
MAKE ADJUSTMENTS appears.
3.
Press ENTER to access the Make Adjustments
menu.
ADJUST BRIGHTNESS
ADJUST BRIGHTNESS appears.
4.
If you do not want to change this setting, press V
to see the next option.
ADJUST LOUDNESS
5.
Press ENTER to select the setting you want to
change.
ADJUST LOUDNESS
6.
Press U and V to change the option or value.
7.
Press ENTER to save the option or value.
(The option or value blinks)
ADJUST LOUDNESS
(Blinking stops)
8.
Press V to display the next option.
9.
Continue to review or change settings by repeating
Steps 4 through 8.
10. Press STOP to exit Make Adjustments.
PRESS GO TO START
The system saves the settings until you change
them again.
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10. Operating Instructions – Make Adjustments
10.2 Option Settings
10.2.1 Adjust Brightness
Follow the steps below to adjust the brightness of the display screen.
Steps to Adjust Brightness
Display screen
1.
Press ENTER to access the MAKE ADJUSTMENTS
menu.
2.
ADJUST BRIGHTNESS is the first option.
ADJUST BRIGHTNESS
3.
Press ENTER.
PLEASE ADJUST NOW
The display screen blinks.
4.
Press U or V.
MAKE ADJUSTMENTS
(The display screen blinks)
PLEASE ADJUST NOW
The brightness of the display screen will change as
you press U or V.
5.
Press ENTER to save the new brightness level.
ADJUST BRIGHTNESS
The display screen stops blinking.
6.
Press V to display the next option.
(Blinking stops)
ADJUST LOUDNESS
– OR –
7.
If you do not want to make any other adjustments,
press STOP to exit Make Adjustments.
PRESS GO TO START
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10. Operating Instructions – Make Adjustments
10.2.2 Adjust Loudness
Follow the steps below to adjust the loudness of the beeps and alarms.
Steps to Adjust Loudness
Display screen
1.
Press ENTER to access the MAKE ADJUSTMENTS
menu.
MAKE ADJUSTMENTS
2.
Press V until ADJUST LOUDNESS appears.
ADJUST LOUDNESS
3.
Press ENTER.
PLEASE ADJUST NOW
The display screen blinks.
4.
Press U or V.
(The display screen blinks)
PLEASE ADJUST NOW
The loudness of the beep will change as you
press U or V.
5.
Press ENTER to save the new loudness level.
The display screen stops blinking.
6.
Press V to display the next option.
ADJUST LOUDNESS
(Blinking stops)
AUTO DIM:
NO
– OR –
7.
If you do not want to make any other adjustments,
press STOP to exit Make Adjustments.
10-4
PRESS GO TO START
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10. Operating Instructions – Make Adjustments
10.2.3 Auto Dim
If AUTO DIM is set to YES, the display screen turns off during your therapy if no
buttons are pressed for five (5) minutes. A single dot will move from left to right
across the screen. The display screen will turn back on if an alarm occurs or if a
button is pressed.
The default setting is AUTO DIM: NO.
h NOTE:
AUTO DIM will not operate when the display screen is showing the
current time or estimated treatment end time.
Follow the steps below to change the Auto Dim option.
Steps to set Auto Dim
Display screen
1.
Press ENTER to access the MAKE ADJUSTMENTS
menu.
2.
Press V until AUTO DIM appears.
AUTO DIM:
NO
3.
Press ENTER.
AUTO DIM:
NO
The YES or NO blinks.
MAKE ADJUSTMENTS
(YES or NO blinks)
4.
Press U or V to change the setting.
AUTO DIM:
YES
5.
Press ENTER to save the new setting.
AUTO DIM:
YES
The blinking stops.
6.
Press V to display the next option.
(Blinking stops)
SET CLOCK:
7:10 AM
– OR –
7.
If you do not want to make any other adjustments,
press STOP to exit Make Adjustments.
PRESS GO TO START
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10-5
10. Operating Instructions – Make Adjustments
10.2.4 Set Clock
Follow the steps below to adjust the hour and minutes of the clock.
h NOTE:
The time can not be changed during therapy.
Steps to set the Clock
Display screen
1.
Press ENTER to access the MAKE ADJUSTMENTS
menu.
2.
Press V until SET CLOCK appears.
SET CLOCK:
7:10 AM
3.
Press ENTER.
SET CLOCK:
7:10 AM
The hour digits blink.
MAKE ADJUSTMENTS
(The hour blinks)
4.
Press U or V to change the hour.
SET CLOCK:
8:10 AM
5.
Press ENTER to save the hour.
SET CLOCK:
8:10 AM
The minute digits then blink.
(The minutes blink)
6.
Press U or V to change the minutes.
SET CLOCK:
8:30 AM
7.
Press ENTER to save the minutes.
SET CLOCK:
8:30 AM
AM/PM then blinks.
(AM / PM blinks)
8.
Press U or V to change AM/PM.
SET CLOCK:
8:30 PM
9.
Press ENTER to save the new time.
SET CLOCK:
8:30 PM
The blinking stops.
10. Press V to display the next option.
(Blinking stops)
SET DATE: 8 JAN 2000
– OR –
11. If you do not want to make any other adjustments,
press STOP to exit Make Adjustments.
10-6
PRESS GO TO START
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10. Operating Instructions – Make Adjustments
10.2.5 Set Date
Follow the steps below to change the day, month, or year.
h NOTE:
The date can not be changed during therapy.
Steps to set the Date
Display screen
1.
Press ENTER to access the MAKE ADJUSTMENTS
menu.
2.
Press V until SET DATE appears.
SET DATE: 8 JAN 2008
3.
Press ENTER.
SET DATE: 8 JAN 2008
The day digits blink.
MAKE ADJUSTMENTS
(The day blinks)
4.
Press U or V to change the day.
SET DATE: 9 JAN 2008
5.
Press ENTER to save the new day.
SET DATE: 9 JAN 2008
The month then blinks.
(The month blinks)
6.
Press U or V to change the month.
SET DATE: 9 FEB 2008
7.
Press ENTER to save the new month.
SET DATE: 9 FEB 2008
The year then blinks.
(The year blinks)
8.
Press U or V to change the year.
SET DATE: 9 FEB 2009
9.
Press ENTER to save the new date.
SET DATE: 9 FEB 2009
The blinking stops.
10. Press V to display the next option.
(Blinking stops)
I-DRAIN TIME:
10:22
– OR –
11. If you do not want to make any other adjustments,
press STOP to exit Make Adjustments.
PRESS GO TO START
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10-7
10. Operating Instructions – Make Adjustments
10.2.6 I-Drain Time
h NOTE:
Initial Drain Time (I-DRAIN TIME) appears in Low Fill Mode only.
Review or adjust the I-DRAIN TIME setting if you change your Last Fill Volume or
if you perform a CAPD exchange during the day.
Steps to set the I-Drain Time
Display screen
1.
Press ENTER to access the MAKE ADJUSTMENTS
menu.
2.
Press V until I-DRAIN TIME appears.
I-DRAIN TIME:
0:22
3.
Press ENTER.
I-DRAIN TIME:
0:22
The digits blink.
4.
Press U or V to change the minutes.
MAKE ADJUSTMENTS
(The digits blink)
I-DRAIN TIME:
0:25
I-DRAIN TIME:
0:25
30 minutes is the maximum time you can set.
5.
Press ENTER to save the Initial Drain Time.
The blinking stops.
6.
Press V to display the next option.
(Blinking stops)
I-DRAIN ALARM:1400ML
– OR –
7.
If you do not want to make any other adjustments,
press STOP to exit Make Adjustments.
10-8
PRESS GO TO START
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10. Operating Instructions – Make Adjustments
10.2.7 I-Drain Alarm
The Initial Drain Alarm (I-DRAIN ALARM) volume is used to determine the
minimum amount of Drain Volume expected during your Initial Drain.
WARNING
Too low an I-Drain Alarm volume can result in an
incomplete Initial Drain followed by a full Fill. This can
result in an increased intraperitoneal volume (IIPV)
situation.
See Table 10-1 on page 10-11 for the recommended
starting points when determining your optimum I-Drain
Alarm volume.
IIPV could result in a feeling of abdominal discomfort,
serious injury, or death. See page 18-58 for IIPV symptoms
or if IIPV is suspected.
Additional care should be taken to monitor for IIPV
symptoms for those patients not able to communicate
essential information to their caregiver during treatment.
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10-9
10. Operating Instructions – Make Adjustments
WARNING
Patients whose Fill volumes are less than 1000 mL may
normally drain slowly. These patients typically weigh less
than 44 lbs (20 kg). Use of the Low Fill Mode minimizes the
incidence of LOW DRAIN VOLUME and CAUTION: NEGATIVE
UF alarms. These alarms can not be bypassed to prevent an
increased intraperitoneal volume (IIPV) situation in Low
Fill Mode. The Negative UF Limit should not be raised
above 50% and the Minimum Drain Volume % should not
be lowered below 85%, (the default values). It is required
that the Low Recirculation Volume Set be used with Low
Fill Mode procedures.
IIPV could result in a feeling of abdominal discomfort,
serious injury, or death. See page 18-58 for IIPV symptoms
or if IIPV is suspected.
Additional care should be taken to monitor for IIPV
symptoms for those patients not able to communicate
essential information to their caregiver during treatment.
Too high an I-Drain Alarm volume can result in an increased number of LOW
DRAIN VOLUME alarms.
If the volume of fluid drained is less than the expected volume, a LOW DRAIN
VOLUME alarm sounds. When Slow Flow or No Flow conditions occur during the
Initial Drain, the I-Drain Alarm volume is used to determine whether the system
alarms or moves on to the Fill cycle.
Review or adjust the I-Drain Alarm setting if you change your Last Fill Volume or if
you perform a CAPD exchange during the day. Refer to Table 10-1 on page 10-11
for the recommended settings based on a percentage of the Last Fill Volume.
10-10
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10. Operating Instructions – Make Adjustments
Table 10-1. Recommended Starting Point for I-Drain Alarm Setting
Last Fill Solution
Last Fill Dwell Time
% of Last Fill Volume
Dianeal
8 to 16 hours
70%*
Dianeal
2 to 4 hours
85%*
Extraneal
8 to 16 hours
95%*
* The settings for these percentages are calculated for you in Table 19-8 on
page 19-17 in 19.16, Determining Initial Drain Alarm Volume Settings.
h NOTE:
If the I-DRAIN ALARM is set to OFF, the HomeChoice APD System
moves on to Fill when a No Flow condition occurs. Baxter
recommends that this setting not be used since there is no Minimum
Drain Volume requirement. A LOW DRAIN VOLUME alarm is posted if
the flow rate is below 50 mL/min for 10 minutes. Subsequent alarms
are posted every 5 minutes. The I-DRAIN: OFF option is not available
in the Low Fill Mode.
h NOTE:
For “Dry Day” patients, set the I-Drain Alarm to 0 mL, or a very small
volume. If your patient line is greater than 12 feet (3.6 meters) in
length, set the I-Drain Alarm to at least 30 mL. Check with your
dialysis center for the correct number to set. Setting the I-Drain Alarm
to NO in the Standard Fill Mode will activate a No Flow or Slow Flow
alarm.
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10-11
10. Operating Instructions – Make Adjustments
Steps to set the I-Drain Alarm
Display screen
1.
Press ENTER to access the MAKE ADJUSTMENTS
menu.
2.
Press V until I-DRAIN ALARM appears.
I-DRAIN ALARM:1400ML
3.
Press ENTER.
I-DRAIN ALARM:1400ML
The volume digits blink.
MAKE ADJUSTMENTS
(The volume blinks)
4.
Press U or V to change the setting.
I-DRAIN ALARM:1800ML
5.
Press ENTER to save the new Initial Drain Alarm
volume.
I-DRAIN ALARM:1800ML
The blinking stops.
6.
Press V to display the next option.
(Blinking stops)
COMFORT CONTROL:
36
– OR –
7.
If you do not want to make any other adjustments,
press STOP to exit Make Adjustments.
10-12
PRESS GO TO START
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10. Operating Instructions – Make Adjustments
10.2.8 Comfort Control
Follow the steps below to adjust the temperature of the heater bag. The range is
from 35°C to 37°C. The default setting is 36°C.
Steps to adjust the temperature
Display screen
1.
Press ENTER to access the MAKE ADJUSTMENTS
menu.
2.
Press V until COMFORT CONTROL appears.
COMFORT CONTROL:
36
3.
Press ENTER.
COMFORT CONTROL:
36
The temperature digits blink.
MAKE ADJUSTMENTS
(The temperature blinks)
4.
Press U or Vto change the temperature.
COMFORT CONTROL:
37
5.
Press ENTER to save the new temperature.
COMFORT CONTROL:
37
The blinking stops.
6.
Press V to display the next option.
(Blinking stops)
LAST MANUAL DRAIN: N
– OR –
7.
If you do not want to make any other adjustments,
press STOP to exit Make Adjustments.
PRESS GO TO START
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10-13
10. Operating Instructions – Make Adjustments
10.2.9 Last Manual Drain
Baxter recommends YES be selected for the LAST MANUAL DRAIN option. A good
starting point for setting your Target UF is 70% of your expected Total UF. If the UF
is less than the Target UF at the end of the last Drain of the therapy, the system
stops and a LOW UF alarm appears on the display screen.
Occasionally, the location of the catheter tip can be in a less-than-optimal position.
This can lead to an incomplete Drain of the dialysis solution when lying down.
With the Last Manual Drain option, you may want to change position before the
Last Fill is performed by the system.
h NOTE:
If a LAST MANUAL DRAIN is set to YES, a UF Target and a UF Alarm
must be set. See 10.2.10, UF Target and Alarm, on page 10-15.
Follow the steps below to set Last Manual Drain.
Steps to set Last Manual Drain
Display screen
1.
Press ENTER to access the MAKE ADJUSTMENTS
menu.
2.
Press V until LAST MANUAL DRAIN appears.
LAST MANUAL DRAIN: N
3.
Press ENTER.
LAST MANUAL DRAIN: N
The N (NO) or Y (YES) blinks.
MAKE ADJUSTMENTS
(N or Y blinks)
4.
Press U or V to change the setting.
LAST MANUAL DRAIN: Y
5.
Press ENTER to save the new setting.
LAST MANUAL DRAIN: Y
The Y or N stops blinking.
6.
If LAST MANUAL DRAIN is set to YES, press V.
UF TARGET appears.
(Blinking stops)
UF TARGET:
0ML
– OR –
7.
If LAST MANUAL DRAIN is set to NO, press STOP
to exit Make Adjustments.
10-14
PRESS GO TO START
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10. Operating Instructions – Make Adjustments
10.2.10 UF Target and Alarm
This option only appears on the Make Adjustments menu if Last Manual Drain is
set to YES.
WARNING
Setting your UF Target too low can cause an incomplete last
Drain, leaving fluid in your peritoneal cavity. This can
result in an increased intraperitoneal volume (IIPV)
situation during your next Fill.
IIPV could result in a feeling of abdominal discomfort,
serious injury, or death. See page 18-58 for IIPV symptoms
or if IIPV is suspected.
Additional care should be taken to monitor for IIPV
symptoms for those patients not able to communicate
essential information to their caregiver during treatment.
The UF TARGET allows you to set a minimum amount of UF that must be drained
before the Last Manual Drain option is enabled. Seventy percent (70%) of your
expected UF is a good starting point for setting your UF Target. For help in
converting 70% of your expected total therapy UF into a value that can be
programmed as your Total UF for your Tidal therapy, see 19.17, Determining Tidal
Total UF and Last Manual Drain UF Target Volume Settings, on page 19-18. If the
accumulated UF for the therapy (including nighttime UF and Hi-Dose UF) is below
the UF Target at the end of the last regular Drain, the therapy stops and a LOW UF
alarm occurs.
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10-15
10. Operating Instructions – Make Adjustments
The ALARM must be programmed YES or NO.
If ALARM: YES is set, and the UF TARGET is not met, the
HomeChoice/HomeChoice PRO APD System beeps continuously. A LOW UF
alarm appears on the display screen.
If ALARM: NO is set, and the UF TARGET is not met, only the LOW UF
alarm appears on the display screen. The system will not beep. It will wait
for you to wake up and finish draining. At that time, you can change your
position and initiate a Manual Drain.
Steps to set UF Target
If LAST MANUAL DRAIN is set to YES:
Display screen
LAST MANUAL DRAIN: Y
1.
Press V to display the UF TARGET screen.
UF TARGET:
0ML
2.
Press ENTER.
UF TARGET:
0ML
The volume digits blink.
(The volume blinks)
3.
Press U or V to change the setting.
UF TARGET:
1200ML
4.
Press ENTER to save the new setting.
UF TARGET:
1200ML
The blinking stops.
(Blinking stops)
5.
Press V to display the ALARM option.
ALARM:
NO
6.
Press ENTER.
ALARM:
NO
The NO or YES blinks.
(NO or YES blinks)
7.
Press U or V to select YES or NO.
ALARM:
YES
8.
Press ENTER to save the new setting.
ALARM:
YES
The blinking stops.
9.
If you do not want to make any other adjustments,
press STOP to exit Make Adjustments.
10-16
(Blinking stops)
PRESS GO TO START
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11
Operating Instructions –
Prepare for Therapy
11. Prepare for Therapy
Section
Operating Instructions –
Prepare for Therapy
11.1 Gather Your Supplies
Gather all the supplies necessary for your dialysis treatment.
2
1
4
5
3
6
1. Solution Bags
2. Disposable Set (Luer shown)
• Standard set for Fill volumes above 1000 mL
• Low Recirculation Volume set for
Fill volumes at or below 1000 mL
3.
4.
5.
6.
Drain Bag or Drain Line Extension
Disconnect Cap(s)
Face Mask(s)
Patient Line Extension, if needed
Figure 11-1. Supplies
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11-1
11. Operating Instructions – Prepare for Therapy
WARNING
Do not use a Patient Line Extension with the Low
Recirculation Set. Using an extension with this set
increases the recirculation volume and reduces therapy
effectiveness.
WARNING
Do not extend the patient line beyond 34 feet (10.4 meters)
for the standard set. Extending the patient line beyond this
length increases the recirculation volume and reduces
therapy effectiveness.
WARNING
Do not use a Patient Line Extension Set if tip protectors are
not in place. If the tip protectors are not secure, possible
contamination of the fluid or fluid pathways can result.
Contamination of any portion of the fluid or fluid path can
result in peritonitis.
WARNING
If the solution is not clear, do not use and discard the bag.
Follow the labeling instructions supplied with the dialysis
solution for storage and preparation. Failure to follow the
solution labeling instructions can lead to insufficient
therapy or adverse clinical reaction.
11-2
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11. Operating Instructions – Prepare for Therapy
11.2 Prepare Your Solution Bags
WARNING
Follow aseptic technique taught by your dialysis center
when handling lines and solution bags to reduce the
possibility of infection. Always put on a face mask and wash
and dry (or disinfect) your hands thoroughly.
WARNING
If any problems are found while preparing the solution
bags, DO NOT USE THE SOLUTION SUPPLY BAG. DISCARD
THE BAG and get a fresh dialysis solution supply bag. Using
wrong or damaged bags can result in inadequate therapy
or contamination of the fluid lines. Contamination of any
portion of the fluid or fluid path can result in peritonitis.
Contact Baxter or your dialysis center to report any
problems with the bags. See 2.2, Numbers to Call for
Assistance, on page 2-1.
WARNING
The solution bag must be positioned properly on the
heater pan. The edge of the bag should be placed against
the bag stops on the right side of the heater pan. Be sure
that the bag completely covers the silver heater sensor
button. Failure to properly position the solution bag can
result in the delivery of overheated or underheated
dialysis fluid.
WARNING
DO NOT use external heating sources (i.e., microwave
oven) to warm solution bags. This can result in overheated
solution delivered into your peritoneal cavity.
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11. Operating Instructions – Prepare for Therapy
For your comfort, and to avoid alarms during priming: If you perform your
treatment or if you store your supplies in an area colder than 15°C/59°F, turn on
the HomeChoice/HomeChoice PRO APD System and place your bag on the heater
pan 30 to 60 minutes prior to starting setup. In addition, place the cassette on top
of heater bag to help warm it.
Follow the steps below to prepare your solution bags.
Steps to prepare solution bags
1.
Check each solution bag.
Remove the overpouch (protective
wrapping) and check the following:
The solution is clear
The solution matches the prescribed
type
The dextrose concentration is correct
The volume of solution in the bag is
correct
The expiration date has not passed
The pull ring and medication port are in place
Ensure there are no leaks by:
– Wiping condensation from the bag and ensuring bag port is separated
from bag surface
– Squeezing the bag
– Inspecting all seal areas, port areas, and front/back surfaces for leaks
Your clinician may have taught you to check solution bags for SEAL:
Strength
Expiration Date
Amount
Leaks
11-4
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11. Operating Instructions – Prepare for Therapy
Steps to prepare solution bags (Continued)
2.
Place one bag on the heater pan.
a.
Place the edge of the bag against the bag
stops on the right side of the heater pan.
b.
Make sure that the bag completely covers
the silver heater sensor button.
b
GO
STO
P
ENTE
R
a
h NOTE: This bag remains on the heater pan
throughout the treatment.
11.3 Turn On Your HomeChoice APD System
h NOTE:
Please read Section 3, Warnings and Cautions, before you turn on your
HomeChoice or HomeChoice PRO APD System (the “system”).
Follow the steps below to turn on your system.
Steps to turn on the system
1.
Plug the power cord into the back of the cycler.
2.
Plug the other end of the power cord into a
grounded electrical outlet.
h NOTE: Be sure to unplug the power cord before you move the cycler.
h NOTE: If your physician is using the PRO Card option, make sure that the
PRO Card is in the system before you turn it on. See Section 8,
Operating Instructions – PRO Card and Modem, for information
regarding the PRO Card.
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11. Operating Instructions – Prepare for Therapy
Steps to turn on the system (Continued)
3.
Press the On/Off Switch to the ON position ( I ).
The On/Off Switch is located on the back of the
cycler, next to the power cord.
4.
After turning on the system, make sure you hear
the beep that verifies that the audible alarm is
working.
5.
Observe that all of the characters on the display
screen have all pixels ON (not blinking) for several
seconds.
Pixels are the small dots that form the displayed
letters and numbers.
6.
Next, observe that all of the characters have all
pixels (display dots) OFF for several seconds.
h NOTE: If the display performs differently than stated in Steps 4, 5, and 6,
contact Baxter Technical Assistance.
h NOTE: If your dialysis center is using the HomeChoice PRO APD System
prompts option, the prompts will appear at this time. See Section 8,
Operating Instructions – PRO Card and Modem for information about
this option.
7.
The current operating mode (STANDARD MODE or
LOW FILL MODE) appears for a few seconds.
When the system is ready, PRESS GO TO START
appears.
h NOTE:
11-6
STANDARD MODE ON
PRESS GO TO START
If you have received a new system, or “swap,” or your prescription has
changed, verify the therapy settings are correct, as directed by your
dialysis nurse. See Section 9, Operating Instructions – Change
Program, for instructions on verifying your therapy settings.
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11. Operating Instructions – Prepare for Therapy
11.4 Menu Options at Startup
Prior to starting a therapy you can review your therapy settings, last therapy
results, and other information. Table 11-1 lists the options you can select before
you press GO to start your dialysis treatment.
1.
Press V to view each option.
2.
Press ENTER to select an option.
3.
Press STOP to return to the previous menu.
Table 11-1. Options Available at Startup
Option
Start Setup
Description
PRESS GO TO START
Shows that the system is ready for you to begin preparing
for your treatment.
Change Program
– OR –
Review Program
CHANGE PROGRAM
Press ENTER to change your therapy settings. Press STOP
to return to the previous menu.
REVIEW PROGRAM
REVIEW PROGRAM appears if the program is locked.
See Section 9, Operating Instructions – Change Program for
instructions.
Make
Adjustments
MAKE ADJUSTMENTS
Press ENTER to change or review system settings. Press
STOP to return to the previous menu.
See Section 10, Operating Instructions – Make Adjustments,
for instructions.
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11. Operating Instructions – Prepare for Therapy
Table 11-1. Options Available at Startup (Continued)
Option
Initial Drain
Volume
Last Manual
Drain
Last
Ultrafiltration
Description
I-DRAIN VOL:
65ML
Shows the volume from the Initial Drain of your last
treatment.
LAST M-DRAIN:
60ML
Only appears if you drained some fluid using the Manual
Drain option after a Last Fill. Shows the amount of solution
drained.
LAST UF:
350ML
Amount of ultrafiltrate removed during the last treatment.
Press ENTER to review cycle-by-cycle information. Press
STOP to return to the previous menu.
If this value is lower than usual, or negative, temporarily
increase your I-Drain Alarm setting when Verify I-Drain is
displayed prior to the start of the Initial Drain. This ensures
a complete Initial Drain. See 10.2.7, I-Drain Alarm, on
page 10-9.
Average Dwell
Time
Alarm Log
AVG DWELL TIME: 1:34
Average actual Dwell Time per cycle for the last treatment.
Press ENTER to review cycle-by-cycle information. Press
STOP to return to the previous menu.
ALARM LOG
Press ENTER to review the last 20 alarms. Press STOP to
return to the previous menu.
LOG IS EMPTY appears if no alarms occurred.
11-8
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11. Operating Instructions – Prepare for Therapy
Table 11-1. Options Available at Startup (Continued)
Option
Therapy Log
Description
THERAPY LOG
Press ENTER to review information about the 5 or 6 most
recently performed treatments. It does not include the
treatment in process. Press STOP to return to the previous
menu.
Modem Connect
MODEM CONNECT
Press ENTER to begin a modem data transfer. See
8.4, Install the Modem Option, on page 8-14 for details.
Current Time
9:30 PM
Shows the current time. See 10.2.4, Set Clock, on page 10-6
if you need to change the time.
Software Version
SOFTWARE VER: 10.210
Shows the software version of the HomeChoice/HomeChoice
PRO APD System.
h NOTE: The software version that appears on your
system may differ from this example.
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11-9
11. Operating Instructions – Prepare for Therapy
11.5 Load the Disposable Set
WARNING
Connect yourself only when CONNECT YOURSELF appears
on the display screen.
Connecting yourself before CONNECT YOURSELF appears
can cause air to be delivered to your peritoneal cavity. This
can result in shoulder and abdominal pain.
This can also result in an increased intraperitoneal volume
(IIPV) situation if you had fluid in your peritoneal cavity
prior to the Initial Drain.
IIPV could result in a feeling of abdominal discomfort,
serious injury, or death. See page 18-58 for IIPV symptoms
or if IIPV is suspected.
Additional care should be taken to monitor for IIPV
symptoms for those patients not able to communicate
essential information to their caregiver during treatment.
11-10
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11. Operating Instructions – Prepare for Therapy
WARNING
Before loading the disposable set, inspect the cassette and
tubing for damage. Using damaged sets can result in
contamination of the fluid or fluid pathways.
Contamination of any portion of the fluid or fluid path can
result in peritonitis.
Inspect the flexible surfaces of the cassette for obvious
signs of damage, including cuts, tears, or punctures.
Ensure the tip protectors on the ends of the tubing are
on and unbroken.
If damage is found, obtain a new disposable set and repeat
inspection procedure.
Tubing indentations can be present on disposable sets due
to the supple nature of the tubing. Slight tubing
indentations are cosmetic in nature and should have no
impact on the functionality of the product.
Follow the steps below to load the disposable set.
Steps to load the disposable set
1.
Prepare the disposable set.
Open the packaging and remove the
disposable set.
Close all clamps.
– 3-prong set has 5 clamps
– 4-prong set has 6 clamps
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11-11
11. Operating Instructions – Prepare for Therapy
Steps to load the disposable set (Continued)
2.
Prepare drain option.
For Drain Bag – close the clamp on the line
with the blue pull ring.
For Drain Line Extension – leave the line
clamp open.
3.
If you are using a Patient Line Extension Set,
open the package and place it on a clean
surface.
4.
Press GO when you are ready to begin.
LOAD THE SET appears.
LOAD THE SET
h NOTE: LOW FILL MODE IS OFF appears if your Fill Volume is less than
1000 mL and you are not using the Low Fill Mode. If this occurs, call
your dialysis center to see if your treatment should be performed in
the Low Fill Mode. Otherwise, if you are sure the Fill Volume and
therapy mode settings are correct, press GO again to see LOAD THE
SET.
5.
Push up the handle on the front of the cycler to
unlock and open the door.
h NOTE: The door must be opened within
2 minutes (30 seconds for Low Fill
Mode). If you do not open the door
within that time, press STOP and GO
again to retract the occluder for an
additional 2 minutes (30 seconds for
Low Fill Mode).
11-12
GO
STOP
ENTER
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11. Operating Instructions – Prepare for Therapy
Steps to load the disposable set (Continued)
6.
Load the cassette.
The cassette only fits in one way, with the
lines leading to the right of the cycler.
Insert the cassette bottom edge first, then
press in the top.
Pull the lines back toward the rear to lock
the cassette into the cycler.
h NOTE: Connect yourself only when CONNECT
YOURSELF appears on the display
screen.
7.
Press down the handle to close and lock the
door.
h NOTE: Do not open the door until ending
GO
therapy.
8.
STO
P
ENTE
R
Place the organizer:
a.
Place the long slot of the organizer over the
hook at the top of the door.
b.
Snap the lower slot of the organizer over
the post at the front of the door.
c.
Make sure the end of the patient line is
correctly positioned in the organizer as
shown.
c
a
b
h NOTE: Connect yourself only when CONNECT
YOURSELF appears on the display
screen.
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11-13
11. Operating Instructions – Prepare for Therapy
11.6 Attach the Drain Option
WARNING
When a drain line extension is used instead of a drain bag,
you must leave an air gap (space) between the end of the
drain line and any fluid in the drain or container. This
prevents non-sterile fluid from flowing backwards up the
drain line. Non-sterile fluid can contaminate the fluid path
resulting in peritonitis.
Follow the steps below to attach your drain option.
Steps to attach a drain option
1.
Attach your drain option:
Drain Line Extension – remove tip
protectors from both ends of drain.
– OR –
15L Drain Bag – close clamp on short tube
to prevent leakage.
h NOTE: If you use more than one drain bag, use
a drain manifold to connect the bags.
2.
Open all clamps in the drain lines.
3.
Press GO.
The display screen changes to SELF TESTING.
When the self-test is complete, CONNECT BAGS
appears.
11-14
SELF TESTING...
CONNECT BAGS
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11. Operating Instructions – Prepare for Therapy
11.7 Connect the Solution Bags
h NOTE:
Connect yourself only when CONNECT YOURSELF appears on the
display screen.
WARNING
If the solution bag on the heater pan does not cover the
heater button on the right end of the heater, delivery of
overheated solution can result. In some circumstances, this
can cause injury to the patient. Additional care should be
taken when positioning small solution bags on the heater
pan.
WARNING
If you use a Last Fill with a different solution, the line with
the BLUE clamp must be connected to the Last Fill solution
bag. If the solution concentration is incorrect or the wrong
solution is connected to the Last Fill line, UF alarms can
occur during therapy because the wrong solution can
generate too much or not enough ultrafiltrate volume.
If you discover that your therapy was performed with an
incorrect solution, or an incorrect solution was connected
to the Last Fill (BLUE clamp) line, contact your dialysis
center.
WARNING
Follow aseptic technique taught by your dialysis center
when handling lines and solution bags to reduce the
possibility of infection. Always put on a face mask and wash
and dry (or disinfect) your hands thoroughly.
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11. Operating Instructions – Prepare for Therapy
Follow the steps below to connect your solution bags.
h NOTE:
Connect yourself only when CONNECT YOURSELF appears on the
display screen.
Steps to connect solution bags
1.
Put on face mask and wash and dry (or disinfect)
your hands thoroughly.
WARNING
Do not use a Patient Line Extension with the Low Recirculation Set.
Using an extension with this set increases the recirculation volume
and reduces therapy effectiveness.
WARNING
Do not extend the patient line beyond 34 feet (10.4 meters) for the
standard set. Extending the patient line beyond this length increases
the recirculation volume and reduces therapy effectiveness.
2.
If you are using a patient extension line, connect it
to the patient line.
3.
Remove the line with the RED clamp.
11-16
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11. Operating Instructions – Prepare for Therapy
Steps to connect solution bags (Continued)
4.
Connect the line to the heater bag as you have
been taught by your dialysis trainer.
5.
Repeat for all the solution bags necessary for your treatment.
The lines with white clamps are for additional solution bags.
6.
Leave any unused lines in the organizer with clamps closed.
7.
Review your connections to make sure that:
b
GO
STOP
d
ENTE
R
a
c
a.
The line with the RED clamp is connected to the solution bag on the
heater pan.
b.
The solution bag on the heater pan covers the heater button on the right
end of the heater.
c.
The line with the BLUE clamp must be connected to the Last Fill solution
bag if you use a Last Fill with a different solution.
d.
You have connected enough bags of the right size to deliver your
prescribed volume.
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11. Operating Instructions – Prepare for Therapy
11.8 Prime the Disposable Set
Follow the steps below to prime your disposable set.
Steps to prime the disposable set
1.
Open clamps only on lines connected
to solution bags.
2.
Open the clamp on the patient line.
3.
Make sure the end of the patient line and/or
extension line is correctly positioned in the
organizer.
h NOTE: Do NOT connect yourself until
CONNECT YOURSELF appears on the
display screen.
WARNING
Failure to open the clamp on the patient line after connecting the
solution bags will prevent the patient line from being primed. This
can cause air to be delivered to you during FILL 1.
If CONNECT YOURSELF appears on the display screen and you find the
clamp is still closed, do NOT connect yourself. Instead, open the clamp
and reprime the patient line. (See 11.8.1, Reprime the Patient Line, on
page 11-23.) If you have already connected yourself and find the
clamp is still closed, start a Manual Drain before you open the clamp.
The Manual Drain procedure is located in 18.5, Manual Drain
Procedure, on page 18-53.
11-18
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11. Operating Instructions – Prepare for Therapy
Steps to prime the disposable set (Continued)
WARNING
If your patient line is greater than 12 feet (3.6 meters) in length, and
your Initial Drain Alarm is set to less than 30 mL, the Initial Drain can
end early and result in an increased intraperitoneal volume (IIPV)
situation.
IIPV could result in a feeling of abdominal discomfort, serious injury,
or death. See page 18-58 for IIPV symptoms or if IIPV is suspected.
Additional care should be taken to monitor for IIPV symptoms for
those patients not able to communicate essential information to their
caregiver during treatment.
WARNING
Do not use a Patient Line Extension with the Low Recirculation Set.
Using an extension with this set increases the recirculation volume
and reduces therapy effectiveness.
WARNING
Do not extend the patient line beyond 34 feet (10.4 meters) for the
standard set. Extending the patient line beyond this length:
Increases the recirculation volume which can result in reduced
therapy effectiveness.
Impacts priming which can result in air infusion. Air infusion can
cause abdominal and/or shoulder pain.
4.
Press GO.
CONNECT BAGS
STOP
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ENTER
11-19
11. Operating Instructions – Prepare for Therapy
Steps to prime the disposable set (Continued)
PRIMING . . . appears.
PRIMING...
The display screen alternates between
CONNECT YOURSELF and CHECK PATIENT
LINE.
5.
Verify that the patient line is properly primed.
6.
Before you wash your hands and connect
yourself:
a.
Make sure fluid is present near the
connector at the end of the patient line.
b.
Make sure the patient line clamp
is open.
11-20
CONNECT YOURSELF
CHECK PATIENT LINE
a
b
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11. Operating Instructions – Prepare for Therapy
WARNING
CHECK FLUID LEVEL IN PATIENT LINE
BEFORE CONNECTING
Do not connect to your patient line unless the fluid level is
at or near the connector at the end of the disposable set
patient line. Connecting when air is present will result in
sterile air being delivered during the first Fill if there was
no Initial Drain. Air introduced into your peritoneal cavity
can cause shoulder or abdominal pain.
To ensure proper priming:
Verify that the white clamp on the patient line is open.
Verify that the end of the patient line, or the end of the
Patient Extension Line when an extension is used, is
placed in the left slot in the blue organizer.
Before connecting yourself:
Verify that the fluid level is at or near the connector at
the end of the disposable set patient line.
If the fluid level is not near the connector, reprime the
patient line. Press the STOP then V button to access
the REPRIME PATIENT LINE screen. Verify that the
patient line is properly primed. See 11.8.1, Reprime the
Patient Line, on page 11-23. There is no need to load a
new set.
h NOTE: If a Low Recirculation Volume set is not primed
properly, and the Fill Volume is less than 100 mL, a LOW
DRAIN VOLUME alarm can occur. Improper priming in
these conditions can also contribute to negative UF alarms
later in the therapy.
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11. Operating Instructions – Prepare for Therapy
IF THE POWER IS INTERRUPTED
DURING PRIME:
To restart Priming after a power failure during prime:
1. Press GO to restart the treatment.
2. Press GO again when LOAD THE SET appears.
3. Open the bag clamps when CONNECT BAGS appears.
4. Make sure all clamps on the patient line and connected
lines are open.
WARNING
If a disposable set is already present in the system after a
power failure, CLOSE ALL CLAMPS before you press GO to
start your therapy. This prevents flow of fluid from one bag
to another and/or to the patient during the time when
LOAD THE SET is displayed. Uncontrolled gravity flow of
fluid can result in an increased intraperitoneal volume
(IIPV) situation.
IIPV could result in a feeling of abdominal discomfort,
serious injury, or death. See page 18-58 for IIPV symptoms
or if IIPV is suspected.
Additional care should be taken to monitor for IIPV
symptoms for those patients not able to communicate
essential information to their caregiver during treatment.
11-22
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11. Operating Instructions – Prepare for Therapy
11.8.1 Reprime the Patient Line
If the fluid level is not at or near the connector at the end of the patient line, follow
the steps below to reprime the patient line.
Steps to reprime the patient line
Press STOP when the display screen alternates
between CONNECT YOURSELF and
CHECK PATIENT LINE.
CHECK PATIENT LINE
2.
Press V until REPRIME PATIENT LINE appears.
REPRIME PATIENT LINE
3.
Press ENTER.
4.
Verify that the patient line is properly primed:
1.
a.
CONNECT YOURSELF
Make sure fluid is present near the connector
at the end of the patient line.
a
The display screen alternates between
CONNECT YOURSELF and CHECK PATIENT LINE.
5.
Repeat Steps 1 through 4 until the patient line is
primed.
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11. Operating Instructions – Prepare for Therapy
11.9 Connect Yourself to the Disposable Set
WARNING
Follow aseptic technique taught by your dialysis center
when handling lines and solution bags to reduce the
possibility of infection. Always put on a face mask and wash
and dry (or disinfect) your hands thoroughly.
Follow the steps below to connect yourself to the system.
Steps to connect yourself
1.
Get your transfer set ready.
Make the transfer set accessible, but do not remove
the cap until after you have washed your hands.
2.
Prepare the room for treatment as instructed by
your dialysis center.
3.
Put on a face mask and wash and dry (or disinfect)
your hands thoroughly.
11-24
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11. Operating Instructions – Prepare for Therapy
Steps to connect yourself (Continued)
4.
Remove the patient line from the organizer.
5.
Connect the transfer set to the patient line.
a.
Remove pull ring from patient line connector.
b.
Remove cap from transfer set, and immediately
connect to the patient line connector.
6.
Open the transfer set.
7.
Press GO to start your treatment.
Treatment begins with an INITIAL DRAIN.
INITIAL DRAIN
STOP
8.
ENTER
Continue with Section 12, Operating Instructions –
Perform Therapy.
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11. Operating Instructions – Prepare for Therapy
11-26
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12
Operating Instructions –
Perform Therapy
12. Perform Therapy
Section
Operating Instructions –
Perform Therapy
Be sure you have followed all instructions in Section 11, Operating Instructions –
Prepare for Therapy, before proceeding with this section.
12.1 Initial Drain
Your treatment always begins with INITIAL DRAIN. During each Drain phase, used
dialysis solution (effluent) containing waste products and excess fluids, is drained
from the peritoneal cavity.
h NOTE:
Change position if the Drain stops and you believe that you are not
empty. Fluid may have pocketed near your catheter and changing
positions can assist draining.
WARNING
Do not replace empty solution bags or reconnect
disconnected solution bags during your therapy. If a bag
becomes disconnected during your therapy, follow the End
Therapy Early procedure. (See 18.6, End Therapy Early
Procedure, on page 18-55.)
Discard the disposable set and all solution bags at the end
of therapy. Possible contamination of the fluid or fluid
pathways can result if disposables are reused.
Contamination of any portion of the fluid or fluid path can
result in peritonitis.
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12. Operating Instructions – Perform Therapy
WARNING
Bypassing an Initial Drain when there is still fluid left in the
peritoneal cavity can result in an increased intraperitoneal
volume (IIPV) situation later in your therapy. Change your
position or sit up to aid draining completely during the
Initial Drain.
IIPV could result in a feeling of abdominal discomfort,
serious injury, or death.
If any patient, or patient caregiver, suspects the patient has
IIPV during a treatment, press STOP immediately, then
press V and initiate a Manual Drain. The Manual Drain
procedure is located in 18.5, Manual Drain Procedure, on
page 18-53. See 18.8, Increased Intraperitoneal Volume
(IIPV), on page 18-58 if IIPV is suspected.
Additional care should be taken to monitor for IIPV
symptoms for those patients not able to communicate
essential information to their caregiver during treatment.
WARNING
Inspect the initial drained effluent for clarity. If effluent is
cloudy, call your dialysis center. Cloudy effluent may be a
sign of peritonitis.
If your previous therapy ended early for any reason, or if you performed an off-cycler
exchange, you can be left with more fluid in your peritoneal cavity than normal. If
this occurs, your Initial Drain Alarm (I-DRAIN ALARM) setting may be too low. To
minimize the potential for an increased intraperitoneal volume (IIPV) situation, do
one of the following:
If a VERIFY I-DRAIN: ML prompt appears, press STOP and press U or V
to increase your I-DRAIN ALARM setting to at least 70% of your current
expected peritoneal volume for this therapy only.
– OR –
12-2
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12. Operating Instructions – Perform Therapy
If a VERIFY I-DRAIN prompt does not appear, press STOP and V to
MANUAL DRAIN. Press ENTER to initiate a Manual Drain.
The system will return to STOPPED: DRAIN when the Manual Drain ends.
You can repeat the Manual Drain any number of times without an audible
alarm. Resuming the Drain can result in an audible alarm.
If your I-DRAIN ALARM setting is OFF or zero (0) because you normally have a dry
day, Baxter recommends it be set to a value greater than zero (0). If your patient
line is greater than 12 feet (3.6 meters) in length, set the I-Drain Alarm to at least
30 mL. This increases the chance that your peritoneal cavity is completely emptied
during Initial Drain. Refer to 10.2.7, I-Drain Alarm, on page 10-9 to permanently
change your I-Drain Alarm setting.
The system will assume that you are empty at the end of the Initial Drain. If you
are not empty, the fluid in your peritoneal cavity can contribute to IIPV.
If you need to end your therapy after the Initial Drain begins, you must follow the
instructions in 18.6, End Therapy Early Procedure, on page 18-55.
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12. Operating Instructions – Perform Therapy
12.1.1 Menu Options During Initial Drain
INITIAL DRAIN
Table 12-1 lists the options you can select during INITIAL DRAIN.
1.
Press V to view each option.
2.
Press ENTER to select an option.
3.
Press STOP to return to the previous menu.
Table 12-1. Options Available During Initial Drain
Option
Description
Drain Volume
DRAIN VOLUME:
60ML
Initial Drain Volume updated every few seconds.
Review Program
REVIEW PROGRAM
Allows you to review the programmed therapy.
Current Time
9:05 PM
Current time.
Therapy End
Time
FINISH AT
6:52 AM
Estimated time when treatment will end.
12-4
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12. Operating Instructions – Perform Therapy
12.2 Fill
WARNING
IIPV could result in a feeling of abdominal discomfort,
serious injury, or death.
If any patient, or patient caregiver, suspects the patient has
IIPV during a treatment, press STOP immediately, then
press V and initiate a Manual Drain. The Manual Drain
procedure is located in 18.5, Manual Drain Procedure, on
page 18-53. See 18.8, Increased Intraperitoneal Volume
(IIPV), on page 18-58 if IIPV is suspected.
Additional care should be taken to monitor for IIPV
symptoms for those patients not able to communicate
essential information to their caregiver during treatment.
After the Initial Drain, the first FILL begins. The cycler pulls dialysis solution from
the heater bag and delivers it to your peritoneal cavity. The Fill phase begins the
cycle.
12.2.1 Menu Options During Fill
FILL
X OF X
Table 12-2 lists the options you can select during the FILL phase.
1.
Press V to view each option.
2.
Press ENTER to select an option.
3.
Press STOP to return to the previous menu.
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12. Operating Instructions – Perform Therapy
Table 12-2. Options Available During Fill
Option
Description
Fill Volume
FILL VOLUME:
60ML
Fill Volume delivered. This is updated every few seconds.
Initial Drain
Volume
I-DRAIN VOL:
65ML
Volume from Initial Drain of the current treatment.
Total
Ultrafiltration
TOTAL UF:
252ML
The total therapy UF, updated after each Drain is completed.
Press ENTER to review cycle-by-cycle information. Press
STOP to return to the previous menu.
Average Dwell
Time
AVG DWELL TIME: 1:32
Average actual Dwell Time for your treatment. Press
ENTER to review cycle-by-cycle information. Press STOP to
return to the previous menu.
Review Program
REVIEW PROGRAM
Allows you to review the programmed therapy.
Current Time
11:25 PM
Current time.
Therapy End
Time
12-6
FINISH AT
6:52 AM
Estimated time when treatment will end.
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12. Operating Instructions – Perform Therapy
12.3 Dwell Phase
After the first Fill, the first DWELL phase begins. During the Dwell phase, waste
products and excess fluids pass from the bloodstream through the peritoneal
membrane and into the dialysis solution. It is during the Dwell phase that the
cycler pulls fluid from the supply bags to replenish the heater bag and warm the
solution for the next Fill phase.
12.3.1 Menu Options During Dwell
DWELL
X OF X
Table 12-3 lists the options you can select during the DWELL phase.
1.
Press V to view each option.
2.
Press ENTER to select an option.
3.
Press STOP to return to the previous menu.
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12. Operating Instructions – Perform Therapy
Table 12-3. Options Available During Dwell
Option
Description
Dwell Time Left
DWELL TIME LEFT 0:52
Dwell Time left in the current cycle.
Initial Drain
Volume
I-DRAIN VOL:
65ML
Volume from Initial Drain of the current treatment.
Total
Ultrafiltration
TOTAL UF:
252ML
The total therapy UF, updated after each Drain is
completed. Press ENTER to review cycle-by-cycle
information. Press STOP to return to the previous menu.
Average Dwell
Time
AVG DWELL TIME: 1:32
Average actual Dwell Time for your treatment. Press
ENTER to review cycle-by-cycle information. Press STOP to
return to the previous menu.
Review Program
REVIEW PROGRAM
Allows you to review the programmed therapy.
Current Time
12:01 PM
Current time.
Therapy End
Time
12-8
FINISH AT
6:52 AM
Estimated time when treatment will end.
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12. Operating Instructions – Perform Therapy
12.4 Drain Phase
WARNING
Bypassing the Drain phase can leave fluid in the peritoneal
cavity and result in an increased intraperitoneal volume
(IIPV) situation.
IIPV could result in a feeling of abdominal discomfort,
serious injury, or death.
If any patient, or patient caregiver, suspects the patient has
IIPV during a treatment, press STOP immediately, then
press V and initiate a Manual Drain. The Manual Drain
procedure is located in 18.5, Manual Drain Procedure, on
page 18-53. See 18.8, Increased Intraperitoneal Volume
(IIPV), on page 18-58 if IIPV is suspected.
Additional care should be taken to monitor for IIPV
symptoms for those patients not able to communicate
essential information to their caregiver during treatment.
The DRAIN phase completes the cycle.
12.4.1 Menu Options During Drain
DRAIN
X OF X
Table 12-4 lists the options you can select during the DRAIN phase.
1.
Press V to view each option.
2.
Press ENTER to select an option.
3.
Press STOP to return to the previous menu.
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12. Operating Instructions – Perform Therapy
Table 12-4. Options Available During Drain
Option
Description
Drain Volume
DRAIN VOLUME:
60ML
Drain Volume updated every few seconds.
Initial Drain
Volume
I-DRAIN VOL:
65ML
Volume from Initial Drain of the current treatment.
Total
Ultrafiltration
TOTAL UF:
252ML
The total therapy UF, updated after each Drain is
completed. Press ENTER to review cycle-by-cycle
information. Press STOP to return to the previous menu.
Average Dwell
Time
AVG DWELL TIME: 1:32
Average actual Dwell Time for your treatment. Press
ENTER to review cycle-by-cycle information. Press STOP
to return to the previous menu.
Review Program
REVIEW PROGRAM
Allows you to review the programmed therapy.
Current Time
1:45 PM
Current time.
Therapy End
Time
12-10
FINISH AT
6:52 AM
Estimated time when treatment will end.
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12. Operating Instructions – Perform Therapy
12.5 Pause Therapy
Press STOP to pause your therapy. STOPPED and the current phase appears on
your display screen.
12.5.1 Menu Options When STOP is Pressed
STOPPED:
FILL
This sample screen shows that STOP was pressed during the Fill phase.
Table 12-5 lists the options you can select when you press STOP.
1.
Press V to view each option.
2.
Press ENTER to select an option.
3.
Press GO to continue your therapy.
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12. Operating Instructions – Perform Therapy
Table 12-5. Options Available When STOP is Pressed
Option
Description
Fill Volume
FILL VOLUME:
60ML
Shows the status of the current phase.
Bypass
BYPASS
Press ENTER to select.
See 18.4, Bypass Procedures, on page 18-37 for instructions.
Change Program
– OR –
CHANGE PROGRAM
Press ENTER to change your therapy settings.
Review Program
REVIEW PROGRAM
REVIEW PROGRAM appears if the program is locked.
See Section 9, Operating Instructions – Change Program for
instructions.
Make
Adjustments
MAKE ADJUSTMENTS
If you want to adjust system settings.
See Section 10, Operating Instructions – Make Adjustments
for instructions.
Manual Drain
MANUAL DRAIN
Press ENTER to select.
Alarm Log
ALARM LOG
Press ENTER to review the 20 most recent alarms. Press
STOP to return to the previous menu.
Software Version
SOFTWARE VER: 10.210
Displays the software version. The software version on your
system may differ from this example.
12-12
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12. Operating Instructions – Perform Therapy
12.6 Hi-Dose Therapy
This therapy allows you to combine your regular nighttime therapies, such as
CCPD or Tidal, with additional daytime exchanges. This may help improve the
quality of your dialysis treatment.
Key features of Hi-Dose therapy include:
Daytime exchanges. These additional exchanges may help to improve the
quality of your dialysis treatment.
Flexible length daytime Dwells based on your needs and daytime
schedule. During the Dwell phase of a daytime exchange, you can
disconnect from the system and have the freedom to conduct your normal
daytime activities.
Use of a disconnect cap such as the FlexiCap or MiniCap disconnect caps
between Hi-Dose exchanges.
Different daytime and nighttime Fill volumes.
Flexibility for up to nine (9) Hi-Dose exchanges. The number of Hi-Dose
exchanges is pre-programmed and fixed.
System setup and start of therapy takes place at the time of the first
Hi-Dose exchange.
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12. Operating Instructions – Perform Therapy
WARNING
Bypassing an Initial Drain when there is still fluid left in the
peritoneal cavity can result in an increased intraperitoneal
volume (IIPV) situation later in your therapy. Change your
position or sit up to aid draining completely during the
Initial Drain.
IIPV could result in a feeling of abdominal discomfort,
serious injury, or death.
If any patient, or patient caregiver, suspects the patient has
IIPV during a treatment, press STOP immediately, then
press V and initiate a Manual Drain. The Manual Drain
procedure is located in 18.5, Manual Drain Procedure, on
page 18-53. See 18.8, Increased Intraperitoneal Volume
(IIPV), on page 18-58 if IIPV is suspected.
Additional care should be taken to monitor for IIPV
symptoms for those patients not able to communicate
essential information to their caregiver during treatment.
WARNING
Bypassing the Day Drain phase can leave fluid in the
peritoneal cavity and result in an increased
intraperitoneal volume (IIPV) situation.
IIPV could result in a feeling of abdominal discomfort,
serious injury, or death.
If any patient, or patient caregiver, suspects the patient has
IIPV during a treatment, press STOP immediately, then
press V and initiate a Manual Drain. The Manual Drain
procedure is located in 18.5, Manual Drain Procedure, on
page 18-53. See 18.8, Increased Intraperitoneal Volume
(IIPV), on page 18-58 if IIPV is suspected.
Additional care should be taken to monitor for IIPV
symptoms for those patients not able to communicate
essential information to their caregiver during treatment.
12-14
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12. Operating Instructions – Perform Therapy
12.6.1 Day Dwell Options
DAY DWELL
X OF X
Table 12-6 lists the options you can select during the DAY DWELL phase in
Hi-Dose Therapy.
1.
Press V to view each option.
2.
Press ENTER to select an option.
3.
Press STOP to return to the previous menu.
Table 12-6. Options Available During Day Dwell
Option
Day Dwell Time
Description
DAY DWELL TIME: 0:31
The amount of time elapsed during the daytime Dwell.
Continue
Therapy
PRESS GO TO CONTINUE
Connect
Yourself
CONNECT YOURSELF
Initial Drain
Volume
Total
Ultrafiltration
Press GO twice to drain the Day Fill and perform the next
cycle.
I-DRAIN VOL:
65ML
Volume from Initial Drain.
TOTAL UF:
252ML
The total therapy UF, updated after each Drain is
completed. Press ENTER to review cycle-by-cycle
information. Press STOP to return to the previous menu.
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12. Operating Instructions – Perform Therapy
Table 12-6. Options Available During Day Dwell (Continued)
Option
Description
Average Dwell
Time
AVG DWELL TIME: O:OO
Average actual Dwell Time only reflects the average of the
nighttime cycles. During daytime cycles, 0:00 appears.
Press ENTER to review cycle-by-cycle information. Press
STOP to return to the previous menu.
Review Program
REVIEW PROGRAM
Allows you to review the programmed treatment.
Current Time
6:10 PM
Current time.
12.7 Perform a Hi-Dose Day Exchange
h NOTE:
If you bypass a Hi-Dose daytime exchange, the solution volume from
that exchange will be added to the available nighttime therapy
volume.
Follow the steps below to perform daytime exchange.
Steps to perform a daytime exchange
Hi-Dose therapy begins when INITIAL DRAIN is
complete.
1.
DAY FILL begins automatically when INITIAL
DRAIN is complete.
12-16
Display screen
INITIAL DRAIN
DAY FILL
1 OF 1
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12. Operating Instructions – Perform Therapy
Steps to perform a daytime exchange (Continued) Display screen
2.
When DAY FILL 1 is complete, DAY DWELL 1
begins.
DAY DWELL 1 OF 1
During Day Dwell, you can disconnect from the
cycler. See 12.7.1, Disconnect Yourself During
Hi-Dose Dwell, on page 12-18.
3.
Press V to display elapsed DAY DWELL TIME in
hours and minutes.
4.
Reconnect yourself when the appropriate Dwell
Time is reached. See 12.7.2, Reconnect and
Continue Treatment, on page 12-20.
DAY DWELL TIME: 4:00
h NOTE: Do not press V or GO during the last Day Dwell until you are ready
to begin your nighttime treatment.
5.
Press GO.
DAY DRAIN
The system automatically begins DAY DRAIN 1.
If this is the last Day Dwell, INITIAL DRAIN will
begin.
6.
When DAY DRAIN 1 is complete, the nighttime
therapy begins with FILL 1.
– or –
INITIAL DRAIN
FILL 1 OF 4
or
– OR –
If more than one Hi-Dose exchange is programmed,
the next DAY FILL begins.
1 OF 1
DAY FILL 2 OF 2
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12. Operating Instructions – Perform Therapy
12.7.1 Disconnect Yourself During Hi-Dose Dwell
Follow the steps below if you choose to disconnect yourself during Hi-Dose Dwell.
Steps to disconnect during Hi-Dose Dwell
1.
Close your transfer set.
2.
Close the clamp on the patient line.
WARNING
Follow aseptic technique taught by your
dialysis center when handling lines and
solution bags to reduce the possibility of
infection. Always put on a face mask and wash
and dry (or disinfect) your hands thoroughly.
3.
Put on a face mask and disinfect your hands
thoroughly.
12-18
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12. Operating Instructions – Perform Therapy
Steps to disconnect during Hi-Dose Dwell
4.
Open and remove new MiniCap and FlexiCap
disconnect caps from the package.
5.
Disconnect the transfer set from the patient line of
the disposable set.
6.
Place the patient line back on the organizer.
7.
Immediately place the MiniCap disconnect cap on
the transfer set.
Tighten the MiniCap until fully secured.
8.
Attach the new FlexiCap disconnect cap to the
patient line connector in the organizer.
Tighten the FlexiCap disconnect cap until fully
secured.
9.
You may now leave the system.
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12. Operating Instructions – Perform Therapy
12.7.2 Reconnect and Continue Treatment
Follow the steps below to reconnect yourself and continue therapy.
Steps to reconnect and continue treatment
1.
During the Dwell phase, press V to display
elapsed DAY DWELL TIME in hours and minutes.
2.
When the appropriate Dwell Time is reached,
prepare the room for reconnect.
DAY DWELL TIME: 4:00
h NOTE: Do not press V or GO during the last Day Dwell until you are ready
to begin your night treatment.
3.
Press V.
PRESS GO TO CONTINUE
4.
Press GO.
CONNECT YOURSELF
The system reminds you to connect yourself.
WARNING
Follow aseptic technique taught by your
dialysis center when handling lines and
solution bags to reduce the possibility of
infection. Always put on a face mask and wash
and dry (or disinfect) your hands thoroughly.
5.
Put on a face mask and wash and dry hands
thoroughly.
6.
Remove the FlexiCap disconnect cap from the
patient line connector.
12-20
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12. Operating Instructions – Perform Therapy
Steps to reconnect and continue treatment (Continued)
7.
Remove the MiniCap disconnect cap from the
transfer set connector.
8.
Immediately connect the patient line connector to
the transfer set.
9.
Open the patient line clamp.
10. Open the transfer set.
11. Press GO.
DAY DRAIN
1 OF 1
The system automatically begins DAY DRAIN 1.
12. Discard the used MiniCap disconnect cap and
FlexiCap disconnect cap.
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12. Operating Instructions – Perform Therapy
12-22
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Section
Operating Instructions –
End Therapy
13. End Therapy
13
Operating Instructions –
End Therapy
13.1 Ending Your Therapy
When the last phase of your treatment cycle is complete, the HomeChoice APD
System or HomeChoice PRO APD System indicates that the therapy is complete.
WARNING
Notify your dialysis center if you had an incomplete
treatment, skipped the prescribed Last Fill, or in other
situations as instructed by your clinician. Multiple
incomplete or skipped treatments can cause reduced Dwell
or Therapy Time. This can lead to symptoms and signs of
end-stage renal disease (ESRD), including fluid overload.
WARNING
Follow aseptic technique taught by your dialysis center
when handling lines and solution bags to reduce the
possibility of infection. Always put on a face mask and wash
and dry (or disinfect) your hands thoroughly.
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13. Operating Instructions – End Therapy
Follow the steps below to end your therapy and disconnect from the system.
Steps to end your therapy
1.
END OF THERAPY appears.
2.
Press V to view the end of therapy summary
information.
3.
Record your I-DRAIN VOLUME.
Display screen
END OF THERAPY
I-DRAIN VOL:
ML
LAST M-DRAIN:
ML
TOTAL UF:
ML
The amount shown is the total Initial Drain Volume
from the current therapy.
4.
Press V.
LAST M-DRAIN appears only if LAST MANUAL
DRAIN was set to YES. The amount shown is the
volume of solution drained during the Last Manual
Drain.
5.
Press V.
The amount shown is the TOTAL UF for the
therapy.
h NOTE: A low, or negative, Total UF at the end of a therapy may indicate your
last Drain was incomplete and too much fluid may still remain in your
peritoneal cavity. Make sure the Last Manual Drain option is set to
ON, and a UF Target set with a value that equals around 70% of your
expected UF. For help in converting 70% of your expected total
therapy UF into a value that can be programmed as your Total UF for
your Tidal therapy, see 19.17, Determining Tidal Total UF and Last
Manual Drain UF Target Volume Settings, on page 19-18. See also
10.2.9, Last Manual Drain, on page 10-14.
6.
Press ENTER to access cycle-by-cycle UF
information starting with the last cycle. Press
STOP to return to the previous menu.
13-2
CYCLE 5 UF:
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13. Operating Instructions – End Therapy
Steps to end your therapy (Continued)
Display screen
WARNING
A consistently high UF in the last cycle may indicate that UF is
accumulating in your peritoneal cavity during the course of your
therapy.
For a CCPD therapy, your Minimum Drain Volume percent may be
programmed too low.
For a Tidal therapy, your expected Total UF may be programmed too
low.
Either of these conditions can result in an increased intraperitoneal
volume (IIPV) situation. Using a higher than normal dextrose
concentration in combination with either of these conditions can
further increase the risk of an IIPV situation.
IIPV can result in a feeling of abdominal discomfort, serious injury, or
death.
If any patient, or patient caregiver, suspects the patient has IIPV
during a treatment, press STOP immediately, then press V and
initiate a Manual Drain. The Manual Drain procedure is located in
18.5, Manual Drain Procedure, on page 18-53. See 18.8, Increased
Intraperitoneal Volume (IIPV), on page 18-58 if IIPV is suspected.
Additional care should be taken to monitor for IIPV symptoms those
patients not able to communicate essential information to their
caregiver during treatment.
7.
Press V to continue accessing cycle UF values.
CYCLE 4 UF:
ML
You can view up to 29 cycles.
8.
Press V.
AVG DWELL TIME:HH:MM
The average actual Dwell Time for the therapy is
shown.
To review cycle-by-cycle information, press
ENTER. Press STOP to return to END OF
THERAPY.
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13. Operating Instructions – End Therapy
Steps to end your therapy (Continued)
9.
Display screen
Press V.
LOST DWELL:
HH:MM
The amount of Dwell Time LOST or ADDED is
based on the estimated Dwell Time calculated at
the beginning of therapy.
ADDED DWELL:
HH:MM
If the Lost Dwell is 30 minutes or longer, and you
have not viewed this information, the system will
beep and display the Lost Dwell Time.
10. Press V.
MANUAL DRAIN
Press ENTER to select MANUAL DRAIN.
11. Press V.
ALARM LOG
Press ENTER to review the 20 most recent alarms.
Press STOP to return to the previous menu.
12. Press STOP after you review and record your end
of therapy summary.
13. Press GO.
END OF THERAPY
CLOSE ALL CLAMPS
CLOSE ALL CLAMPS appears.
13-4
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13. Operating Instructions – End Therapy
Steps to end your therapy (Continued)
Display screen
WARNING
Do not press GO again until you have CLOSED ALL CLAMPS. This
prevents the flow of fluid from one bag to another and/or to the
patient during the time when DISCONNECT YOURSELF appears. This
flow of fluid could result in an increased intraperitoneal volume
(IIPV) situation.
IIPV can result in a feeling of abdominal discomfort, serious injury, or
death.
If any patient, or patient caregiver, suspects the patient has IIPV
during a treatment, press STOP immediately, then press V and
initiate a Manual Drain. The Manual Drain procedure is located in
18.5, Manual Drain Procedure, on page 18-53. See 18.8, Increased
Intraperitoneal Volume (IIPV), on page 18-58 if IIPV is suspected.
Additional care should be taken to monitor for IIPV symptoms those
patients not able to communicate essential information to their
caregiver during treatment.
14. Close the transfer set.
15. Close patient clamp on disposable set.
16. CLOSE ALL CLAMPS and disconnect yourself as
instructed in the steps in 13.2, Disconnect Yourself,
on page 13-6.
Do NOT press GO again until AFTER you have
disconnected.
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13-5
13. Operating Instructions – End Therapy
13.2 Disconnect Yourself
WARNING
Follow aseptic technique taught by your dialysis center
when handling lines and solution bags to reduce the
possibility of infection. Always put on a face mask and wash
and dry (or disinfect) your hands thoroughly.
Steps to disconnect yourself
1.
Put on a face mask and disinfect your hands
thoroughly.
2.
Open and remove new MiniCap disconnect cap
from the package.
13-6
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13. Operating Instructions – End Therapy
Steps to disconnect yourself (Continued)
3.
Disconnect the transfer set from the patient line of
the disposable set.
4.
Place the patient line back on the organizer.
5.
Immediately place the MiniCap disconnect cap on
the transfer set.
6.
Tighten the MiniCap until fully secured.
WARNING
Do NOT press GO again until AFTER you have disconnected! Touching
any unsterile surface before completing your disconnect increases
your risk of infection.
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13. Operating Instructions – End Therapy
13.3 Shut Down
WARNING
Discard the disposable set and all solution bags at the end
of therapy. Possible contamination of the fluid or fluid
pathways could result if disposables are reused.
Contamination of any portion of the fluid or fluid path may
result in peritonitis.
WARNING
Do not open the door until you have CLOSED ALL CLAMPS.
This prevents the flow of fluid from one bag to another,
and/or to the patient. Uncontrolled gravity flow of fluid can
result in an increased intraperitoneal volume (IIPV)
situation.
IIPV can result in a feeling of abdominal discomfort,
serious injury, or death.
If any patient, or patient caregiver, suspects the patient has
IIPV during a treatment, press STOP immediately, then
press V and initiate a Manual Drain. The Manual Drain
procedure is located in 18.5, Manual Drain Procedure, on
page 18-53. See 18.8, Increased Intraperitoneal Volume
(IIPV), on page 18-58 if IIPV is suspected.
Additional care should be taken to monitor for IIPV
symptoms those patients not able to communicate
essential information to their caregiver during treatment.
13-8
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13. Operating Instructions – End Therapy
Steps to shut down the cycler
h NOTE: Close all clamps and disconnect yourself by following the steps in
13.2, Disconnect Yourself, on page 13-6 before continuing.
1.
Press GO.
CLOSE ALL CLAMPS
The display alternates between CLOSE ALL
CLAMPS and DISCONNECT YOURSELF.
DISCONNECT YOURSELF
The occluder (behind door) retracts for 2 minutes
(30 seconds for Low Fill Mode) to allow removal of
the cassette.
2.
Lift the latch up to unlock and open door.
3.
If the occluder closes before you open the door,
press STOP and then GO.
The occluder retracts again for a short time.
GO
STOP
4.
ENTER
Remove and discard the disposable set and solution
bags.
Follow your local guidelines for disposal of dialysis
waste materials.
GO
STOP
ENTER
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13. Operating Instructions – End Therapy
Steps to shut down the cycler (Continued)
5.
Press GO.
TURN ME OFF
TURN ME OFF appears.
6.
Press the On/Off switch to the OFF position.
13.3.1 Menu Options During End of Therapy
END OF THERAPY
Table 13-1 lists the options you can select during END OF THERAPY.
1.
Press V to view each option.
2.
Press ENTER to select an option.
3.
Press STOP to return to the previous menu.
13-10
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13. Operating Instructions – End Therapy
Table 13-1. End of Therapy Options
Option
Initial Drain
Volume
Last M-Drain
Description
I-DRAIN VOL:
65ML
Volume from Initial Drain of the current therapy.
LAST M-DRAIN:
60ML
Only appears if you drained some fluid using the Manual
Drain option before a Last Fill. Shows the amount of
solution drained.
Total
Ultrafiltration
TOTAL UF:
150ML
The total amount of UF for the entire night’s therapy. Press
ENTER to review cycle-by-cycle information. Press STOP
to exit cycle-by-cycle information.
h NOTE: A lower than usual or negative Total UF at the
end of a therapy may indicate that your last
Drain was incomplete. The Last Manual Drain
option should be turned ON and a UF Target
programmed with a value that equals around
70% of your expected UF. For help in
converting 70% of your expected total therapy
UF into a value that can be programmed as
your Total UF for your Tidal therapy, see
19.17, Determining Tidal Total UF and Last
Manual Drain UF Target Volume Settings, on
page 19-18. See also 10.2.9, Last Manual Drain,
on page 10-14.
Average Dwell
Time
AVG DWELL TIME: 1:32
Average actual Dwell Time for your therapy. Press ENTER
to review cycle-by-cycle information. Press STOP to exit
cycle-by-cycle information.
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13. Operating Instructions – End Therapy
Table 13-1. End of Therapy Options (Continued)
Option
Lost Dwell
Description
LOST DWELL:
1:05
– or –
ADDED DWELL:
1:05
Displays amount of Dwell Time “lost” or “added,” based on
estimated Dwell Time calculated at the beginning of
therapy. This message displays automatically if Lost Dwell
is 30 minutes or greater and you have not viewed this
information.
Manual Drain
MANUAL DRAIN
Press ENTER to select.
Alarm Log
ALARM LOG
Press ENTER to review the 20 most recent alarms. Press
STOP to return to the previous menu.
13-12
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Section
14
14. Effluent Sampling
Operating Instructions –
Effluent Sampling
Operating Instructions –
Effluent Sampling
14.1 Introduction
An effluent sample is a small amount of solution that has been drained from the
peritoneal cavity during your regular drain. Your dialysis nurse will tell you how
often you should take a sample.
2
1
3
1. Drain Line
2. Effluent Sampling Site
3. Effluent Sample Bag
Figure 14-1. Disposable Set
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14. Operating Instructions – Effluent Sampling
WARNING
Follow aseptic technique taught by your dialysis center
when handling lines and solution bags to reduce the
possibility of infection. Always put on a face mask and wash
and dry (or disinfect) your hands thoroughly.
14.2 Take an Effluent Sample
Follow the steps below to take an effluent sample.
Steps to take an effluent sample
1.
Put on a face mask and wash and dry your
hands thoroughly.
2.
Open the effluent sample bag packaging.
3.
Close the clamp on the effluent sample
bag.
14-2
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14. Operating Instructions – Effluent Sampling
Steps to take an effluent sample (Continued)
4.
Prepare the sampling site.
Make sure the clamp is closed on the
sampling line.
5.
Remove the cap from the effluent sample
bag.
Save the cap to recap the connectors.
6.
Remove the cap from the sampling site.
Save the cap to recap the connectors.
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14. Operating Instructions – Effluent Sampling
Steps to take an effluent sample (Continued)
7.
Connect the effluent sample bag and
position the bag below the level of the
drain line.
8.
After draining for 2 or 3 minutes, open the
clamps.
9.
When the effluent sample bag is full, close
both clamps.
14-4
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14. Operating Instructions – Effluent Sampling
Steps to take an effluent sample (Continued)
10. Disconnect the effluent sample bag from
the drain line and recap the connectors.
h NOTE:
Follow your dialysis nurse’s instructions for handling the effluent
sample.
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14-5
14. Operating Instructions – Effluent Sampling
14-6
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Section
15
Cleaning
15. Cleaning
Cleaning
15.1 Introduction
WARNING
Do not open the HomeChoice/HomeChoice PRO APD System
cycler. Electrical circuitry inside may pose a shock hazard.
WARNING
Do not apply alcohol, hydrogen peroxide, or antiseptic
containing alcohol to the disposable set or to the cassette
interface inside the door of the cycler. Using these products
can cause the cassette to develop cracks.
CAUTION
Do not use chemical cleaning agents or aerosol spray
cleaners. These products might damage the plastics or
surface finishes.
h NOTE:
The cycler does not need to be sterilized or disinfected between uses.
The HomeChoice/HomeChoice PRO APD System uses a disposable set
that provides a sterile fluid pathway.
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15. Cleaning
15.2 Cleaning the Cycler
WARNING
Unplug the HomeChoice/HomeChoice PRO APD System
power cord from the wall outlet, or other AC power source,
before cleaning the system. Failure to do so can cause an
electric shock.
The surface of the cycler should only be cleaned using mild soap and water. Follow
the steps below to clean your cycler.
Steps to clean the cycler
1.
Turn the cycler off.
2.
Unplug the cycler from the power source.
3.
Use a small amount of mild soap and water to wipe
the exterior.
Do not apply alcohol, hydrogen peroxide, or
antiseptic containing alcohol to the disposable set
or to the cassette interface inside the door of the
cycler.
4.
Wipe up any solution spills as soon as possible.
Any residue may be cleaned with a mixture of mild
soap and water.
15-2
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15. Cleaning
15.3 Preparing the Cycler for Return to Baxter
IMPORTANT
Return this cycler to your dialysis center or to Baxter by
calling Baxter Technical Assistance.
Before you return the HomeChoice APD System cycler to Baxter, follow the steps
below:
Steps to prepare the cycler for return
1.
Put on protective rubber gloves and an apron.
2.
Mix a sanitizing solution of 1 gallon (3.8 liters) water and 16 oz or 2 cups
(0.5 liter) household bleach.
3.
Wipe all outer surfaces of the cycler with a sponge dampened with the
sanitizing solution.
Be careful not to apply too much solution.
4.
Use a clean cloth or paper towels to wipe any excess moisture from the
surface.
If you have any questions or have difficulty with this procedure, contact Baxter
Technical Assistance at the number listed in 2.2, Numbers to Call for Assistance, on
page 2-1.
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15. Cleaning
15-4
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Maintenance
16
16. Maintenance
Section
Maintenance
A regular maintenance schedule is not needed. The HomeChoice/HomeChoice PRO
APD System monitors itself. It will notify you if service is needed.
The battery pack is automatically checked and recharged during operation. The
battery does not need regular maintenance.
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16. Maintenance
16-2
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Storage
17
17. Storage
Section
Storage
17.1 Cycler
The HomeChoice/HomeChoice PRO APD System should be stored in the following
conditions:
Temperature between –25°F to 130°F (–34°C to 54°C)
Humidity between 10% and 95%
Altitude –1,100 ft to +18,000 ft (–340 m to +5,500 m)
17.2 Battery
If the cycler is not used for more than 12 months, the battery pack must be
removed. This must be done by a qualified Baxter service representative. See
2.2, Numbers to Call for Assistance, on page 2-1.
17.3 Dialysis Solution and Disposables
Follow the instructions on the label supplied with the dialysis solution and
disposables for storage and preparation. Failure to follow the solution and
disposable label instructions may lead to insufficient therapy or adverse clinical
reaction.
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17. Storage
17-2
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Section
18. Troubleshooting
Troubleshooting
18
Troubleshooting
This section contains information about alarms, and also contains special
procedures related to alarm situations.
h NOTE:
Alarms pertaining to the PRO Card are described in 8.3, Display
Messages, on page 8-11.
18.1 List of Alarms and Procedures
The following is an alphabetical list of alarm messages and special procedures
contained in this section:
Alarm Messages
Page
Caution: Negative UF . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-22
Caution: Positive UF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-29
Check Drain Line . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-5
Check Final Line . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-5
Check Heater Line. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-5
Check Lines and Bags . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-9
Check Patient Line . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-5
Check Supply Line. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-5
Check Therapy Time . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-10
Check Tidal Volume % . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-10
Check Total UF . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-10
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18. Troubleshooting
Alarm Messages
Page
Check Total Volume . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-10
Check Your Position . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-24
Drain Not Finished . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-11
Fill Not Finished. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-11
Load a New Set . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-12
Load New Set & Bags . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-12
Low UF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-13
Low Drain Volume . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-15
Machine Tilted . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-20
Refill Not Finished. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-11
Reload the Set . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-26
Slow Flow Drain. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-19
Slow Flow Heater . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-19
Slow Flow Patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-19
Slow Flow Supply . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-19
System Errors 2240 or 2267. . . . . . . . . . . . . . . . . . . . . . . . . . 18-31
System Error nnnn . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-33
Temp Stabilizing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-35
Verify I-Drain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-30
Warming Solution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-21
18-2
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Special Procedures
Page
Bypass Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-37
Emergency Disconnect Procedure . . . . . . . . . . . . . . . . . . . . 18-65
End Therapy Early Procedure . . . . . . . . . . . . . . . . . . . . . . . . 18-55
Increased Intraperitoneal Volume (IIPV) . . . . . . . . . . . . . 18-58
Manual Drain Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-53
Power Failure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-62
Reprime Patient Line Procedure. . . . . . . . . . . . . . . . . . . . . . 18-57
18.2 Correcting Alarms
During therapy, the HomeChoice/HomeChoice PRO APD System (the “system”)
continually checks that the therapy is working properly. It also monitors the
internal system. Whenever the system finds an issue, it will:
Sound an alarm
Stop moving solution, in some circumstances
Display the type of alarm
Record the issue on the PRO Card, if applicable
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18. Troubleshooting
18.2.1 Types of Alarms
There are three (3) types of alarm messages that can occur during therapy:
Auto Restart
These alarms can be corrected by reading the display screen and checking
for the problem explained in the alarm message.
– You do not need to press any buttons to correct these alarms.
– The alarms beep 3 times, then the system continues therapy.
– If the alarm continues, the system beeps 6 times then continues
therapy.
After an Auto Restart Alarm occurs twice, the alarm becomes a Manual
Restart Alarm.
Manual Restart
These alarms must be corrected by following the instructions in
18.3, Alarms.
– The alarms beep continuously until you press STOP.
– Press STOP, correct the problem, then press GO to continue your
therapy.
System Error
These alarms are caused by problems inside the system. Contact Baxter
for assistance when these occur. Baxter Technical Assistance is available
24 hours a day for HomeChoice/HomeChoice PRO APD System users. Call
the number located in 2.2, Numbers to Call for Assistance, on page 2-1.
18-4
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18.3 Alarms
18.3.1 Check Lines
WARNING
Do not replace empty solution bags or reconnect
disconnected solution bags during your therapy.
Possible contamination of the fluid or fluid pathways can
result if disposables are reused. Contamination of any
portion of the fluid or fluid path can result in peritonitis.
If a bag becomes disconnected during your therapy, follow
the End Therapy Early procedure. Discard the disposable
set and all solution bags at the end of therapy. (See
18.6, End Therapy Early Procedure, on page 18-55.)
CHECK LINE
Display Message:
CHECK DRAIN LINE
CHECK PATIENT LINE
CHECK FINAL LINE
CHECK SUPPLY LINE
CHECK HEATER LINE
Cause 1:
This is an Auto Restart Alarm.
The line referenced on the display screen is blocked due to:
–
–
–
–
–
Kinks
Closed clamps
Fibrin blockage
Disconnected solution bags
Empty solution bags
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18. Troubleshooting
CHECK LINE (Continued)
To Correct
Cause 1:
1.
Check the line referenced on the display screen for:
–
–
–
–
–
2.
Kinks
Closed clamps
Fibrin blockage
Disconnected solution bags
Empty solution bags
Correct the issue you found.
You do not need to press any buttons.
– OR –
If the alarm becomes a Manual Restart Alarm:
1.
Press STOP to mute the alarm.
2.
Check the line referenced on the display screen for:
–
–
–
–
–
3.
Kinks
Closed clamps
Fibrin blockage
Disconnected solution bags
Empty solution bags
Correct the issue you found, if possible.
– OR –
If the issue is not corrected, contact your dialysis center.
4.
18-6
Press GO to return to the therapy.
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18. Troubleshooting
CHECK LINE (Continued)
Cause 2:
CHECK PATIENT LINE appears at start of FILL 1 in Standard
Mode only.
The clamp on the patient line was not opened after
connecting the solution bags or after you were connected.
This prevented priming of the patient line and caused the
Initial Drain to end with little or no fluid drained.
If this alarm occurs, do NOT open the clamp.
WARNING
Opening the clamp, at this point, can cause air to be delivered to your
peritoneal cavity. This can result in shoulder and abdominal pain.
This can also result in an increased intraperitoneal volume (IIPV)
situation if you had fluid in your peritoneal cavity prior to the Initial
Drain.
IIPV can result in a feeling of abdominal discomfort, serious injury, or
death.
If any patient, or patient caregiver, suspects the patient has IIPV
during a treatment, press STOP immediately, then press V and
initiate a Manual Drain. The Manual Drain procedure is located in
18.5, Manual Drain Procedure, on page 18-53. See 18.8, Increased
Intraperitoneal Volume (IIPV), on page 18-58 if IIPV is suspected.
Additional care should be taken to monitor for IIPV symptoms for
those patients not able to communicate essential information to their
caregiver during treatment.
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18. Troubleshooting
CHECK LINE (Continued)
To Correct
Cause 2:
If you suspect this is the cause:
1.
Press STOP.
2.
Press V until you see MANUAL DRAIN.
3.
Press ENTER to initiate a Manual Drain. Then open the
clamp on the patient line.
Do not open the clamp until after you press ENTER.
Cause 3:
4.
When the Manual Drain ends, STOPPED: FILL appears.
5.
Press GO to resume Fill.
CHECK HEATER LINE appears at start of FILL 1 only.
The pump chambers are not able to fill from the heater or
empty to the drain completely.
Blocked heater or drain line.
To Correct
Cause 3:
1.
Check heater line.
2.
Check drain line.
h NOTE: Even though CHECK HEATER LINE appears on
the display screen, it is possible that the cause is
a blocked drain line.
18-8
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18.3.2 Check Lines and Bags
WARNING
Do not replace empty solution bags or reconnect
disconnected solution bags during your therapy.
Possible contamination of the fluid or fluid pathways can
result if disposables are reused. Contamination of any
portion of the fluid or fluid path can result in peritonitis.
If a bag becomes disconnected during your therapy, follow
the End Therapy Early procedure. Discard the disposable
set and all solution bags at the end of therapy. (See
18.6, End Therapy Early Procedure, on page 18-55.)
CHECK LINES AND BAGS
Display Message: CHECK LINES AND BAGS
Cause:
One or more of the lines are blocked or solution bags are
empty.
This is a Manual Restart Alarm.
To Correct:
1.
Press STOP to mute the alarm.
2.
Check all lines and bags for:
–
–
–
–
–
Kinks
Closed clamps
Fibrin blockage
Disconnected solution bags
Empty solution bags
3.
Correct the issue you found.
4.
Press GO to return to the therapy.
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18. Troubleshooting
18.3.3 Check Therapy Setting Value
Check value
Display Message:
Cause:
CHECK THERAPY TIME
CHECK TIDAL VOL PCT
CHECK TOTAL UF
CHECK TOTAL VOLUME
The value of the programmed therapy setting is not valid. If
you are using a HomeChoice/HomeChoice PRO APD System
for the first time, this alarm occurs to remind you to program
your therapy.
This is a Manual Restart Alarm.
To Correct:
1.
Press STOP to mute the alarm.
The display screen automatically returns to the
incorrect setting and flashes the value you need to
change.
18-10
2.
Change the value or other values.
3.
Press STOP to exit Change Program.
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18. Troubleshooting
18.3.4 Phase Not Finished
WARNING
Bypassing the Drain phase can leave fluid in the peritoneal
cavity and result in an increased intraperitoneal volume
(IIPV) situation.
IIPV can result in a feeling of abdominal discomfort,
serious injury, or death.
If any patient, or patient caregiver, suspects the patient has
IIPV during a treatment, press STOP immediately, then
press V and initiate a Manual Drain. The Manual Drain
procedure is located in 18.5, Manual Drain Procedure, on
page 18-53. See 18.8, Increased Intraperitoneal Volume
(IIPV), on page 18-58 if IIPV is suspected.
Additional care should be taken to monitor for IIPV
symptoms for those patients not able to communicate
essential information to their caregiver during treatment.
NOT FINISHED
Display Message:
DRAIN NOT FINISHED
REFILL NOT FINISHED
FILL NOT FINISHED
Cause:
You have tried to bypass an alarm or phase and you have not
completed the phase.
This is a Manual Restart Alarm.
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18. Troubleshooting
NOT FINISHED (Continued)
To Correct:
1.
Press STOP to mute the alarm.
2.
Check with your dialysis center to learn when it is safe
to bypass. See 18.4, Bypass Procedures, on page 18-37.
3.
If you are sure that you want to bypass the alarm or
phase, press V until the display screen shows BYPASS.
4.
Press ENTER to select BYPASS.
You have bypassed the alarm or phase and moved to the
next phase in your therapy.
18.3.5 Load a New Set
LOAD A NEW SET
Display Message:
Cause:
LOAD A NEW SET
LOAD NEW SET & BAGS
The disposable set has failed testing during setup.
This is a Manual Restart Alarm.
To Correct:
18-12
1.
Press STOP to mute the alarm.
2.
Remove and discard the disposable set, and solution
bags if necessary.
3.
Get a new disposable set, and new solution bags if
needed.
4.
Load the cassette.
5.
Press GO and follow the setup instructions on the
display screen.
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18. Troubleshooting
18.3.6 Low Ultrafiltration (UF)
WARNING
Bypassing a LOW UF alarm can leave fluid in the peritoneal
cavity and result in an increased intraperitoneal volume
(IIPV) situation.
IIPV can result in a feeling of abdominal discomfort,
serious injury, or death.
If any patient, or patient caregiver, suspects the patient has
IIPV during a treatment, press STOP immediately, then
press V and initiate a Manual Drain. The Manual Drain
procedure is located in 18.5, Manual Drain Procedure, on
page 18-53. See 18.8, Increased Intraperitoneal Volume
(IIPV), on page 18-58 if IIPV is suspected.
Additional care should be taken to monitor for IIPV
symptoms for those patients not able to communicate
essential information to their caregiver during treatment.
LOW UF
Display Message:
Cause:
LOW UF
The UF Target was not met.
This setting is programmed as a part of the Last Manual
Drain feature.
When ALARM: YES is set, this is an audible Manual
Restart Alarm.
When ALARM: NO is set, this is a silent Manual Restart
Alarm with a display message only.
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18. Troubleshooting
LOW UF (Continued)
To Correct:
1.
Press STOP to mute the alarm.
2.
Press GO to continue draining automatically.
– OR –
3.
Press V to:
– View Manual Drain information.
– Check with your dialysis center to learn when it is
–
safe to bypass. To bypass the alarm, see Steps to
bypass LOW UF alarm, below.
Initiate a Manual Drain.
Steps to bypass LOW UF alarm
Display screen
LOW UF
1.
Press STOP.
DRAIN N OF N
alternates with
LOW UF
2.
Press V.
3.
Check DRAIN VOLUME.
4.
Press V.
DRAIN VOLUME:
ML
I-DRAIN VOL:
ML
TOTAL UF:
ML
An incomplete Initial Drain is not reflected in
your UF.
5.
Press V.
The volume shown is the TOTAL UF from the
current Drain.
6.
Press V.
18-14
BYPASS
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18. Troubleshooting
Steps to bypass LOW UF alarm (Continued)
7.
Press ENTER to bypass.
Display screen
END OF THERAPY
END OF THERAPY or LAST FILL appears.
– or –
LAST FILL
18.3.7 Low Drain Volume
WARNING
Bypassing a LOW DRAIN VOLUME alarm can leave fluid in
the peritoneal cavity and result in an increased
intraperitoneal volume (IIPV) situation.
IIPV can result in a feeling of abdominal discomfort,
serious injury, or death.
If any patient, or patient caregiver, suspects the patient has
IIPV during a treatment, press STOP immediately, then
press V and initiate a Manual Drain. The Manual Drain
procedure is located in 18.5, Manual Drain Procedure, on
page 18-53. See 18.8, Increased Intraperitoneal Volume
(IIPV), on page 18-58 if IIPV is suspected.
Additional care should be taken to monitor for IIPV
symptoms for those patients not able to communicate
essential information to their caregiver during treatment.
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18. Troubleshooting
LOW DRAIN VOLUME
Display Message:
LOW DRAIN VOLUME
A Slow Flow, No Flow, or air and fluid condition
occurred before the programmed Minimum Drain
Volume % (or Initial Drain Volume) completed.
A No Flow condition occurred before the Low Fill Mode
Minimum Drain Time completed.
Cause:
This is an Auto Restart Alarm.
To Correct:
1.
Change your position to try to drain more fluid.
2.
Check for kinks in your patient line.
3.
Correct the problem you found.
You do not need to press any buttons.
– OR –
If the alarm becomes a Manual Restart Alarm:
1.
Press STOP to mute the alarm.
2.
Change your position or lower the cycler by six (6)
inches.
3.
Press GO to return to your therapy.
If the alarm continues during your therapy, or if the alarm
occurs regularly over multiple therapies:
18-16
1.
Follow the steps below to check your Drain Volume.
2.
Contact your dialysis center to learn when it is safe to
bypass. See 18.4.5, Bypass Low Drain Volume Alarm, on
page 18-45.
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18. Troubleshooting
WARNING
Bypassing a LOW DRAIN VOLUME alarm can leave fluid in
the peritoneal cavity and result in an increased
intraperitoneal volume (IIPV) situation.
IIPV can result in a feeling of abdominal discomfort,
serious injury, or death.
If any patient, or patient caregiver, suspects the patient has
IIPV during a treatment, press STOP immediately, then
press V and initiate a Manual Drain. The Manual Drain
procedure is located in 18.5, Manual Drain Procedure, on
page 18-53. See 18.8, Increased Intraperitoneal Volume
(IIPV), on page 18-58 if IIPV is suspected.
Additional care should be taken to monitor for IIPV
symptoms for those patients not able to communicate
essential information to their caregiver during treatment.
Steps to check the Drain Volume
LOW DRAIN VOLUME appears on the screen.
1.
Press V.
2.
Check DRAIN VOLUME.
3.
Press V.
Display screen
LOW DRAIN VOLUME
DRAIN VOLUME:
ML
I-DRAIN VOL:
ML
TOTAL UF:
ML
An incomplete Initial Drain causes fluid to remain
in your peritoneal cavity. This can cause the actual
UF to be lower than the Total UF displayed.
4.
Press V.
The volume shown is the TOTAL UF from the
previous Drain.
5.
Press V.
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BYPASS
18-17
18. Troubleshooting
Steps to check the Drain Volume (Continued)
Display screen
h NOTE: Resume the Drain or select MANUAL DRAIN unless you have
absorbed a lot of fluid. Resuming the Drain can result in an audible
alarm. Using Manual Drain repeatedly does not generate an audible
alarm.
6.
Select one of the following options:
a.
Press GO to return to Drain if you do not want
to bypass.
DRAIN 2 OF 5
DRAINING:
ML
This is the recommended option.
– OR –
a.
Press V until MANUAL DRAIN appears.
b.
Press ENTER.
MANUAL DRAIN
– OR –
a.
Press ENTER to bypass only if your clinician
instructs you to do so.
Contact your dialysis center to learn when it is
safe to bypass.
You have bypassed the LOW DRAIN VOLUME
alarm. The next FILL begins.
FILL 3 OF 5
h NOTE: Do NOT bypass if you have a Negative UF, if your current Drain
Volume is lower than usual, if your abdomen feels full, or if you think
you are full.
h NOTE: By selecting BYPASS, you indicate that you are empty. The system
considers your volume zero (0) and delivers your entire prescribed
Fill Volume.
h NOTE: If your Drain Volume is less than your prescribed Fill Volume, the
difference is subtracted from the previous Drain Total UF to obtain
your current UF.
18-18
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18.3.8 Slow Flow Rate
SLOW FLOW
Display Message:
Cause:
SLOW FLOW DRAIN
SLOW FLOW HEATER
SLOW FLOW PATIENT
SLOW FLOW SUPPLY
Flow rate is very slow. A slow flow rate can reduce the Dwell
Time and decrease the amount of effective dialysis time.
There can be a partial kink on the specified line.
This is an Auto Restart Alarm.
To Correct:
1.
Check the line shown in the display for:
–
–
–
–
–
2.
Kinks
Closed clamps
Fibrin blockage
Disconnected solution bags
Empty solution bags
Correct the problem you found.
You do not need to press any buttons.
– OR –
If the alarm becomes a Manual Restart Alarm:
1.
Press STOP to mute the alarm.
2.
Check the line shown in the display for:
–
–
–
–
–
Kinks
Closed clamps
Fibrin blockage
Disconnected solution bags
Empty solution bags
3.
Correct the problem you found.
4.
Press GO to return to the therapy.
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18-19
18. Troubleshooting
18.3.9 Machine Tilted
MACHINE TILTED
Display Message:
Cause:
MACHINE TILTED
The cycler is tilted.
If this alarm occurs during therapy, it is a Auto Restart
Alarm.
To Correct:
1.
Make sure that the system is on a flat surface and is not
tilted.
– OR –
If the alarm becomes a Manual Restart Alarm or occurs at
PRESS GO TO START:
18-20
1.
Press STOP to mute the alarm.
2.
Place the cycler on a flat, even surface.
3.
Press GO to return to the therapy.
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18. Troubleshooting
18.3.10 Warming Solution
WARMING SOLUTION
Display Message:
Cause:
WARMING SOLUTION
The temperature of the fluid in the heater bag as measured
by the cycler is below 33°C.
Fluid delivery is not allowed at this time.
The message continues to appear while the fluid in the
heater bag is being heated.
The message clears 5 (five) minutes after the heater bag
temperature reaches 33°C.
The message can also appear for an extended period if the
heater bag is not in full contact with the heater plate during
normal operation.
To Correct:
If the alarm becomes a WARMING TIMEOUT alarm after
45 minutes:
1.
Press STOP to mute the alarm.
2.
Press GO to gain another 45 minutes to heat the
solution.
3.
Press the heater bag down against the heater plate to
improve the heating rate.
A SYSTEM ERROR appears if the heating system fails.
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18-21
18. Troubleshooting
18.3.11 Caution: Negative UF
WARNING
Bypassing a CAUTION: NEGATIVE UF alarm can leave fluid
in the peritoneal cavity and result in an increased
intraperitoneal volume (IIPV) situation.
IIPV can result in a feeling of abdominal discomfort,
serious injury, or death.
If any patient, or patient caregiver, suspects the patient has
IIPV during a treatment, press STOP immediately, then
press V and initiate a Manual Drain. The Manual Drain
procedure is located in 18.5, Manual Drain Procedure, on
page 18-53. See 18.8, Increased Intraperitoneal Volume
(IIPV), on page 18-58 if IIPV is suspected.
Additional care should be taken to monitor for IIPV
symptoms for those patients not able to communicate
essential information to their caregiver during treatment.
CAUTION: NEGATIVE UF
Display Message: CAUTION: NEGATIVE UF
Cause:
You have retained more than the allowable percentage of the
programmed Fill Volume in either the current cycle or over
the course of several cycles.
The allowable percentage in Standard Fill Mode is 50%.
In Low Fill Mode, it is adjustable from 20% to 60%.
This is a Manual Restart Alarm.
18-22
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18. Troubleshooting
CAUTION: NEGATIVE UF (Continued)
To Correct:
1.
Press STOP to mute the alarm.
2.
Follow the steps below to check Total UF.
3.
Change your position.
4.
Press GO to return to the therapy.
Contact your dialysis center if this alarm continues. Do not
bypass this alarm except on your dialysis center’s advice.
This alarm can be bypassed only once. See 18.4, Bypass
Procedures, on page 18-37.
Steps to check Total UF
Display screen
1.
Press STOP.
CAUTION: NEGATIVE UF
2.
Press V.
DRAIN VOLUME:
60ML
3.
Press V.
I-DRAIN VOL:
500ML
4.
Press V.
TOTAL UF:
5.
Check your TOTAL UF.
6.
Select one of the following options:
a.
-500ML
DRAIN 2 OF 5
Press GO to return to Drain if you do not want
to bypass.
This is the recommended option.
h NOTE: Unless you have absorbed a lot of fluid, resume the Drain or select
MANUAL DRAIN. Using Manual Drain repeatedly does not generate
an audible alarm.
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18-23
18. Troubleshooting
Steps to check Total UF (Continued)
Display screen
– OR –
a.
Press V until MANUAL DRAIN appears.
b.
Press ENTER.
DRAINING:
– OR –
a.
MANUAL DRAIN
Press ENTER to bypass the alarm.
ML
CAUTION: NEGATIVE UF
CAUTION: NEGATIVE UF appears briefly, then
the next FILL begins.
FILL 3 OF 5
h NOTE: By selecting BYPASS, you indicate that you are empty. The system
considers your volume zero (0) and delivers your entire prescribed
Fill Volume.
18.3.12 Check Your Position
CHECK YOUR POSITION
Message Display: CHECK YOUR POSITION
Cause 1:
Your position is more than one foot (12 inches) above the
cycler.
This is an Auto Restart Alarm.
To Correct
Cause 1:
1.
Check the position of the system.
2.
If the system is too low, raise it by at least six (6) inches.
You do not need to press any buttons.
– OR –
18-24
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18. Troubleshooting
CHECK YOUR POSITION (Continued)
If the alarm becomes a Manual Restart Alarm:
Cause 2:
1.
Press STOP to mute the alarm.
2.
Place the cycler on a surface that is approximately level
with you.
3.
Press GO to return to the therapy.
(Start of FILL 1 in Standard Mode only)
The clamp on the patient line was not opened after
connecting the solution bags and after you were connected.
This prevented priming of the patient line and caused the
Initial Drain to end with little or no fluid drained.
If this alarm occurs, do NOT open the clamp.
WARNING
Opening the clamp, at this point, can cause air to be delivered to your
peritoneal cavity.
This can result in shoulder and abdominal pain. This can also result in
an increased intraperitoneal volume (IIPV) situation if you had fluid
in your peritoneal cavity prior to the Initial Drain.
IIPV can result in a feeling of abdominal discomfort, serious injury, or
death.
If any patient, or patient caregiver, suspects the patient has IIPV
during a treatment, press STOP immediately, then press V and
initiate a Manual Drain. The Manual Drain procedure is located in
18.5, Manual Drain Procedure, on page 18-53. See 18.8, Increased
Intraperitoneal Volume (IIPV), on page 18-58 if IIPV is suspected.
Additional care should be taken to monitor for IIPV symptoms for
those patients not able to communicate essential information to their
caregiver during treatment.
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18-25
18. Troubleshooting
CHECK YOUR POSITION (Continued)
To Correct
Cause 2:
If you suspect this is the cause:
1.
Press STOP.
2.
Press V until you see MANUAL DRAIN.
3.
Press ENTER to initiate a Manual Drain. Then open the
clamp on the patient line.
Do not open the clamp until after you press ENTER.
4.
When the Manual Drain ends, STOPPED: FILL appears.
5.
Press GO to resume Fill.
18.3.13 Reload the Set
WARNING
Do not open the door until you have CLOSED ALL CLAMPS.
This prevents the flow of fluid from one bag to another,
and/or to the patient. Uncontrolled gravity flow of fluid can
result in an increased intraperitoneal volume (IIPV)
situation.
IIPV can result in a feeling of abdominal discomfort,
serious injury, or death.
If any patient, or patient caregiver, suspects the patient has
IIPV during a treatment, press STOP immediately, then
press V and initiate a Manual Drain. The Manual Drain
procedure is located in 18.5, Manual Drain Procedure, on
page 18-53. See 18.8, Increased Intraperitoneal Volume
(IIPV), on page 18-58 if IIPV is suspected.
Additional care should be taken to monitor for IIPV
symptoms for those patients not able to communicate
essential information to their caregiver during treatment.
18-26
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18. Troubleshooting
RELOAD THE SET
Display Message: RELOAD THE SET
Cause:
The cassette is loaded incorrectly or there is a problem with
the system. See Table 18-1 on page 18-28 for possible
causes.
This is a Manual Restart Alarm.
To Correct:
1.
Press STOP to mute the alarm.
2.
CLOSE ALL CLAMPS.
3.
Open the door.
4.
Remove the cassette.
5.
Lift the cassette to drain fluid, if it is full.
6.
Reload the cassette.
7.
Hold tubing where it exits the cassette holder on your
right and push back while you close the door.
8.
Open the clamps.
9.
Press GO.
10. Press GO again when the display screen shows
CONNECT BAGS.
The priming procedure begins.
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18. Troubleshooting
Table 18-1. Possible Causes for Reload the Set Alarms
Reload Set Number Possible Cause
143, 163, 165–169
The occluder is unable to pinch off flow due to:
Cold solution
Cassette tubing overlapping or touching where it
exits the door
h NOTE: Placing the heater bag and cassette on the
heater pan prior to the start of therapy can
often prevent this alarm.
134–137, 156, 157
Clamped or kinked line
WARNING
To prevent delivery of non-sterile air to your peritoneal cavity, load a
new set and bags if RELOAD SET: 201 occurs and fluid flows from the
patient line. Non-sterile air in the peritoneal cavity can cause
peritonitis. Air in the peritoneal cavity can cause abdominal and/or
shoulder pain.
201
Pneumatic leak between cassette and membrane
gasket due to incorrect loading
Debris on outside of cassette
Hole in cassette sheeting
h NOTE: Load a new set and bags if RELOAD SET: 201
occurs and fluid flows from the patient line.
h NOTE: Always check cassette for debris, slits, tears,
or punctures before use.
200, 202, 203
Pneumatic leak between cassette and membrane
gasket due to incorrect loading
Debris on outside of cassette
Hole in cassette sheeting
h NOTE: Always check cassette for debris, slits, tears,
or punctures before use.
All others
18-28
Incorrect loading of set or issue with cassette
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18. Troubleshooting
18.3.14 Caution: Positive UF
CAUTION: POSITIVE UF
Message Display: CAUTION: POSITIVE UF
Low Fill Mode only.
Cause:
You have removed more than the allowable ultrafiltrate
volume in either the current cycle or over the course of
several cycles.
The allowable volume can be set between 0 (zero) and
5000 mL.
This is a Manual Restart Alarm.
To Correct:
1.
Press STOP to mute the alarm.
2.
Press V until BYPASS appears.
3.
Press ENTER to choose BYPASS.
You have bypassed the alarm and treatment resumes.
Notify your dialysis center if the alarm continues.
Ultrafiltration (UF) may be set too high, or the alarm setting
may be too low.
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18. Troubleshooting
18.3.15 Verify I-Drain
VERIFY IDRAIN
Message Display: VERIFY IDRAIN:
OFF
Cause 1:
The I-DRAIN ALARM setting is OFF.
To Correct
Cause 1:
1.
Press the power switch OFF and ON again.
2.
Set the I-DRAIN ALARM to a value other than OFF. See
10.2.7, I-Drain Alarm, on page 10-9.
h NOTE: You have permanently changed the Initial Drain Alarm setting for
this therapy and all future therapy sessions.
Cause 2:
The I-Drain Alarm setting is lower than expected.
To Correct
Cause 2:
1.
Press STOP and the setting blinks.
2.
Press U or V to temporarily change the minimum
I-Drain Alarm setting.
3.
Press ENTER to accept the value.
4.
Press GO to resume Initial Drain.
h NOTE: You have temporarily changed the Initial Drain Alarm setting for this
treatment session. To permanently change the I-Drain Alarm, see
10.2.7, I-Drain Alarm, on page 10-9.
18-30
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18. Troubleshooting
18.3.16 System Errors 2240 or 2267
WARNING
Do not attempt to reuse any disposable supplies. Possible
contamination of the fluid or fluid pathways can result if
disposables are reused. Contamination of any portion of
the fluid or fluid path can result in peritonitis.
WARNING
Do not open the door until you have CLOSED ALL CLAMPS.
This prevents the flow of fluid from one bag to another,
and/or to the patient. Uncontrolled gravity flow of fluid can
result in an increased intraperitoneal volume (IIPV)
situation.
IIPV can result in a feeling of abdominal discomfort,
serious injury, or death.
If any patient, or patient caregiver, suspects the patient has
IIPV during a treatment, press STOP immediately, then
press V and initiate a Manual Drain. The Manual Drain
procedure is located in 18.5, Manual Drain Procedure, on
page 18-53. See 18.8, Increased Intraperitoneal Volume
(IIPV), on page 18-58 if IIPV is suspected.
Additional care should be taken to monitor for IIPV
symptoms for those patients not able to communicate
essential information to their caregiver during treatment.
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18. Troubleshooting
SYSTEM ERROR 2240 or 2267
Message Display:
Cause:
SYSTEM ERROR 2240
SYSTEM ERROR 2267
The system detected air in the disposable tubing set and
solution bag, and diverted flow to drain.
SYSTEM ERROR 2240 and SYSTEM ERROR 2267 can be
caused by one or more of the following:
–
Leaks
Disconnected disposable tubing
Loose connections
Fluid level not at or near the patient connector after
completing the prime cycle (incomplete prime)
Unclamped, unused supply lines (if the tip protector has
been disrupted)
Use of “Dummy Tummy” during training
1.
Press STOP to mute the alarm.
2.
Write down the System Error number and treatment
phase (Fill, Drain, or Dwell) that appears on the display
screen.
3.
Turn the power switch OFF and ON to end therapy.
–
–
–
–
–
To Correct:
SYSTEM ERROR 2367 appears.
4.
Press the power switch OFF and ON again.
PRESS GO TO START appears.
5.
Close all clamps.
6.
Discard the disposable set and solution bags.
7.
Notify your dialysis nurse.
h NOTE: If you need help to correct the alarm, contact Baxter Technical
Assistance at the number listed in 2.2, Numbers to Call for Assistance,
on page 2-1.
18-32
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18. Troubleshooting
SYSTEM ERROR 2240 or 2267 (Continued)
8.
Complete your treatment with a manual exchange.
– OR –
9.
Set up the cycler with new supplies.
A device swap is not necessary.
18.3.17 System Error nnnn
WARNING
Do not open the door until you have CLOSED ALL CLAMPS.
This prevents the flow of fluid from one bag to another,
and/or to the patient. Uncontrolled gravity flow of fluid can
result in an increased intraperitoneal volume (IIPV)
situation.
IIPV can result in a feeling of abdominal discomfort,
serious injury, or death.
If any patient, or patient caregiver, suspects the patient has
IIPV during a treatment, press STOP immediately, then
press V and initiate a Manual Drain. The Manual Drain
procedure is located in 18.5, Manual Drain Procedure, on
page 18-53. See 18.8, Increased Intraperitoneal Volume
(IIPV), on page 18-58 if IIPV is suspected.
Additional care should be taken to monitor for IIPV
symptoms for those patients not able to communicate
essential information to their caregiver during treatment.
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18. Troubleshooting
SYSTEM ERROR nnnn
Message Display:
SYSTEM ERROR
nnnn
Cause:
A problem occurred inside the system in the current cycle or
over several cycles.
To Correct:
1.
2.
3.
4.
Press STOP to mute the alarm.
Write down the System Error number and therapy
phase that appears on the display screen.
For instructions and assistance, contact Baxter
Technical Assistance at the number listed in
2.2, Numbers to Call for Assistance, on page 2-1.
Follow the instructions from Baxter Technical
Assistance. Your next steps will vary, as shown in
Table 18-2.
Table 18-2. Steps to Correct System Error Alarms
System Error
Steps to Correct
2042, 2044, 2046
If this alarm occurs before you are connected, treat as a
Reload Set Alarm. 18.3.5, Load a New Set, on page 18-12.
Otherwise treat as a System Error.
2065 to 2071,
2098, 2265
Close all clamps.
Press the power switch Off and On to end the therapy.
2240, 2267, 2367
See 18.3.16, System Errors 2240 or 2267, on page 18-31 for
these alarms.
All others
One of the following:
– Continue the therapy
– End the therapy early
– Bypass a phase
– Perform a Manual Drain
The HomeChoice APD System usually recovers from the System Error. Device
swaps are necessary only if the System Error repeats with different disposables.
18-34
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18. Troubleshooting
18.3.18 Temp Stabilizing
TEMP STABILIZING
Message Display:
Cause:
TEMP STABILIZING
The temperature of the fluid in the heater bag measured by
the cycler is above 40°C.
Fluid delivery is not allowed at this time.
The room temperature combined with the heat from the
system (even with the bag heater off) is raising the solution
bag temperature too high to deliver safe fluids to you.
To Correct:
1.
Press the power switch OFF.
2.
Allow the system to cool for 10 to 20 minutes.
Bags containing less fluid cool in less time.
3.
Press the power switch ON.
POWER RESTORED appears on the display screen.
4.
Press STOP.
5.
Press GO.
Therapy automatically resumes if the fluid temperature
falls below 40°C.
If the TEMP STABILIZING message continues to appear:
1.
Press the power switch OFF.
2.
Wait another 20 minutes.
3.
Repeat Steps 3 through 5 above.
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18. Troubleshooting
TEMP STABILIZING (Continued)
h NOTE: The system provides a display alarm only. There is no audible alarm.
To avoid recurrence of this alarm for future therapies, reduce the
room temperature by:
Relocating the cycler, if it is in direct sunlight
Opening windows in the room
Turning on a window fan and directing the flow toward the
cycler
Turning on an air conditioner, if one is available
The use of an empty heater bag, or a heater bag that is close in
volume to the programmed Fill Volume, can also reduce the chance
for this alarm because a replenish occurs before each Fill.
h NOTE: Close windows and turn off fans before connecting or disconnecting
yourself.
18-36
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18. Troubleshooting
18.4 Bypass Procedures
18.4.1 Bypass Initial Drain
Follow the steps below to bypass an INITIAL DRAIN. Contact your dialysis center
to learn when it is safe to bypass.
WARNING
Bypassing an Initial Drain when there is still fluid left in the
peritoneal cavity can result in an increased intraperitoneal
volume (IIPV) situation later in your therapy. Change your
position or sit up to aid draining completely during the
Initial Drain.
IIPV can result in a feeling of abdominal discomfort,
serious injury, or death.
If any patient, or patient caregiver, suspects the patient has
IIPV during a treatment, press STOP immediately, then
press V and initiate a Manual Drain. The Manual Drain
procedure is located in 18.5, Manual Drain Procedure, on
page 18-53. See 18.8, Increased Intraperitoneal Volume
(IIPV), on page 18-58 if IIPV is suspected.
Additional care should be taken to monitor for IIPV
symptoms for those patients not able to communicate
essential information to their caregiver during treatment.
Steps to bypass Initial Drain
INTIAL DRAIN appears on the display screen.
1.
Press STOP.
2.
Press V.
Display screen
INITIAL DRAIN
STOPPED: DRAIN
DRAIN VOLUME:
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ML
18-37
18. Troubleshooting
Steps to bypass Initial Drain (Continued)
3.
Press V.
4.
Select one of the following options:
a.
Display screen
BYPASS
INITIAL DRAIN
Press GO to return to INITIAL DRAIN if you do
not want to bypass.
This is the recommended option.
h NOTE: Unless you have absorbed a lot of fluid, resume the Drain or select
MANUAL DRAIN. Using Manual Drain repeatedly does not generate
an audible alarm.
h NOTE: The Manual Drain can facilitate obtaining a complete Initial Drain. If a
Manual Drain ends due to Slow/No Flow, the system will revert to
STOPPED: DRAIN without alarming.
– OR –
a.
Press V until MANUAL DRAIN appears.
b.
Press ENTER.
DRAINING:
– OR –
a.
MANUAL DRAIN
Press ENTER.
ML
FILL 1 OF 5
Initial Drain is bypassed and the first FILL
begins.
– OR –
18-38
An alarm sounds if less than your Initial Drain
Alarm limit has been drained.
DRAIN NOT FINISHED
See 18.4.4, Bypass Drain Not Finished Alarm, on
page 18-43.
INITIAL DRAIN
alternates with
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18. Troubleshooting
18.4.2 Bypass Low Drain Volume Alarm During Initial Drain
Follow the steps below to bypass a LOW DRAIN VOLUME alarm during an Initial
Drain. Contact your dialysis center to learn when it is safe to bypass.
WARNING
Bypassing a LOW DRAIN VOLUME alarm during Initial
Drain when there is still fluid left in the peritoneal cavity
can result in an increased intraperitoneal volume (IIPV)
situation later in your therapy. Change your position or sit
up to aid draining completely during the Initial Drain.
IIPV can result in a feeling of abdominal discomfort,
serious injury, or death.
If any patient, or patient caregiver, suspects the patient has
IIPV during a treatment, press STOP immediately, then
press V and initiate a Manual Drain. The Manual Drain
procedure is located in 18.5, Manual Drain Procedure, on
page 18-53. See 18.8, Increased Intraperitoneal Volume
(IIPV), on page 18-58 if IIPV is suspected.
Additional care should be taken to monitor for IIPV
symptoms for those patients not able to communicate
essential information to their caregiver during treatment.
Steps to bypass Low Drain Volume alarm
during I-Drain
LOW DRAIN VOLUME appears on the display screen.
1.
Press STOP.
Display screen
LOW DRAIN VOLUME
LOW DRAIN VOLUME
alternates with
INITIAL DRAIN
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18. Troubleshooting
Steps to bypass Low Drain Volume alarm
during I-Drain (Continued)
2.
Press V.
Display screen
DRAIN VOLUME:
ML
TOTAL UF:
ML
The DRAIN VOLUME appears.
3.
Press V.
Initial Drain is not included in TOTAL UF.
4.
Press V.
5.
Select one of the following options:
a.
BYPASS
Press V until MANUAL DRAIN appears.
MANUAL DRAIN
This is the recommended option.
Press ENTER.
DRAINING:
ML
DRAINING:
ML
– OR –
a.
Press GO to return to Drain if you do not want
to bypass.
h NOTE: When a Manual Drain ends due to low or No
Flow conditions, LOW DRAIN VOLUME
alternates with INITIAL DRAIN on the
display screen.
LOW DRAIN VOLUME
alternates with
INITIAL DRAIN
– OR –
a.
Press ENTER to bypass the I-Drain Alarm.
FILL 1 OF X
The next FILL begins.
h NOTE: By selecting BYPASS, you indicate that you are empty. The system
considers your volume zero (0) and delivers your entire prescribed
Fill Volume.
18-40
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18. Troubleshooting
Steps to bypass Low Drain Volume alarm
during I-Drain (Continued)
6.
Change your position and resume Initial Drain as
often as necessary.
Display screen
DRAIN VOLUME:
ML
I-DRAIN VOL:
ML
Using Manual Drain repeatedly does not generate
an audible alarm.
7.
Press V from the alarm stopped state to see the
total Initial Drain Volume (I-DRAIN VOL).
18.4.3 Bypass Drain Phase
WARNING
Bypassing a Drain phase can leave fluid in the peritoneal
cavity and result in an increased intraperitoneal
volume (IIPV) situation.
IIPV can result in a feeling of abdominal discomfort,
serious injury, or death.
If any patient, or patient caregiver, suspects the patient has
IIPV during a treatment, press STOP immediately, then
press V and initiate a Manual Drain. The Manual Drain
procedure is located in 18.5, Manual Drain Procedure, on
page 18-53. See 18.8, Increased Intraperitoneal Volume
(IIPV), on page 18-58 if IIPV is suspected.
Additional care should be taken to monitor for IIPV
symptoms for those patients not able to communicate
essential information to their caregiver during treatment.
Follow the next steps to bypass a non-Initial Drain phase. Contact your dialysis
center to learn when it is safe to bypass.
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18-41
18. Troubleshooting
Steps to bypass a Drain phase
DRAIN phase number appears on the display screen.
Display screen
DRAIN 2 OF 5
1.
Press STOP.
STOPPED:
2.
Press V.
DRAIN VOLUME:
ML
I-DRAIN VOL:
ML
TOTAL UF:
ML
DRAIN
The DRAIN VOLUME is shown.
3.
Press V.
The Initial Drain Volume (I-DRAIN VOL) is shown.
4.
Press V.
The TOTAL UF at the end of your previous Drain is
shown.
5.
Press V.
6.
Press ENTER.
BYPASS
FILL
3 OF 5
The next FILL will begin. It will be a full Fill if no
alarm occurred.
– OR –
DRAIN NOT FINISHED
If the volume drained is less than your Minimum
Drain Volume, a DRAIN NOT FINISHED alarm
appears if you try to bypass. See 18.4.4, Bypass
Drain Not Finished Alarm, on page 18-43.
– OR –
CAUTION: NEGATIVE UF
A CAUTION: NEGATIVE UF alarm may appear. See
18.3.11, Caution: Negative UF, on page 18-22 and
18.4.6, Bypass Caution: Negative UF Alarm, on
page 18-49.
18-42
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18. Troubleshooting
18.4.4 Bypass Drain Not Finished Alarm
WARNING
Bypassing a DRAIN NOT FINISHED alarm can leave fluid in
the peritoneal cavity and result in an increased
intraperitoneal volume (IIPV) situation.
IIPV can result in a feeling of abdominal discomfort,
serious injury, or death.
If any patient, or patient caregiver, suspects the patient has
IIPV during a treatment, press STOP immediately, then
press V and initiate a Manual Drain. The Manual Drain
procedure is located in 18.5, Manual Drain Procedure, on
page 18-53. See 18.8, Increased Intraperitoneal Volume
(IIPV), on page 18-58 if IIPV is suspected.
Additional care should be taken to monitor for IIPV
symptoms for those patients not able to communicate
essential information to their caregiver during treatment.
Follow the next steps to bypass a DRAIN NOT FINISHED alarm. Contact your
dialysis center to learn when it is safe to bypass.
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18-43
18. Troubleshooting
Steps to bypass
Drain Not Finished alarm
The DRAIN NOT FINISHED alarm appears when you try
to bypass and your current Drain Volume is less than
the Minimum Drain Volume.
1.
Press STOP to silence the alarm.
2.
Press V.
Display screen
DRAIN NOT FINISHED
DRAIN VOLUME:
ML
I-DRAIN VOL:
ML
TOTAL UF:
ML
The volume drained is subtracted from your Fill
Volume. Your next Fill is reduced by this difference.
If this alarm occurs during Initial Drain,
DRAIN VOLUME: ML does not appear.
3.
Press V.
The Initial Drain Volume (I-DRAIN VOL) from the
current therapy is shown.
4.
Press V.
The TOTAL UF from the end of the previous Drain
is shown.
5.
Press V.
6.
Press ENTER to bypass the DRAIN NOT FINISHED
alarm.
BYPASS
FILL 3 OF 5
The next FILL begins. The volume of fluid that was
not drained is subtracted from the Fill Volume for
this phase.
18-44
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18. Troubleshooting
18.4.5 Bypass Low Drain Volume Alarm
WARNING
Bypassing a LOW DRAIN VOLUME alarm can leave fluid in
the peritoneal cavity and result in an increased
intraperitoneal volume (IIPV) situation.
IIPV can result in a feeling of abdominal discomfort,
serious injury, or death.
If any patient, or patient caregiver, suspects the patient has
IIPV during a treatment, press STOP immediately, then
press V and initiate a Manual Drain. The Manual Drain
procedure is located in 18.5, Manual Drain Procedure, on
page 18-53. See 18.8, Increased Intraperitoneal Volume
(IIPV), on page 18-58 if IIPV is suspected.
Additional care should be taken to monitor for IIPV
symptoms for those patients not able to communicate
essential information to their caregiver during treatment.
A LOW DRAIN VOLUME alarm occurs to let you know that your Drain flow rates
indicate that you are empty, but have not achieved your Minimum Drain Volume.
Follow the steps below to bypass a LOW DRAIN VOLUME alarm. Contact your
dialysis center to learn when it is safe to bypass.
Steps to bypass
Low Drain Volume alarm
LOW DRAIN VOLUME appears on the display screen.
1.
Press STOP to silence the alarm.
Display screen
LOW DRAIN VOLUME
LOW DRAIN VOLUME
alternates with
DRAIN 2 OF 5
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18-45
18. Troubleshooting
Steps to bypass
Low Drain Volume alarm (Continued)
2.
Press V.
Display screen
DRAIN VOLUME:
ML
I-DRAIN VOL:
ML
TOTAL UF:
ML
The DRAIN VOLUME is shown.
3.
Press V.
The Initial Drain Volume (I-DRAIN VOL) from the
current therapy is shown.
4.
Press V.
The TOTAL UF from the end of the previous Drain
is shown.
WARNING
Bypassing a LOW DRAIN VOLUME alarm when the Total UF at the end
of the last cycle is lower than normal for this point in the therapy can
result in an increased intraperitoneal volume (IIPV) situation. A
negative UF value can result in a greater potential for IIPV. Press GO
to resume Drain.
IIPV can result in a feeling of abdominal discomfort, serious injury, or
death.
If any patient, or patient caregiver, suspects the patient has IIPV
during a treatment, press STOP immediately, then press V and
initiate a Manual Drain. The Manual Drain procedure is located in
18.5, Manual Drain Procedure, on page 18-53. See 18.8, Increased
Intraperitoneal Volume (IIPV), on page 18-58 if IIPV is suspected.
Additional care should be taken to monitor for IIPV symptoms for
those patients not able to communicate essential information to their
caregiver during treatment.
18-46
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18. Troubleshooting
Steps to bypass
Low Drain Volume alarm (Continued)
5.
Display screen
Press V.
BYPASS
Bypassing confirms that you are empty and that
you want the next Fill delivery to equal your
prescribed Fill Volume.
You will achieve negative UF if you bypass the Low
Drain Alarm and your Drain Volume is less than
your Fill Volume. Your UF decreases by the amount
your Drain is short of your prescribed Fill Volume.
6.
Press GO to return to Drain.
DRAIN 2 OF 5
This is the recommended option.
– OR –
Press ENTER to bypass.
FILL 3 OF 5
The next FILL begins. Your full Fill Volume is
delivered.
If you pressed ENTER and the increase in negative
UF exceeds your Negative UF Limit, a CAUTION:
NEGATIVE UF alarm occurs. See 18.4.6, Bypass
Caution: Negative UF Alarm, on page 18-49.
a.
Press STOP to silence the alarm.
CAUTION: NEGATIVE UF
CAUTION: NEGATIVE UF
alternates with
DRAIN 2 OF 5
b.
Press GO to resume DRAIN.
DRAIN 2 OF 5
h NOTE: Change your position after you resume Drain. Occasionally, the
location of the catheter tip can be in a less-than-optimal position.
Changing your position may resolve the low Drain flow issue.
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18. Troubleshooting
Steps to bypass
Low Drain Volume alarm (Continued)
Display screen
h NOTE: If LOW DRAIN VOLUME alarms continue to occur after you resume
Drain, and it is necessary to bypass the Drain (for example, to reverse
the flow in the catheter to correct a fibrin blockage issue):
Press STOP to silence a LOW DRAIN VOLUME alarm.
Press GO to resume Drain.
Press STOP to stop the Drain (when no alarm is present).
Bypass the Drain phase. See 18.4.3, Bypass Drain Phase, on
page 18-41.
A DRAIN NOT FINISHED alarm occurs if you have not met your
minimum Drain Volume when bypassing a Drain phase. If a DRAIN
NOT FINISHED alarm occurs, your next Fill will be reduced by the
amount that your Drain Volume was less than your prescribed Fill
Volume. If you do not encounter a DRAIN NOT FINISHED alarm, your
next Fill Volume will equal your prescribed Fill Volume.
18-48
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18. Troubleshooting
18.4.6 Bypass Caution: Negative UF Alarm
WARNING
Bypassing a CAUTION: NEGATIVE UF alarm can leave fluid
in the peritoneal cavity and result in an increased
intraperitoneal volume (IIPV) situation.
IIPV can result in a feeling of abdominal discomfort,
serious injury, or death.
If any patient, or patient caregiver, suspects the patient has
IIPV during a treatment, press STOP immediately, then
press V and initiate a Manual Drain. The Manual Drain
procedure is located in 18.5, Manual Drain Procedure, on
page 18-53. See 18.8, Increased Intraperitoneal Volume
(IIPV), on page 18-58 if IIPV is suspected.
Additional care should be taken to monitor for IIPV
symptoms for those patients not able to communicate
essential information to their caregiver during treatment.
h NOTE:
Do not bypass this alarm except on your dialysis center’s advice.
h NOTE:
This alarm can be bypassed only once.
Follow the next steps if you are sure it is safe to bypass a CAUTION: NEGATIVE UF
alarm. Contact your dialysis center to learn when it is safe to bypass.
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18-49
18. Troubleshooting
Steps to bypass
Caution: Negative UF alarm
CAUTION: NEGATIVE UF appears on the display screen.
1.
Press STOP to silence the alarm.
The CAUTION: NEGATIVE UF alarm alternates with
the current DRAIN phase.
Display screen
CAUTION: NEGATIVE UF
CAUTION: NEGATIVE UF
alternates with
DRAIN 2 OF 5
h NOTE: The default value for the Negative UF alarm is 50% of your
prescribed Fill Volume.
h NOTE: The Negative UF alarm limit can be programmed at 20% to 60% in
the Low Fill Mode.
2.
Press V.
DRAIN VOLUME:
ML
h NOTE: The amount that your Drain Volume is short of your prescribed Fill
Volume is subtracted from the previous Drain Total UF (see below) to
obtain your current UF that resulted in the Negative UF alarm.
3.
Press V.
I-DRAIN VOL:
ML
TOTAL UF:
ML
The Initial Drain Volume (I-DRAIN VOL) from the
current therapy is shown.
4.
Press V.
The TOTAL UF from the end of the previous Drain is
shown.
5.
Press V.
BYPASS
h NOTE: Unless you have absorbed a lot of fluid, resume the Drain or select
MANUAL DRAIN. Using Manual Drain repeatedly does not generate
an audible alarm.
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18. Troubleshooting
Steps to bypass
Caution: Negative UF alarm (Continued)
6.
Press ENTER to bypass.
Display screen
CAUTION: NEGATIVE UF
alternates with
DRAIN 2 OF 5
h NOTE: Change your position to assist draining. Fluid may have pocketed
near your catheter.
7.
Press GO to resume DRAIN.
DRAIN 2 OF 5
– OR –
a.
Press V until MANUAL DRAIN appears.
b.
Press ENTER.
MANUAL DRAIN
DRAINING:
ML
– OR –
a.
Press ENTER to bypass.
FILL 3 OF 5
The next FILL begins.
h NOTE: By selecting BYPASS, you indicate that you
are empty. The system considers your
volume zero (0) and delivers your entire
prescribed Fill Volume.
h NOTE: Bypassing a CAUTION: NEGATIVE UF alarm will temporarily increase
your Minimum Drain Volume percentage to 100% of your prescribed
Fill Volume. If your Drain Volume percentage is greater than 100%, it
stays the same. Additional bypassing is allowed only if this Minimum
Drain Volume has been met. Your Minimum Drain Volume
percentage will remain at 100% until your UF falls below the
Negative UF alarm limit (default value is 50%).
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18. Troubleshooting
18.4.7 Check Supply Line Alarm During Replenish
An alarm is posted when there is insufficient fluid to complete an unscheduled
replenish. This alarm can not be bypassed. To return to Fill, follow the steps
below.
Steps to return to Fill
Display screen
CHECK SUPPLY LINE
1.
Press STOP.
CHECK SUPPLY LINE
alternates with
REFILLING THE HEATER
2.
Press GO.
PLEASE WAIT....
appears briefly, then
REFILLING THE HEATER
3.
Press STOP.
4.
Press V.
5.
Press ENTER.
STOPPED: REFILLING
BYPASS
PLEASE WAIT....
appears briefly, then
REFILL NOT FINISHED
6.
Press STOP.
7.
Press V.
8.
Press ENTER.
18-52
REFILL NOT FINISHED
BYPASS
FILL N OF N
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18. Troubleshooting
18.5 Manual Drain Procedure
WARNING
Do not STOP or BYPASS a Manual Drain during Fill. An
increased intraperitoneal volume (IIPV) situation can
result.
IIPV can result in a feeling of abdominal discomfort,
serious injury, or death.
If any patient, or patient caregiver, suspects the patient has
IIPV during a treatment, follow the Manual Drain
procedure below. See 18.8, Increased Intraperitoneal
Volume (IIPV), on page 18-58 for more information.
Additional care should be taken to monitor for IIPV
symptoms for those patients not able to communicate
essential information to their caregiver during treatment.
Steps to perform a Manual Drain
The current FILL phase appears on the display screen.
Display screen
FILL
3 OF 5
1.
Press STOP.
STOPPED:
2.
Press V.
FILL VOLUME:
3.
Press V.
BYPASS
4.
Press V.
CHANGE PROGRAM
5.
Press V.
MAKE ADJUSTMENTS
6.
Press V.
MANUAL DRAIN
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FILL
ML
18-53
18. Troubleshooting
Steps to perform a Manual Drain (Continued)
7.
Press ENTER.
Display screen
DRAINING:
ML
The display screen shows the Drain volume. The
system continues to drain until flow is no longer
detected.
8.
Press GO to return to therapy.
9.
Reinitiate a Manual Drain if it is stopped during Fill.
The amount of fluid drained is recorded in the following ways:
If the Manual Drain occurs after the patient received a Last Fill, the
amount drained is recorded as LAST M-DRAIN: ML and is shown in the
menu at the beginning of your next therapy. See 11.4, Menu Options at
Startup, on page 11-7.
Fluid drained during all other Manual Drains is included as part of the
Total UF for the therapy.
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18. Troubleshooting
18.6 End Therapy Early Procedure
Follow the steps below to end your therapy early.
h NOTE:
If you end your therapy early for any reason, you can be left with
more fluid in your peritoneal cavity than normal. If this occurs, your
Initial Drain Alarm (I-DRAIN ALARM) setting may be too low. To
minimize the potential for an increased intraperitoneal volume (IIPV)
situation, do one of the following at the beginning of your next
therapy:
If a VERIFY I-DRAIN: ML prompt appears, press STOP and
press U or V to increase your I-DRAIN ALARM setting to at least
70% of your current expected peritoneal volume for this therapy
only.
– OR –
If a VERIFY I-DRAIN prompt does not appear, press STOP and V
to MANUAL DRAIN. Press ENTER to initiate a Manual Drain. The
system will return to STOPPED: DRAIN when the Manual Drain
ends. You can repeat the Manual Drain any number of times
without an audible alarm. Resuming the Drain can result in an
audible alarm.
Steps to end therapy early
1.
Press the power switch OFF.
2.
Press the power switch ON.
Display screen
PLEASE WAIT...
The alarm sounds.
POWER RESTORED
3.
Press STOP.
POWER RESTORED
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18. Troubleshooting
Steps to end therapy early (Continued)
4.
Press V.
Display screen
FILL VOL:
60ML
– or –
DWELL TIME LEFT 1:05
– or –
5.
Press V.
DRAIN VOLUME:
60ML
I-DRAIN VOL:
65ML
Volume from Initial Drain of the current therapy is
shown.
6.
Press V.
TOTAL UF:
150ML
TOTAL UF is updated after each Drain is completed.
7.
Press ENTER to review cycle-by-cycle information.
Press STOP to return to the previous menu.
8.
Press V.
AVG DWELL TIME: 1:32
Average actual Dwell Time for your therapy.
9.
Press ENTER to review cycle-by-cycle information.
Press STOP to return to the previous menu.
10. Press V.
END THE THERAPY
END THE THERAPY appears.
11. Press ENTER.
CLOSE ALL CLAMPS
Proceed with the End Therapy procedure. See
Section 13, Operating Instructions – End Therapy.
18-56
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18. Troubleshooting
18.7 Reprime Patient Line Procedure
If the fluid level is not at or near the connector at the end of the patient line, follow
the steps below to reprime the patient line.
Steps to reprime the patient line
1.
Press STOP when the display screen alternates
between CONNECT YOURSELF and
CHECK PATIENT LINE.
Display screen
CONNECT YOURSELF
alternates with
CHECK PATIENT LINE
2.
Press V until REPRIME PATIENT LINE appears.
3.
Press ENTER.
4.
Verify that the patient line is properly primed:
a.
REPRIME PATIENT LINE
a
Make sure fluid is present near the connector
at the end of the patient line.
The display screen alternates between
CONNECT YOURSELF and CHECK PATIENT LINE.
5.
Repeat Steps 1 through 4 until the patient line is
primed.
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18. Troubleshooting
18.8 Increased Intraperitoneal Volume (IIPV)
Overfilling or not draining enough can result in excess fluid in the abdomen, also
known as Increased Intraperitoneal Volume (IIPV). While some people may not
exhibit symptoms, most commonly observed symptoms include:
Feeling full, bloated, or overfull
Abdominal pain or discomfort
Expanded or tense abdomen
Vomiting or spitting-up
Difficulties feeding
Localized swelling around the PD catheter exit site, belly button, groin
region, or genital area
Leakage of fluid from the PD catheter exit site
Difficulty breathing
A child complaining of a "funny feeling" in the abdomen
A child crying
Unexpected increase in blood pressure
IIPV can occur because of one or more of the following reasons:
Low Fill Mode is not programmed for patients whose fill volumes are less
than 1000 mL. These patients typically weigh less than 44 lbs (20 kg).
The Negative UF Limit should not be raised above 50% and the Minimum
Drain Volume % should not be lowered below 85% (the default values).
The Initial Drain Alarm is programmed too low. The system may move on
to the first Fill before you are completely drained if:
– Your last therapy left you with more than your normal Last Fill
–
–
Volume
You did not perform a manual drain
A slow flow condition occurs before you are completely drained
Temporarily increase your I-Drain Alarm setting or perform a Manual
Drain to make sure that your Initial Drain is complete.
The patient line length is greater than 12 feet (3.6 meters) and Initial
Drain Alarm is set below 30 mL. This can cause your Initial Drain to end
early.
18-58
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18. Troubleshooting
The Minimum Drain Volume % is programmed too low. This can cause
your Drain cycles to end early.
Day Fill Volume, Night Fill Volume, or Last Fill Volume is programmed too
high. This can cause you to be overfilled if the volume is not appropriate
for your body's size.
For Tidal therapies, Total UF volume is programmed too low. This can
cause a gradual buildup of UF volume during the therapy.
Last Manual Drain is programmed to No, or the UF Target for the Last
Manual Drain is programmed too low. This can cause an incomplete last
Drain.
Stop and Go are pressed during Tidal dwells over multiple dwell cycles.
This can reduce the volumetric accuracy of the device over the course of
successive Tidal Dwell cycles.
After a power failure during Prime, the Go button is pressed to start
therapy without closing all clamps first. This can cause a free flow of fluid
from one bag to another and/or to the patient during the time when LOAD
THE SET is displayed.
The door is opened during an alarm or System Error without closing all
clamps first. This can cause a free flow of fluid from one bag to another
and/or to the patient.
The transfer set is connected to the patient line before CONNECT
YOURSELF appears on the display screen. This can cause air to be
delivered to your peritoneal cavity, which can cause IIPV if you had fluid
in your peritoneal cavity prior to the Initial Drain.
At the start of Fill 1, the patient line clamp is opened after a Check Patient
Line alarm or Check Your Position alarm appears on the display screen
without first initiating a manual drain. This can cause air to be delivered
to your peritoneal cavity, which can cause IIPV if you had fluid in your
peritoneal cavity prior to the Initial Drain.
Go is pressed at the end of therapy before all clamps are closed when
CLOSE ALL CLAMPS appears on the display screen. This can cause a free
flow of fluid from one bag to another and/or to the patient.
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18. Troubleshooting
The door is opened at the end of therapy before all clamps are closed.
This can cause a free flow of fluid from one bag to another and/or to the
patient.
Any Drain phase is bypassed, including Initial Drain, Day Drain, or Night
Drain. This can cause the system to deliver a full Fill in addition to any
fluid left in the peritoneal cavity.
DRAIN NOT FINISHED, LOW UF, LOW DRAIN VOLUME, or CAUTION:
NEGATIVE UF alarms are bypassed. This can cause the system to deliver a
full Fill in addition to any fluid left in the peritoneal cavity.
A Manual Drain performed during Fill is stopped or bypassed. This can
cause the system to deliver a full Fill in addition to any fluid left in the
peritoneal cavity.
IIPV could result in a feeling of abdominal discomfort, serious injury, or death.
h NOTE:
Additional care should be taken to monitor for IIPV symptoms for
those patients not able to communicate essential information to the
caregiver during treatment.
IF IIPV IS SUSPECTED, PLEASE DO THE FOLLOWING:
1.
Press STOP immediately, then press Vand initiate a Manual Drain.
The Manual Drain procedure is located on the next page.
2.
Once the fluid is completely drained from the abdomen, call your nephrologist.
3.
Call your nephrologist immediately if you have ANY complaints or symptoms
of IIPV including those listed above.
4.
For assistance in performing the above steps, call the Baxter Customer Service
line which is available 24 hours a day, 7 days a week at 1-800-553-6898
Prompt 1.
5.
If you are unable to reach your dialysis center, nephrologist, or the Baxter
Customer Service Line, and you or the patient are experiencing symptoms of
IIPV, call 911 immediately or go to the nearest Emergency Room.
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18. Troubleshooting
Steps to perform a Manual Drain
The current FILL phase appears on the display screen.
Display screen
FILL
3 OF 5
1.
Press STOP.
STOPPED:
2.
Press V.
FILL VOLUME:
3.
Press V.
BYPASS
4.
Press V.
CHANGE PROGRAM
5.
Press V.
MAKE ADJUSTMENTS
6.
Press V.
MANUAL DRAIN
7.
Press ENTER.
DRAINING:
FILL
ML
ML
The display screen shows the Drain volume. The
system continues to drain until flow is no longer
detected.
8.
Press GO to return to therapy.
9.
Reinitiate a Manual Drain if it is stopped during Fill.
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18-61
18. Troubleshooting
18.9 Power Failure
When a power failure occurs (or if the power switch is turned OFF) during setup,
the system closes the occluder and the display screen turns off.
When the power is restored, the system returns to PRESS GO TO START.
WARNING
If a disposable set is already present in the system after a
power failure, CLOSE ALL CLAMPS before you press GO to
start your therapy. This prevents flow of fluid from one bag
to another and/or to the patient during the time when
LOAD THE SET is displayed. Uncontrolled gravity flow of
fluid can result in a patient receiving an increased
intraperitoneal volume (IIPV) situation.
IIPV can result in a feeling of abdominal discomfort,
serious injury, or death.
If any patient, or patient caregiver, suspects the patient has
IIPV during a treatment, press STOP immediately, then
press V and initiate a Manual Drain. The Manual Drain
procedure is located in 18.5, Manual Drain Procedure, on
page 18-53. See 18.8, Increased Intraperitoneal Volume
(IIPV), on page 18-58 if IIPV is suspected.
Additional care should be taken to monitor for IIPV
symptoms for those patients not able to communicate
essential information to their caregiver during treatment.
When a power failure occurs any time during or after Initial Drain, the system
stops your therapy and the display screen turns off. To retrieve any therapy
information during a power failure, the display can be activated by pressing any
button.
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18. Troubleshooting
Table 18-3 lists the options you can view during a loss of power.
1.
Press any button to activate the display.
2.
Press STOP to silence the alarm.
3.
Press V to view each option.
h NOTE:
If no button is pressed for two (2) minutes, the display turns off. Press
any button to activate the display again.
Table 18-3. Options Available During a Power Failure
Option
Power Failure Alarm
and
Current Therapy Phase
Description
POWER FAILURE
alternates with
FILL 3 OF 5
Current Status
FILL VOL:
ML
– or –
DWELL TIME LEFTHH:MM
– or –
DRAIN VOL:
ML
Initial Drain Volume
INITIAL DRAIN:
ML
Total UF
TOTAL UF:
ML
Average Dwell Time
AVG DWELL TIME:HH:MM
End The Therapy
END THE THERAPY
To end the therapy, press ENTER.
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18. Troubleshooting
If the power is restored within 30 minutes:
The system automatically resumes therapy without any alarms.
During the first 30 minutes of a power failure, press any key to retrieve
therapy information. Press STOP and GO to start therapy after power is
restored.
If the power is not restored within 30 minutes:
An alarm occurs after 30 minutes without power. Press STOP to mute the
alarm.
Press V to retrieve therapy information.
If power is restored within approximately two hours:
The therapy can be restarted. An alarm occurs again when power is
restored.
Press STOP and GO to restart therapy.
If power is not restored within two hours:
You must end your therapy. See 18.6, End Therapy Early Procedure, on
page 18-55.
Restart your therapy from the beginning, if needed.
18-64
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18. Troubleshooting
18.10 Emergency Disconnect Procedure
WARNING
This procedure is intended for emergency disconnection
for short periods of time only. Extended time away from
the system during therapy can result in Lost Dwell Time. If
Lost Dwell is 30 minutes or greater, a Lost Dwell message
appears when therapy is completed.
WARNING
Follow aseptic technique taught by your dialysis center
when handling lines and solution bags to reduce the
possibility of infection. Always put on a face mask and wash
and dry (or disinfect) your hands thoroughly.
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18-65
18. Troubleshooting
18.10.1 Disconnect from the System
Steps to disconnect from the system
1.
Press STOP.
The specific therapy phase and STOPPED appear on the display screen when
STOP is pressed. If treatment is stopped during the Dwell phase, the system
continues to count down the Dwell Time to zero (0).
2.
Close the clamp on the patient line and close your transfer set.
3.
Using aseptic technique, prepare to disconnect:
a. Open a new FlexiCap disconnect cap and a new MiniCap disconnect cap.
b. Disconnect the transfer set from the patient line.
c. Place the patient line back in the organizer.
d. Cap off the transfer set with a new MiniCap disconnect cap and tighten
until fully secured.
e. Remove the patient line connector from the organizer and attach the new
FlexiCap disconnect cap to the patient line connector.
f. Tighten the FlexiCap disconnect cap until it is fully secured.
g. Place the capped patient line connector back in the organizer.
4.
You can now leave the HomeChoice APD System.
h NOTE: After 30 minutes, the system sounds an alarm. If you do not plan to
return to therapy, follow the End Therapy Early procedure. See
18.6, End Therapy Early Procedure, on page 18-55.
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18. Troubleshooting
18.10.2 Return to Therapy After an Emergency Disconnect
WARNING
Follow aseptic technique taught by your dialysis center
when handling lines and solution bags to reduce the
possibility of infection. Always put on a face mask and wash
and dry (or disinfect) your hands thoroughly.
Steps to return to therapy
1.
Using aseptic technique, prepare to connect:
a. Remove the FlexiCap disconnect cap from the patient line connector.
b. Remove the MiniCap disconnect cap from the transfer set connector.
c. Remove the patient line connector from the organizer.
d. Connect the patient line connector to the transfer set.
e. Open the clamp on the patient line.
f. Open your transfer set.
g. Press GO.
h. Discard the used MiniCap disconnect cap and FlexiCap disconnect cap.
2.
Your therapy continues.
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18. Troubleshooting
18-68
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Section
19
Technical Data
19. Technical Data
Technical Data
The specifications in this section apply to the Baxter HomeChoice and HomeChoice
PRO APD Systems.
19.1 Physical Specifications
Height:
Width:
Depth:
Weight:
U.S. Standard
7.0 in
19.5 in
15.7 in
27 lbs
Metric
17.8 cm
49.5 cm
39.9 cm
12.3 kg
19.2 Electrical Power Requirements
Product codes:
Voltage range:
Frequency range:
Fuses:
Mode of operation:
Degree of protection against electrical shock:
Type of protection against electrical shock:
Power consumption:
Degree of protection against ingress of water:
5C4471, 5C4471R, 5C8310, 5C8310R
115 VAC ±10%
50/60 Hz
F 5.0A – 125V
Continuous
Type B Applied Part
Class I equipment
Maximum: 600 VA (600 watts)
Average:
100 VA (100 watts)
Meets the requirements of
IEC 60601-2-39 (Clause 44.3)
Line voltage disturbances or improper grounding can adversely affect operation of the
HomeChoice and HomeChoice PRO APD Systems. Variations in line voltage amplitude
should be less than ±10 percent of nominal voltage. The duration of any voltage
disturbance should be less than 5 milliseconds.
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19-1
19. Technical Data
19.2.1 Extension Cords
The use of extension cords is not recommended since they reduce the available
voltage. Only heavy-duty extension cords rated for at least 1200 watts (10 Amps
@ 120V) that are no longer than 12 feet should be used.
The extension cord must have the grounding wire that mates with the grounding
plug on the HomeChoice/HomeChoice PRO APD System power cord.
19.3 System Performance
U.S. Standard
Metric
Fill & Drain
Targeting:
Standard Mode: +5/–20 mL Standard Mode: +5/–20 mL
Low Fill Mode: +5/–10 mL Low Fill Mode: +5/–10 mL
Volumetric Accuracy
Volume Reported:
Greater of 2% or ±10 mL
Greater of 2% or ±10 mL
Display Precision
Volumetric:
1 mL
1 mL
Fluid Temperature
Control (37°C setpoint
typical)
Normal Ambient:
Cold Ambient:
Hot Ambient:
93.2°F to 100.4°F
91.4°F to 98.6°F
95°F to 104°F
34°C to 38°C
33°C to 37°C
35°C to 40°C
Temperature Measurement Range:
41°F to 122°F
5°C to 50°C
Temperature Accuracy:
± 3.6°F
± 2°C
Fluid Temperature Control Setpoint:
95, 96.8, 98.6°F
35, 36, 37°C
19.4 Environmental Requirements
Operating Temperature Limits:
U.S. Standard
Metric
59°F to 96.8°F
15°C to 36°C
15% to 85% Noncondensing
Operating Humidity:
Operating Atmospheric Pressure Range:
10.2 psia to 15.3 psia
70 kPa to 106 kPa
Storage Temperature Limits:
–25°F to 130°F
–32°C to 54°C
10% to 95% Noncondensing
Storage Humidity:
Storage Atmospheric Pressure Range:
7.3 psia to 15.3 psia
Atmosphere:
Non-flammable, non-explosive, non-aerosolized with
normal oxygen concentrations. Equipment not suitable
for use in the presence of a flammable anesthetic
mixture with air or with oxygen or nitrous oxide.
19-2
50 kPa to 106 kPa
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19. Technical Data
19.5 Battery Backup
When power failure occurs during therapy, the HomeChoice/HomeChoice PRO APD
System stops the therapy and the display screen turns off. However, the display
powers up each time a key is pushed during the first 30 minutes of a power failure.
If power is restored within two hours, the therapy can be restarted from where it
left off. If the power is not restored within two hours, the therapy is not allowed to
continue.
19.6 Electromagnetic Compatibility
ONLY DEVICES MARKED WITH THIS SYMBOL ARE
COMPLIANT TO THE IEC 60601-1-2 STANDARD
R
C
US
The HomeChoice/HomeChoice PRO APD System, as with all medical electrical
equipment, needs special precautions regarding EMC (electromagnetic
compatibility), and the following information must be followed when installing
and putting the system into service.
Because the intensity of electromagnetic energy is greatest near the source of a
transmitting antenna, portable and mobile RF communications equipment can
affect medical electrical equipment.
The HomeChoice/HomeChoice PRO APD System has been designed to withstand
the effects of EMI (electromagnetic interference) and meets the most current EMC
standards that apply to the cycler. However, extremely high levels of
electromagnetic energy (above the levels of IEC 60601-1-2) may still produce
interference.
To reduce the risk of EMI, follow these recommendations:
Do not turn on or use hand-held personal communications devices, such
as mobile two-way radios or cellular phones, near the cycler. If these
devices need to be used, follow the recommended separation distance as
shown in the following tables.
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19-3
19. Technical Data
In the case of unexplained EMI, consider the locations of nearby
transmitters, such as radio or TV stations. You may have to move the
cycler or place shield material between the transmitter and the cycler.
Be aware that modifying the cycler or adding accessories or components
not specifically authorized by Baxter may make the cycler more
susceptible to interference from radio waves.
The following cables and accessories have been approved for use with the
HomeChoice/HomeChoice PRO APD System, and comply with current EMC
standards:
– Detachable power cord
– Modem cable
WARNING
When servicing the cycler, use only replacement
components, cables and accessories authorized by Baxter
and be sure to replace all shields, covers, screws, and
gaskets in their exact locations. Failure to do so may result
in increased emissions or decreased immunity of the
cycler.
WARNING
The HomeChoice/HomeChoice PRO APD System should not
be used next to, or stacked with, other electrical
equipment. Such equipment may cause the cycler to
operate incorrectly. However, if it is necessary to use the
cycler close to other equipment, the cycler should be
monitored to verify normal operation.
19-4
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Compliance
Group 1
Class B
Class A
Complies
Emissions Test
RF emissions CISPR 11
RF emissions CISPR 11
Harmonic emissions
IEC 61000-3-2
Voltage fluctuations/flicker
emissions IEC 61000-3-3
The HomeChoice/HomeChoice PRO APD System is suitable for use
in all establishments, including domestic establishments and those
directly connected to the public low-voltage power supply network
that supplies buildings used for domestic purposes.
The HomeChoice/HomeChoice PRO APD System uses RF energy
only for its internal function. Therefore, its RF emissions are very
low and are not likely to cause any interference in nearby
electronic equipment.
Electromagnetic Environment – Guidance
The HomeChoice/HomeChoice PRO APD System is intended for use in the electromagnetic environment specified below.
The user of the system should assure that it is used in such an environment.
Table 19-1. Guidance and Manufacturer’s Declaration – Electromagnetic Emissions
19. Technical Data
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19-5
19-6
±1 kV differential mode
±2 kV common mode
<5% UT (>95% dip in
UT) for 0.5 cycles
40% UT (60% dip in UT)
for 5 cycles
70% UT (30% dip in UT)
for 25 cycles
<5% UT (>95% dip in
UT) for 5 seconds
±1 kV differential mode
±2 kV common mode
<5% UT (>95% dip in
UT) for 0.5 cycles
40% UT (60% dip in
UT) for 5 cycles
70% UT (30% dip in
UT) for 25 cycles
<5% UT (>95% dip in
UT) for 5 seconds
3 A/m
Surge
IEC 61000-4-5
Voltage dips, short
interruptions and
voltage variations
on power supply
input lines
IEC 61000-4-11
Power frequency
(50/60 Hz)
magnetic field
IEC 61000-4-8
NOTE: UT is the a.c. mains voltage prior to application of the test level.
3 A/m
±2 kV for power supply
lines
±1 kV for input/output
lines
±2 kV for power supply
lines
±1 kV for input/output
lines
Electrical fast
transient/burst
IEC 61000-4-4
±6 kV contact
±8 kV air
Compliance Level
±6 kV contact
±8 kV air
IEC 60601
Test Level
Electrostatic
Discharge (ESD)
IEC 61000-4-2
Immunity Test
Power frequency magnetic fields should be at levels
characteristic of a typical public low-voltage power
supply network that supplies hospitals or buildings used
for commercial or domestic purposes.
Mains power quality should be that of a typical public
low-voltage power supply network that supplies
hospitals or buildings used for commercial or domestic
purposes.
If the user of the system requires continued operation
during power mains interruptions, it is recommended
that the system be powered from an uninterruptible
power supply.
Mains power quality should be that of a typical public
low-voltage power supply network that supplies
hospitals or buildings used for commercial or domestic
purposes.
Mains power quality should be that of a typical public
low-voltage power supply network that supplies
hospitals or buildings used for commercial or domestic
purposes.
Floors should be wood, concrete, or ceramic tile. If floors
are covered with synthetic material, the relative
humidity should be at least 30%.
Electromagnetic Environment – Guidance
The HomeChoice/HomeChoice PRO APD System is intended for use in the electromagnetic environment specified below.
The user of the system should assure that it is used in such an environment.
Table 19-2. Guidance and Manufacturer’s Declaration – Electromagnetic Immunity
19. Technical Data
HomeChoice APD Systems Patient At-Home Guide October 2, 2009
07-19-61-244
3Vrms 150 kHz
to 80 MHz
3V/m 80 MHz
to 2.5 GHz
Conducted RF
IEC 61000-4-6
Radiated RF
IEC 61000-4-3
3V/m
3V
Compliance
Level
where P is the maximum output power rating of the transmitter in watts (W)
according to the transmitter manufacturer, and d is the recommended
separation distance in meters (m).
Field strengths from fixed RF transmitters, as determined by an
electromagnetic site surveya, should be less than the compliance level
in each frequency range.b
Interference may occur in the vicinity of equipment marked with the
following symbol:
d = [7 / 3] P 800 MHz to 2.5 GHz
d = [3.5 / 3] P 80 MHz to 800 MHz
d = [3.5 / 3] P
Portable and mobile RF communications equipment should be used no closer to
any part of the HomeChoice/HomeChoice PRO APD System, including cables,
than the recommended separation distance calculated from the equation
applicable to the frequency of the transmitter.
Recommended separation distance:
Electromagnetic Environment – Guidance
07-19-61-244 October 2, 2009 HomeChoice APD Systems Patient At-Home Guide
a. Field strengths from fixed transmitters, such as base stations for radio (cellular/cordless) telephones and land mobile radios,
amateur radio, AM and FM radio broadcast, and TV broadcast can not be predicted theoretically with accuracy. To assess the
electromagnetic environment due to fixed RF transmitters, an electromagnetic site survey should be considered. If the measured
field strength in the location in which the system is used exceeds the applicable RF compliance level above, the system should be
observed to verify normal operation. If abnormal performance is observed, additional measures may be necessary, such as
reorienting or relocating the system.
b. Over the frequency range 150 kHz to 80 MHz, field strengths should be less than 3V/m.
NOTES:
• At 80 MHz and 800 MHz, the higher frequency applies.
• These guidelines may not apply in all situations. Electromagnetic propagation is affected by absorption and reflection from
structures, objects, and people.
IEC 60601
Test Level
Immunity Test
The HomeChoice/HomeChoice PRO APD System is intended for use in the electromagnetic environment specified below.
The user of the system should assure that it is used in such an environment.
Table 19-3. Guidance and Manufacturer’s Declaration – Electromagnetic Immunity
19. Technical Data
19-7
19-8
0.37
1.20
3.70
12.00
0.1
1
10
100
P
12.00
3.70
1.20
0.37
0.12
d = [3.5 / 3]
P
80 MHz to 800 MHz
23.00
7.40
2.30
0.74
0.23
d = [7 / 3]
P
800 MHz to 2.5 GHz
At 80 MHz and 800 MHz, the higher frequency applies.
These guidelines may not apply in all situations. Electromagnetic propagation is affected by absorption and reflection from
structures, objects and people.
•
•
NOTES:
For transmitters rated at a maximum output power not listed above, the recommended separation distance d in meters (m) can be
estimated using the equation applicable to the frequency of the transmitter, where P is the maximum output power rating of the
transmitter in watts (W) according to the transmitter manufacturer.
0.12
d = [3.5 / 3]
150 kHz to 80 MHz
0.01
Rated maximum output
power of transmitter
W
Separation distance according to frequency of transmitter
m
The HomeChoice/HomeChoice PRO APD System is intended for use in an electromagnetic environment in which radiated
RF disturbances are controlled. The user of the system can help prevent electromagnetic interference by maintaining a
minimum distance between portable and mobile RF communications equipment (transmitters) and the system as
recommended below, according to the maximum output power of the communications equipment.
Table 19-4. Recommended separation distance between portable and mobile RF
communications equipment and the HomeChoice APD System – for equipment
and systems that are not life-supporting
19. Technical Data
HomeChoice APD Systems Patient At-Home Guide October 2, 2009
07-19-61-244
19. Technical Data
19.7 Solution Temperature Protective System
Overheated solution is prevented from reaching the patient by the solution
temperature protective system that uses a microprocessor, temperature sensor,
and cutoff switch that are independent of the temperature control system. The
protective system temperature sensing is accurate to ±2°C. The HomeChoice/
HomeChoice PRO APD System sounds a system alarm within 5 seconds of sensing
an overheated condition.
19.8 Audible Alarm Silence Period
If the user presses the STOP button to silence an alarm and does not take action to
clear the alarm, the HomeChoice/HomeChoice PRO APD System will reactivate the
alarm in 30 minutes.
19.9 Range of Sound Pressure Levels
The HomeChoice/HomeChoice PRO APD System audible alarm can be set to
produce sound pressure levels within the range of 65 dBA to 75 dBA at 1 meter.
System alarms are always at maximum volume.
19.10 Maximum Pressures Used to Transfer
Solution To and From the Patient
The HomeChoice/HomeChoice PRO APD System limits the pressure used to pump
the solution to and from the patient to a maximum positive pressure of +10 kPa
(+75 mmHg) (+1.5 psig) and a maximum negative pressure of –10 kPa
(–75 mmHg) (–1.5 psig).
07-19-61-244 October 2, 2009 HomeChoice APD Systems Patient At-Home Guide
19-9
19. Technical Data
19.11 Protective System Preventing Air Infusion
The HomeChoice/HomeChoice PRO APD System is capable of detecting air in the
vertically oriented pumping chambers. If air volumes exceeding 3 cc are detected,
the air is pumped out of the top of the chamber to the drain line. Air volumes that
are smaller than this are physically unable to exit the bottom of the chamber to the
Fill line. This method is effective in preventing air from being pumped into the
patient, as long as the cassette is undamaged and the patient line is primed with
fluid at the beginning of the therapy. Refer to 11.5, Load the Disposable Set, on
page 11-10 for information on inspecting the cassette for damage.
The disposable set patient line is primed manually using the weight of the fluid in
the heater bag. The patient line is correctly primed when the fluid level is at or
near the connector at the end of the patient line. The system can not detect
whether the patient line is correctly primed. Refer to 11.8.1, Reprime the Patient
Line, on page 11-23 for information on verifying proper priming.
19.12 Protective System Preventing IIPV
The HomeChoice/HomeChoice PRO APD System uses two independent fluid
measurement systems to monitor Fill and Drain volumes. These two systems must
agree within 0.1% or a system error will result. In case of a power failure or when
the system is off, the occluder prevents any solution from being delivered to the
patient. The volume measuring system is accurate to the greater of ±2% or
±10 mL.
If any patient, or patient caregiver, suspects the patient has an increased
intraperitoneal volume (IIPV) situation during a therapy, press STOP
immediately, then press V and initiate a Manual Drain. The Manual Drain
procedure is located in 18.5, Manual Drain Procedure, on page 18-53.
See 18.8, Increased Intraperitoneal Volume (IIPV), on page 18-58 for more
information.
19-10
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19. Technical Data
19.13 Drain Logic Options
19.13.1 Standard Fill Mode Drain Logic
The HomeChoice/HomeChoice PRO APD System drains until the system encounters
Slow Flow from the patient line for a period of time, or a single pump stroke of
No Flow from the patient line.
If Slow Flow persists for a preset period of time, the system looks at the Minimum
Drain Volume to determine what to do next.
If the Minimum Drain Volume has not been met, a 3-beep auto restart
LOW DRAIN VOLUME alarm is posted. If this alarm repeats, it is promoted
first to a 6-beep auto restart alarm, and then a continuous beep alarm that
requires operator intervention.
If the Minimum Drain Volume has been met, the system will set the
patient volume to zero (0) and move on to the Fill phase.
If No Flow occurs, the system checks to see if the No Flow condition also applies to
flow to the patient.
If the No Flow condition applies to both outflow and inflow, a CHECK
PATIENT LINE alarm occurs.
If the “pushback” flows normally toward the patient, the system looks at
the Minimum Drain Volume to determine what to do next.
– If the Minimum Drain Volume has not been met, a 3-beep auto restart
LOW DRAIN VOLUME alarm occurs. If this alarm repeats, it is
promoted first to a 6-beep auto restart alarm, and then a continuous
beep alarm that requires operator intervention.
– If the Minimum Drain Volume has been met, the system will set the
patient volume to zero (0) and move on to the fill phase.
The Minimum Initial Drain Volume setting is made in the Make Adjustments menu.
The Minimum Drain Volume percent setting is made in the Nurse’s Menu. The
Drain Volume percent is multiplied by the Day Fill Volume for day drains and the
Night Fill Volume for night drains.
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19-11
19. Technical Data
19.13.2 Low Fill Mode Drain Logic
The Low Fill Mode Drain Logic is similar to the Standard Fill Mode Drain Logic.
The thresholds for Slow Flow and No Flow are lower because Low Fill Mode
patients typically drain slower. The Low Fill Mode also has an Initial Drain Time
(I-DRAIN TIME) setting in the Make Adjustments menu. There is a Minimum Drain
Time (MIN DRAIN TIME) setting for Day and Night Drains in the Nurse’s Menu.
The Minimum Drain Volume and the Minimum Drain Time settings must both be
met for the system to advance to the Fill phase when Slow Flow or No Flow occurs.
Some LOW DRAIN VOLUME alarms that could occur due to Slow Flow or No Flow
are suppressed if the Minimum Drain Time is not met.
Table 19-5 compares the Standard Fill Mode Drain Logic with the Low Fill Mode
Drain Logic.
Table 19-5. Drain Logic Options
FLOW
CONDITION
Standard Fill Mode
Drain Logic
VOLUME OF FLUID DRAINED
when Flow Condition Occurs
Minimum Drain Volume
HAS NOT been reached
Minimum Drain Volume
HAS been reached
Slow Flow
LOW DRAIN VOLUME alarm will
Below 50 mL/min sound.
Automatically moves on to Fill mode with
100% of Fill Volume being delivered.
No Flow*
LOW DRAIN VOLUME alarm will
Below 12 mL/min sound.
Automatically moves on to Fill mode with
100% of Fill Volume being delivered.
Low Fill Mode
Drain Logic
Minimum Drain Volume
HAS been reached
Minimum Drain Volume
HAS NOT been reached
Slow Flow
If Minimum Drain Time has not
Below 15 mL/min elapsed, no alarm will sound.
If Minimum Drain Time has
elapsed, LOW DRAIN VOLUME
alarm will sound.
If Minimum Drain Time has elapsed, moves on
to Fill mode with 100% of Fill Volume being
delivered.
No Flow*
Below 3 mL/min
If Minimum Drain Time has not elapsed, the
Drain will continue with no alarm, unless
100% of the Fill Volume has been drained, in
which case it moves on to Fill mode.
If Minimum Drain Time has elapsed, moves on
to Fill mode with 100% of Fill Volume being
delivered.
LOW DRAIN VOLUME alarm will
sound.
* A single pump stroke volume of fluid is pushed back to the patient when a Drain ends due to No Flow to
verify that the patient line is not occluded. The next Fill begins at this volume.
19-12
HomeChoice APD Systems Patient At-Home Guide October 2, 2009
07-19-61-244
19. Technical Data
The Low Fill Mode logic will continue to drain without alarming for lower flow
rates when compared to the Standard Fill Mode logic. It also has a Minimum Drain
Time setting that must be met along with the Minimum Drain Volume before the
system can move on to Fill.
The Low Fill Mode is restricted to Fill volumes of 60 mL to 1000 mL. This mode is
suitable for patients with small Fill volumes who may normally drain slowly. It is
required that the Low Recirculation Volume Set be used with Low Fill Mode
procedures.
The Standard Fill Mode Drain Logic can be used for patient volumes ranging from
100 mL to 3000 mL. It has higher Slow Flow alarm thresholds than the Low Fill
Mode.
19.14 Replenish Logic
19.14.1 Scheduled Replenish
The system uses the first part of each cycle’s Dwell Time to transfer solution from
the supply bags to the heater bag. This replaces the solution used during the
previous Fill. This is a scheduled replenish because it is a planned function of the
system. The system does not alarm for a scheduled replenish if the fluid flow slows
or stops.
The system stops replenishing if LAST FILL DEXTROSE is set to DIFFERENT when
the supply bags (lines with white clamps) run empty. The system alarms REFILL
NOT FINISHED if you try to bypass Dwell before replenish has finished.
The system tries to draw fluid from the Last Fill bag line (line with BLUE clamp)
when the supply bags run empty and the LAST FILL DEXTROSE is set to SAME. The
system never draws fluid from the supply bag line (lines with WHITE clamps) and
Last Fill bag line (line with BLUE clamp) at the same time.
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19-13
19. Technical Data
19.14.2 Unscheduled Replenish
If the heater bag empties before the end of the Fill phase, the system will usually,
but not always, transfer solution from the supply bags to the heater bag in order to
complete the Fill phase. This is an unscheduled replenish because the heater bag
ran dry unexpectedly during Fill.
An unscheduled replenish is performed if the Fill Volume delivered to the patient
when the heater bag empties is less than the volumes shown in the Table 19-6 on
page 19-14. If the delivered Fill Volume is greater than the amounts shown in the
table, the system considers the Fill complete and transitions from the Fill phase to
the Dwell phase.
Table 19-6. Unscheduled Replenish Logic
Fill Descriptions
Unscheduled Replenish
Day Fill 1
Volume Delivered < 90% of Fill Volume
Day Fill 2 and up
Volume Delivered < 100% of Fill Volume
Fill 1 of n
Volume Delivered < 90% of Fill Volume
Fill 2 thru n-1
Volume Delivered < 100% of Fill Volume
Fill n
Volume Delivered < 75% of Fill Volume
Last Fill
Volume Delivered < 75% of Fill Volume
h NOTE:
An alarm is posted when there is insufficient fluid to complete an
unscheduled replenish. This alarm can not be bypassed. To return to
Fill, see 18.4.7, Check Supply Line Alarm During Replenish, on
page 18-52.
19.15 Determining Maximum Fill Volume
Table 19-7 on page 19-15 allows you to determine the highest Fill Volume that
should be programmed for a given dry weight. This information allows you to
verify that the entered Fill Volume is not accidentally programmed too high for
you or a caregiver’s patient. In fact, most patients require a Fill Volume that is
much lower than the values listed in this table.
19-14
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07-19-61-244
19. Technical Data
To use Table 19-7, find the row with your weight in pounds (or kilograms) and
read across to find the corresponding Fill Volume Limit.
EXAMPLE: If dry weight is 120 pounds, the Fill Volume Limit is 2500 mL.
If your weight is between the values listed in two adjacent rows, choose the row
with lower weight and read across to find the corresponding Fill Volume Limit.
EXAMPLE: If dry weight is 137 pounds, the Fill Volume Limit for
135 pounds is 2800 mL.
Use a Fill Volume Limit of 3000 mL if your weight is 145 pounds or greater.
Table 19-7. Determining Maximum Fill Volume
Weight
Fill Volume Limit
Weight
Pounds
(lbs)
Fill Volume Limit
Pounds
(lbs)
Kilograms
(kg)
Milliliters
(mL)
Kilograms
(kg)
Milliliters
(mL)
5
2
100
10
5
250
80
36
1700
15
7
350
85
39
1800
20
9
450
90
41
1900
25
11
550
95
43
2000
30
14
700
100
45
2100
35
16
800
105
48
2200
40
18
900
110
50
2300
45
20
1000
115
52
2400
50
23
1100
120
55
2500
55
25
1200
125
57
2600
60
27
1300
130
59
2700
65
30
1400
135
61
2800
70
32
1500
140
64
2900
75
34
1600
145 or
more
66 or
more
3000
continued from first column
continued in next column
07-19-61-244 October 2, 2009 HomeChoice APD Systems Patient At-Home Guide
19-15
19. Technical Data
19.16 Determining Initial Drain Alarm Volume
Settings
Table 19-8 on page 19-17 allows you to determine the Initial Drain Alarm
(I-DRAIN ALARM) volume setting based on different percentages of the Last Fill
Volume.
To use Table 19-8, identify the row with your Last Fill Volume (mL) and read
across to the column with the desired percentage (%) to find the corresponding
Initial Drain Alarm volume setting.
EXAMPLE: If your Last Fill Volume is 2000 mL and you desire a limit that
is 85% of the Last Fill Volume, your Initial Drain Alarm volume setting is
1700 mL.
If your Last Fill Volume is between the values listed in two adjacent rows, choose
the row with lower Last Fill Volume and read across to find the corresponding
Initial Drain Alarm volume setting.
EXAMPLE: If your Last Fill Volume is 550 mL and you desire a limit that is
85% of the Last Fill Volume, your Initial Drain Alarm volume setting is
430 mL.
19-16
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07-19-61-244
19. Technical Data
Table 19-8. Initial Drain Alarm Volume Based on % of Last Fill Volume
Last Fill
Volume
(mL)
Last Fill
Volume
(mL)
70%
75%
80%
85%
90%
95%
60
40
50
50
50
50
60
80
60
60
60
70
70
80
700
490
550
550
100
70
80
80
90
90
100
800
550
600
120
80
90
100
100
110
110
900
650
140
100
110
110
120
130
130
1000
160
110
120
130
140
140
150
180
130
140
140
150
160
200
140
150
160
170
220
150
170
180
240
170
180
260
180
280
90%
95%
600
650
650
650
700
700
750
700
700
750
800
850
700
750
800
850
900
950
1100
750
850
900
950
1000
1000
170
1200
850
900
950
1000
1100
1100
180
190
1300
900
1000
1000
1100
1200
1200
190
200
210
1400
1000
1100
1100
1200
1300
1300
190
200
220
230
1500
1100
1100
1200
1300
1400
1400
200
210
220
230
250
1600
1100
1200
1300
1400
1400
1500
200
210
220
240
250
270
1700
1200
1300
1400
1400
1500
1600
300
210
230
240
260
270
290
1800
1300
1400
1400
1500
1600
1700
320
220
240
260
270
290
300
1900
1300
1400
1500
1600
1700
1800
340
240
260
270
290
310
320
2000
1400
1500
1600
1700
1800
1900
360
250
270
290
310
320
340
2100
1500
1600
1700
1800
1900
2000
380
270
290
300
320
340
360
2200
1500
1700
1800
1900
2000
2100
400
280
300
320
340
360
380
2300
1600
1700
1800
2000
2100
2200
420
290
320
340
360
380
400
2400
1700
1800
1900
2000
2200
2300
440
310
330
350
370
400
420
2500
1800
1900
2000
2100
2300
2400
460
320
350
370
390
410
440
2600
1800
2000
2100
2200
2300
2500
480
340
360
380
410
430
460
2700
1900
2000
2200
2300
2400
2600
500
350
380
400
430
450
480
2800
2000
2100
2200
2400
2500
2700
600
420
450
480
500
550
550
2900
2000
2200
2300
2500
2600
2800
3000
2100
2300
2400
2600
2700
2900
continued in next column
70%
75%
80%
85%
continued from first column
07-19-61-244 October 2, 2009 HomeChoice APD Systems Patient At-Home Guide
19-17
19. Technical Data
19.17 Determining Tidal Total UF and Last Manual
Drain UF Target Volume Settings
Table 19-9 on page 19-19 allows you to determine the:
Total UF volume setting for a Tidal therapy, or
UF Target volume setting for the Last Manual Drain
based on different percentages of the estimated Total UF volume.
To use Table 19-9, identify the row with your expected Total UF volume and read
across to the column with the desired Total UF volume percentage (%) to find the
recommended Total UF volume setting.
EXAMPLE 1: If your expected Total UF volume for the therapy is 1300 mL
and you desire to program your Tidal Total UF volume at 70%, use a Total
UF volume setting of 910 mL.
If your expected Total UF volume is between the values listed in two adjacent
rows, choose the row with the lower Total UF volume and read across to find the
corresponding UF Target volume setting.
EXAMPLE 2: If your expected Total UF volume for the therapy is 1300 mL
and you desire to program your Total UF volume for the Last Manual
Drain at 70%, your UF Target volume setting is 900 mL.
19-18
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07-19-61-244
19. Technical Data
Table 19-9. Tidal Total UF and Last Manual Drain UF Target Volume Settings
based upon % of Expected Total UF Volume
Tidal
TOTAL UF Volume Settings (mL)
Last Manual Drain
UF TARGET Volume Settings (mL)
Expected
Total UF
(mL)
70%
75%
80%
85%
90%
95%
70%
75%
80%
85%
90%
95%
20
10
20
20
20
20
20
0
0
0
0
0
0
40
30
30
30
30
40
40
50
50
50
50
50
50
60
40
50
50
50
50
60
50
50
50
50
50
50
80
60
60
60
70
70
80
50
50
50
50
50
100
100
70
80
80
90
90
100
50
100
100
100
100
100
120
80
90
100
100
110
110
100
100
100
100
100
100
140
100
110
110
120
130
130
100
100
100
100
150
150
160
110
120
130
140
140
150
100
100
150
150
150
150
180
130
140
140
150
160
170
150
150
150
150
150
150
200
140
150
160
170
180
190
150
150
150
150
200
200
220
150
170
180
190
200
210
150
150
200
200
200
200
240
170
180
190
200
220
230
150
200
200
200
200
250
260
180
200
210
220
230
250
200
200
200
200
250
250
280
200
210
220
240
250
270
200
200
200
250
250
250
300
210
230
240
260
270
290
200
250
250
250
250
300
320
220
240
260
270
290
300
200
250
250
250
300
300
340
240
260
270
290
310
320
250
250
250
300
300
300
360
250
270
290
310
320
340
250
250
300
300
300
350
380
270
290
300
320
340
360
250
300
300
300
350
350
400
280
300
320
340
360
380
300
300
300
350
350
400
420
290
320
340
360
380
400
300
300
350
350
400
400
440
310
330
350
370
400
420
300
350
350
350
400
400
460
320
350
370
390
410
440
300
350
350
400
400
450
480
340
360
380
410
430
460
350
350
400
400
450
450
500
350
380
400
430
450
480
350
400
400
450
450
500
600
420
450
480
510
540
570
400
450
500
500
550
550
700
490
530
560
600
630
670
500
550
550
600
650
650
800
560
600
640
680
720
760
550
600
650
700
700
750
900
630
680
720
770
810
860
650
700
700
750
800
850
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19-19
19. Technical Data
Table 19-9. Tidal Total UF and Last Manual Drain UF Target Volume Settings
based upon % of Expected Total UF Volume (Continued)
Tidal
TOTAL UF Volume Settings (mL)
Last Manual Drain
UF TARGET Volume Settings (mL)
Expected
Total UF
(mL)
70%
75%
80%
85%
90%
95%
70%
75%
80%
85%
90%
95%
1000
700
750
800
850
900
950
700
750
800
850
900
950
1100
770
830
880
940
990
1000
750
850
900
950
1000
1050
1200
840
900
960
1000
1100
1100
850
900
950
1000
1100
1150
1300
910
980
1000
1100
1200
1200
900
1000
1050
1100
1150
1250
1400
980
1100
1100
1200
1300
1300
1000
1050
1100
1200
1250
1350
1500
1100
1100
1200
1300
1400
1400
1050
1150
1200
1300
1350
1450
1600
1100
1200
1300
1400
1400
1500
1100
1200
1300
1350
1450
1500
1700
1200
1300
1400
1400
1500
1600
1200
1300
1350
1450
1550
1600
1800
1300
1400
1400
1500
1600
1700
1250
1350
1450
1550
1600
1700
1900
1300
1400
1500
1600
1700
1800
1350
1450
1500
1600
1700
1800
2000
1400
1500
1600
1700
1800
1900
1400
1500
1600
1700
1800
1900
2100
1500
1600
1700
1800
1900
2000
1450
1600
1700
1800
1900
2000
2200
1500
1700
1800
1900
2000
2100
1550
1650
1750
1850
2000
2100
2300
1600
1700
1800
2000
2100
2200
1600
1750
1850
1950
2050
2200
2400
1700
1800
1900
2000
2200
2300
1700
1800
1900
2050
2150
2300
2500
1800
1900
2000
2100
2300
2400
1750
1900
2000
2150
2250
2400
2600
1800
2000
2100
2200
2300
2500
1800
1950
2100
2200
2350
2450
2700
1900
2000
2200
2300
2400
2600
1900
2050
2150
2300
2450
2550
2800
2000
2100
2200
2400
2500
2700
1950
2100
2250
2400
2500
2650
2900
2000
2200
2300
2500
2600
2800
2050
2200
2300
2450
2600
2750
3000
2100
2300
2400
2600
2700
2900
2100
2250
2400
2550
2700
2850
19-20
HomeChoice APD Systems Patient At-Home Guide October 2, 2009
07-19-61-244
Section
20
Quick Reference
20. Quick Reference
Quick Reference
This section is intended to guide you through common procedures. It should not
replace the complete operating instructions contained in the other sections of this
guide. Read the entire manual before operating the HomeChoice APD System or
HomeChoice PRO APD System.
Following is a list of the topics covered in this section:
Topic
Page
Prepare for Therapy
20-2
Perform a Hi-Dose Therapy
20-13
End Therapy
20-19
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20-1
20. Quick Reference
20.1 Prepare for Therapy
1. Gather your supplies.
1 – Solution Bags
2 – Drain Option
3 – Disposable Set
4 – Disconnect Cap(s)
5 – Face Mask(s)
Patient Line Extension,
if needed (not pictured)
1
4
2
3
5
Check solution bags
for SEAL:
Strength
Expiration Date
Amount
Leaks
20-2
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20. Quick Reference
WARNING
The solution bag must be positioned properly on the heater pan,
covering the silver heater sensor button. Failure to properly position
the solution bag can result in overheated or underheated dialysis
fluid.
WARNING
DO NOT use external heating sources (i.e., microwave oven) to warm
solution bags. This can result in overheated solution delivered into
your peritoneal cavity.
2. Place a solution bag on the
heater pan.
3. Turn on the cycler.
Press the On/Off switch to the
ON position.
Observe that the characters on
the display screen turn on and
then off for several seconds.
The current mode (STANDARD
MODE or LOW FILL MODE)
appears for a few seconds.
When the system is ready,
PRESS GO TO START appears.
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20-3
20. Quick Reference
WARNING
Before loading the disposable set, inspect the cassette and tubing for
damage. Using a damaged set can result in contamination of the fluid
which can result in peritonitis.
4. Prepare the disposable set.
Open the packaging by
grasping the top and pulling
down in opposite directions.
Close all clamps on the
disposable set.
5. Prepare your drain option.
For Drain Bag: close the clamp
on the line with the blue pull
ring.
For Drain Line Extension:
leave the line clamp open.
When a drain line extension is
used instead of a drain bag, you
must leave a space between the
end of the drain line and any fluid
in the drain or container.
20-4
HomeChoice APD Systems Patient At-Home Guide October 2, 2009
07-19-61-244
20. Quick Reference
WARNING
If a disposable set is already present in the cycler, CLOSE ALL CLAMPS
before you press GO. This prevents fluid from flowing from one bag
to another, or to the patient, when LOAD THE SET appears. The
uncontrolled gravity flow of fluid can result in an increased
intraperitoneal volume (IIPV) situation.
6. Press GO when you are
ready to begin.
LOAD THE SET appears.
7. Open the door.
Push the handle up to unlock
and open the door.
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20-5
20. Quick Reference
8. Load the cassette.
The cassette only fits one way,
with the lines leading to the
right of the cycler.
Press the handle down to close
and lock the door.
9. Place the organizer.
Place the long slot of the
organizer over the hook at the
top of the door.
20-6
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07-19-61-244
20. Quick Reference
10. Prepare your drain option.
Drain Bag: close clamp on the
short tube to prevent leakage.
Drain Line Extension: remove
tip protectors from both ends
of drain.
11. Attach your drain option.
12. Open all drain clamps.
13. Press GO.
SELF TESTING appears on the
display screen.
When the self-test is complete,
CONNECT BAGS appears on the
display screen.
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20-7
20. Quick Reference
WARNING
Follow aseptic technique taught by your dialysis center when
handling lines and solution bags to reduce the possibility of infection.
14. Put on face mask and wash
and dry your hands
thoroughly.
15. Connect bags.
Connect the line with the RED
clamp to the heater bag.
Connect the line with the BLUE
clamp to the Last Fill bag.
Connect the lines with the
white clamps to additional
solution bags, if needed.
20-8
HomeChoice APD Systems Patient At-Home Guide October 2, 2009
07-19-61-244
20. Quick Reference
16. Check connections and open
clamps.
Open clamps only on lines
connected to solution bags.
Make sure the patient line is in
the left slot of the organizer.
Open the clamp on the patient
line.
WARNING
Failure to open the clamp on the patient line after connecting the
solution bags will prevent the patient line from being primed. This
can cause air to be delivered to you during FILL 1.
17. Press GO to begin priming.
07-19-61-244 October 2, 2009 HomeChoice APD Systems Patient At-Home Guide
20-9
20. Quick Reference
18. Priming complete.
When priming is complete, the
display screen alternates
between CONNECT YOURSELF
and CHECK PATIENT LINE.
WARNING
Verify that the fluid level is at or near the connector at the end of the
disposable set patient line. Connecting when air is present can result
in sterile air being delivered, which can cause shoulder or abdominal
pain.
19. Get your transfer set ready.
Make sure your transfer set is
available but do not remove the
cap until after you have washed
your hands.
20-10
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07-19-61-244
20. Quick Reference
20. Put on face mask and wash
and dry your hands
thoroughly.
21. Connect yourself.
Remove the MiniCap from the
transfer set.
Connect the transfer set to the
patient line by removing the
pull ring and attaching the
transfer set.
Open the transfer set.
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20-11
20. Quick Reference
22. Press GO.
Treatment begins with
INITIAL DRAIN.
If you perform a Hi-Dose therapy,
skip to 20.2, Perform a Hi-Dose
Therapy.
If you are not performing a
Hi-Dose therapy, skip to 20.3, End
Therapy, on page 20-19.
20-12
HomeChoice APD Systems Patient At-Home Guide October 2, 2009
07-19-61-244
20. Quick Reference
20.2 Perform a Hi-Dose Therapy
1. Hi-Dose therapy begins
when INITIAL DRAIN is
complete.
2. DAY FILL begins
automatically when
INITIAL DRAIN is complete.
07-19-61-244 October 2, 2009 HomeChoice APD Systems Patient At-Home Guide
20-13
20. Quick Reference
3. During DAY DWELL, you
may choose to disconnect
yourself from the cycler.
4. If you choose to disconnect
yourself:
Close the transfer set.
Clamp the patient line.
Disconnect the transfer set
from the patient line.
Connect a MiniCap disconnect
cap to the transfer set (shown).
Connect a FlexiCap disconnect
cap to the patient line.
20-14
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07-19-61-244
20. Quick Reference
5. Press V to display the
elapsed Dwell Time in hours
and minutes.
6. When you are ready to
continue your therapy,
press V until the display
reads PRESS GO TO
CONTINUE.
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20-15
20. Quick Reference
7. Press GO and the system
prompts you to CONNECT
YOURSELF.
8. Put on face mask and wash
and dry your hands
thoroughly.
20-16
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07-19-61-244
20. Quick Reference
9. Connect yourself.
Remove the MiniCap
disconnect cap from the
transfer set.
Remove the FlexiCap
disconnect cap from the
patient line.
Connect the transfer set to the
patient line.
Open the transfer set.
Open the patient line clamp.
10. Press GO and the system
automatically begins
DAY DRAIN 1.
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20-17
20. Quick Reference
11. When DAY DRAIN 1 is
complete, the nighttime
therapy begins with FILL 1.
– OR –
If more than one Hi-Dose
exchange is programmed,
the next DAY FILL begins.
20-18
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07-19-61-244
20. Quick Reference
20.3 End Therapy
1. The HomeChoice APD
System tells you when your
therapy is complete.
2. Press V to view the end of
therapy summary
information.
3. Write the following on your
treatment record, if
required:
Initial Drain
Total UF
Average Dwell Time
Other data as instructed by
your dialysis nurse
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20-19
20. Quick Reference
4. Press GO.
CLOSE ALL CLAMPS appears
on the display screen.
5. Close all clamps!
6. Put on face mask and wash
and dry your hands
thoroughly.
20-20
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07-19-61-244
20. Quick Reference
7. Open a new MiniCap
disconnect cap.
8. Disconnect the transfer set
from the patient line.
9. Connect a MiniCap
disconnect cap to the
transfer set.
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20-21
20. Quick Reference
10. Press GO.
DISCONNECT YOURSELF
appears on the display screen.
11. Open the door.
12. Remove and discard the
disposable set.
13. Press GO.
TURN ME OFF appears on the
display screen.
14. Press the On/Off switch to
the OFF position.
20-22
HomeChoice APD Systems Patient At-Home Guide October 2, 2009
07-19-61-244
Index
Index
Index
A
Abdomen 1-1, 5-2
Abdominal fullness 1-1
Added dwell 13-12
Adjust brightness 10-3
Adjust loudness 10-4
Aerosols 3-11, 3-15, 15-1, 19-2
Air infusion 1-1, 3-2, 11-19, 19-10
Alarm
caution negative UF 18-22
caution positive UF 18-29
check drain line 18-5
check final line 18-5
check heater line 18-5
check lines and bags 18-9
check patient line 18-5
check supply line 18-5
check therapy time 18-10
check Tidal Vol PCT 18-10
check total UF 18-10
check total volume 18-10
check your position 18-24
drain not finished 18-11
fill not finished 18-11
load a new set 18-12
load new set & bags 18-12
low drain volume 18-16
low UF 18-13
machine tilted 18-20
refill not finished 18-11
reload the set 18-27
slow flow drain 18-19
slow flow heater 18-19
slow flow patient 18-19
slow flow supply 18-19
system error 18-34
system error 2240 18-32
system error 2267 18-32
temp stabilizing 18-35
verify idrain 18-30
warming solution 18-21
Alarm log 11-8, 12-12, 13-12
Alarms
auto restart 18-4
correcting 18-3
list of 18-1
manual restart 18-4
system error 18-4
types of 18-4
Alcohol 3-10, 15-1
Altitude
operating 6-1
storage 17-1
APD 1-2
Aseptic technique 1-1, 3-1
Atmosphere 19-2
Audible alarm 3-11, 5-7, 11-6, 12-3, 19-9
Auto dim 10-5
Auto restart alarm 18-4
Automated Peritoneal Dialysis (APD) 1-2, 5-1,
5-3
Average dwell time 11-8, 12-6, 12-8, 12-10,
12-16, 13-11
B
Back panel
HomeChoice 5-11
HomeChoice PRO 5-9, 8-2
Bag stops 5-8, 5-10
Batteries 3-16, 16-1
Battery backup 19-3
Blood pressure 8-8
diastolic 1-2
systolic 1-2
Brightness 10-3
Button
07-19-61-244 October 2, 2009 HomeChoice APD Systems Patient At-Home Guide
I-1
Index
ENTER 5-9, 5-12
GO 5-9, 5-12
silver heater sensor 5-8, 5-10
STOP 5-9, 5-12
Up/Down 5-9, 5-12
Bypass 1-2, 12-12
Bypass procedure
caution negative UF alarm 18-49
drain not finished alarm 18-43
drain phase 18-41
initial drain 18-37
initial drain alarm 18-39
low drain volume alarm 18-45
C
Calculated settings
cycles 9-7
dwell time 9-7
tidal volume 9-7
UF per cycle 9-7
CAPD 1-3
Card reader disabled 8-12
Card reader error 8-13
Cassette 1-2, 3-10, 5-4, 5-7, 5-14, 5-15, 11-13
Catheter 1-2, 5-2
poor drainage 3-2
Cautions 3-14
CCPD 1-3
hi-dose 1-6
CCPD/IPD 5-4, 9-35
Cellular phones 3-12
Change program 9-4, 10-2, 11-7, 12-12
# of day fills 9-6
day fill volume 9-6
dextrose 9-6
fill volume 9-5
last fill volume 9-6
nite fill volume 9-5
nite therapy time 9-5
therapy 9-5
therapy time 9-5
tidal volume 9-6
total UF 9-6
total volume 9-5
I-2
Changing settings 8-7, 9-5
Check I-Drain volume 9-7
Clamp
blue 5-14, 5-15, 11-15
red 3-9, 5-14, 5-15, 11-16, 11-17
white 5-14, 5-15
Cleaning 15-1
agents 3-15, 15-1
Clinicians 5-1
Comfort control 10-13
Concentration
day 8-9
last fill 8-8
night 1-8, 8-8
Confirm card 8-4
Confirm new program 8-5
Connect solution bags 11-15
Connect yourself 11-24, 12-15
Connectors
Luer 5-14
Spike 5-15
Contamination 1-2
Continue therapy 12-15
Continuous Ambulatory Peritoneal Dialysis
(CAPD) 1-3, 5-3
Continuous Cycling Peritoneal Dialysis
(CCPD) 1-3, 5-4
Contraindications 3-1
Control panel 5-7, 5-8, 5-9, 5-10, 5-11
HomeChoice 5-11
HomeChoice PRO 5-9
Correcting alarms 18-3
Current time 11-9, 12-4, 12-6, 12-8, 12-10,
12-16
Cycle 1-3
Cycler 1-3
HomeChoice 5-10
HomeChoice PRO 5-8
Cycler placement 7-2, 7-3
Cycles 9-7, 9-12, 9-24, 9-38, 9-53
D
Data entry 8-7, 9-4, 10-2
Day concentration 8-9
HomeChoice APD Systems Patient At-Home Guide October 2, 2009
07-19-61-244
Index
Day drain 8-9
Day dwell 12-15
Day dwell time 12-15
Day exchanges 1-1, 8-9, 12-13, 12-16
Day fill n 8-9
Day fill volume 1-3, 9-14, 9-27, 9-41, 9-57
Day fills 1-3, 9-13, 9-26, 9-40, 9-56
Description 5-1
Dextrose 1-4, 3-7, 9-11, 9-16, 9-23, 9-32, 9-37,
9-43, 9-52, 9-61, 11-4
Dialysis 1-4
Dialysis solution 1-4
Dianeal 10-11
Disconnect cap 1-4, 11-1, 12-19, 13-6
Disconnect yourself 12-18, 13-6
Display precision 19-2
Display screen 5-9, 5-11, 11-6
HomeChoice 5-11
HomeChoice PRO 5-9
Display screen test 11-6
Disposable set 1-4, 3-10, 5-13, 11-1, 11-10,
11-11, 13-9, 14-1
Luer 5-13, 5-14
Spike 5-13, 5-15
Disposal 1-12, 3-15
Door 5-6, 5-8, 5-10, 11-12, 13-9
Drain 1-4, 12-9
bag 1-4, 11-1, 11-12, 11-14
decrease flow rate 7-2
extension line 1-5, 3-11
full 1-4
increase flow rate 7-2
initial 1-6
initial drain volume 1-6
line 5-14, 5-15
line extension 11-12
logic 19-11
manual 12-12, 18-53
phase 5-5
volume 1-5
Drain line extension 1-5, 3-11, 11-1, 11-14
Drain logic 19-11
Drain option 5-4, 11-12, 11-14
15L drain bag 11-14
drain line extension 11-14
Drain volume 12-4, 12-10
Dry weight 19-14
Dwell 1-5, 12-7
added 13-12
lost 13-12
phase 5-6
time 1-5, 12-6, 12-10, 12-16
Dwell time 9-12, 9-24, 9-38, 9-53
Dwell time left 12-8
E
Effluent 1-5, 14-1
Effluent sample bag 14-1
Effluent sampling 5-14, 5-15, 14-1
Electrical power requirements 19-1
Electrical shock 19-1
Electromagnetic compatibility 19-3
End therapy 13-1
End therapy early 18-55
End-stage kidney disease (ESKD) 1-5
End-stage renal disease (ESRD) 1-5, 3-2, 3-7,
13-1
ENTER button 5-12
Entering data 8-7
Environmental requirements 19-2
Equipment, other 3-12
ESKD 1-5
ESRD 1-5
Exchange 1-3, 1-5
Exchange time 8-9
Expiration date 3-7
Explosion hazard 3-11
Extension cords 3-14, 19-2
External heating sources 3-11, 11-3
Extraneal 10-11
F
Face mask 1-5, 11-1
Features 5-7
Fill 12-5
first 1-6
last 1-7
07-19-61-244 October 2, 2009 HomeChoice APD Systems Patient At-Home Guide
I-3
Index
low 19-13
phase 5-5
replenish logic 19-13
volume 1-5
Fill volume 9-10, 12-6, 12-12, 19-14
Fill volume limit 19-15
Final line 5-14, 5-15
Fluid circuit 5-4
Fluid line 5-6
Fluid overload 1-6, 3-2, 13-1
Fluid pathways 5-5
Fluid temperature control 19-2
Flush 1-6, 9-3
Frequency range 19-1
Front view
HomeChoice 5-10
HomeChoice PRO 5-8
Full drains every 9-23, 9-32, 9-52, 9-61
Fuse 19-1
G
GO button 5-12
Grounding 7-2, 11-5, 19-2
instructions 7-4
H
Handle 5-8, 5-10
Heater 11-3
bag 11-5
line 5-14, 5-15
pan 3-8, 5-8, 5-10
sensor button 3-8, 5-10
Heater bag empty 9-3
Heater bag position 11-3, 11-5
Heater sensor button 5-8, 5-10
Hi-Dose CCPD 1-3, 1-6, 5-4, 9-13, 9-39
Hi-dose dwell 12-18
Hi-Dose therapy 12-13, 12-16
Hi-Dose Tidal 1-3, 1-6, 5-4, 9-25, 9-54
Home patients 5-1
Humidity
operating 6-1, 19-2
storage 17-1, 19-2
I-4
Hydrogen peroxide 3-10, 15-1
Hypothermia 1-6, 3-9
I
I-Drain 1-6
I-Drain alarm 9-7, 10-9, 12-2
setting 10-11
I-Drain volume 1-6
recovered 1-10
Increased Intraperitoneal Volume (IIPV) 1-1,
1-6, 5-6, 12-2, 18-53, 18-58, 19-10
Initial drain 1-6, 12-1, 12-4
Initial drain alarm 19-16
Initial drain alarm volume settings 19-16
Initial drain volume 11-8, 12-6, 12-8, 12-10,
12-15, 13-11
Intermittent Peritoneal Dialysis (IPD) 1-7, 5-4
Intraperitoneal Volume (IPV) 1-7, 1-8
Invalid PRO card 8-13
IPD 1-7
IPV 1-6, 1-7
Isolation transformer 6-1
J
J1-Service port 5-9, 8-2
J2-Modem port 5-9, 8-2
L
Language 9-3
Last fill
concentration 1-7
volume 1-7, 9-11
Last fill concentration 1-7, 8-8, 9-11, 9-16,
9-23, 9-32, 9-37, 9-43, 9-52, 9-61
Last fill volume 19-16
Last manual drain 10-14, 11-8
Last M-Drain 13-11
Last UF 11-8
Lines 5-14, 5-15
List of alarms 18-1
Load cassette 11-10, 11-13
HomeChoice APD Systems Patient At-Home Guide October 2, 2009
07-19-61-244
Index
Log
alarm 11-8
therapy 11-9
Lost dwell 13-12
Low drain volume 10-10
Low fill mode 1-7, 9-2, 9-34, 19-13
Low recirculation volume set 1-7
M
Maintenance 16-1
Make adjustments 10-1, 11-7, 12-12
Manual drain 12-12, 13-12, 18-53
Manual restart alarm 18-4
Maximum fill volume 19-14
Maximum pressures 19-9
Medication port 3-7
Minimum drain time 9-2
Minimum drain volume 9-2, 19-11
Mode
low fill 1-7, 9-2, 9-34, 19-13
operation 19-1
standard fill 1-10, 9-2, 9-9
Modem 3-11, 8-14
testing 8-16
Modem connect 11-9
Modem connect mode 8-16
Mute 5-12
N
Negative UF limit 9-2
Nerve stimulation devices 3-12
Night concentration 1-8, 8-8
Night fill volume 9-28
Night therapy time 9-15, 9-27, 9-41, 9-57
Night Tidal volume percent 9-29, 9-58
Night UF 9-30, 9-59
Nite 1-7
Nite (night) therapy time 1-7
Nitrous oxide 3-11, 19-2
No flow 1-8, 19-11
No PRO card 8-11
Number of day exchanges 8-9
Number of day fills 9-13, 9-26, 9-40, 9-56
Nurse’s menu 9-2
Nurse’s settings 9-1
O
Occluder 1-8, 5-6, 5-8, 5-10, 11-12, 13-9,
19-10
On/Off switch 5-9, 5-11, 8-2, 11-6
Operating
altitude 6-1
atmospheric pressure 19-2
conditions 6-1
humidity 6-1, 19-2
temperature 6-1, 19-2
Organizer 1-8, 5-14, 5-15, 11-13
Outdoor use 3-12
Overfill 1-1, 1-8
Overheated solution 3-11, 11-3
Oxygen 3-11, 19-2
P
Patient line 3-2, 5-14, 5-15
Patient line extension 1-8, 11-1, 11-12
Pause therapy 12-11
PD 1-9
Perform therapy 12-1
Peritoneal
cavity 1-8, 5-2
membrane 1-9, 5-2
Peritoneal Dialysis (PD) 1-9, 5-2
Peritonitis 1-9
Phase 1-9, 5-5
Phones
cellular 3-12
cordless 3-12
Physical specifications 19-1
Physician order 4-1
Pixels 11-6
Positional drainer 1-9
Positive UF limit 9-3
Power
consumption 19-1
entry 5-9, 5-11, 8-2
failure 5-6, 19-3
07-19-61-244 October 2, 2009 HomeChoice APD Systems Patient At-Home Guide
I-5
Index
Power cord 3-11, 5-9, 5-11, 7-1, 7-4, 8-2, 11-5,
19-2
Prepare for therapy 11-1
Prescription settings 9-1
Press go to start 11-7
Prime patient line 11-20
Priming 1-9, 11-18
PRO Card 1-10, 5-16, 8-1, 11-5
care 8-3
confirm card 8-4
handling 8-3
indicator light 8-2, 8-11
inserting 8-4
messages 8-11
port 5-8, 8-2
prompts 8-7
removing 8-10
PRO card full 8-12
Product code 19-1
Program locked 9-3
Program not valid 8-13
Programming 8-7, 9-1, 9-4
Protective system
preventing air infusion 19-10
preventing IIPV 19-10
solution temperature 19-9
Pull ring 3-7
Pushback 1-10, 19-11
R
Reconnect yourself 12-20
Recovered I-drain volume 1-10
Renal patients 5-1
Replacement cycler 9-3
Replenish
scheduled 19-13
unscheduled 19-14
Replenish logic 19-13
Reprime patient line 11-23, 18-57
Return cycler to Baxter 15-3
Returning the cycler 3-15
Review program 11-7, 12-4, 12-6, 12-8, 12-10,
12-16
Review settings 11-7
I-6
S
Sanitizing solution 15-3
Scheduled replenish 19-13
Serial number 5-8, 5-10
Service 2-1, 3-14, 9-3, 16-1, 19-4
Service ports 5-11
Settings 9-1
Setup 7-1
Shock hazard 3-11
Shut down 13-8, 13-9
Side effects 3-1
Slow flow 1-10, 19-11
Smart dwells 9-3
Software version 11-9, 12-12
Solution bags 1-10, 3-8, 11-1, 11-3, 11-4,
11-15
attaching 3-9
damaged 11-3
placement 7-3
prepare 11-4
Sound pressure levels 19-9
Standard fill mode 1-10, 9-2, 9-9
Start setup 11-7
Starting your cycler 11-5
Startup options 11-7
Steps to change settings 9-5
Steps to enter data 8-7
STOP button 5-12
Stop therapy 12-11
Storage
altitude 17-1
atmospheric pressure range 19-2
battery 17-1
cycler 17-1
disposables 17-1
humidity 17-1, 19-2
solution 17-1
temperature 17-1, 19-2
Supplies 3-6, 11-1, 11-4
Supply line 5-14, 5-15
Swap 9-3
Symbol
alternating current 1-12
Canadian Standards Association 1-13
HomeChoice APD Systems Patient At-Home Guide October 2, 2009
07-19-61-244
Index
crossed-out wheeled bin 1-12
date of manufacture 1-12
fuse 1-12
ingress protection 1-12
mains power 1-13
manufacturer 1-13
rechargeable battery 1-12
recyclable 1-12
serial number 1-12
type B 1-12
Symbols 1-12
System 1-10
performance 19-2
System error 18-31, 18-33
System error alarm 18-4
System settings 9-1
T
Temperature
accuracy 19-2
adjusting 10-13
fluid control 19-2
measurement 19-2
operating 6-1, 19-2
storage 17-1, 19-2
Therapy 11-1, 12-1
Therapy end time 12-4, 12-6, 12-8, 12-10
Therapy log 11-9
Therapy settings 9-1
Therapy time 9-9, 9-19, 9-35, 9-47
Therapy type 9-8
CCPD/IPD 9-8, 9-9, 9-35
Hi-Dose CCPD 9-8, 9-13, 9-39
Hi-Dose Tidal 9-8, 9-25, 9-54
Tidal 9-8, 9-18, 9-45
Tidal 9-18, 9-45
Hi-Dose 1-6
Tidal full drains 9-3
Tidal Peritoneal Dialysis (TPD) 1-11, 5-4
Tidal volume 1-11, 9-24, 9-53
Tidal volume percentage 1-11, 9-20, 9-49
Tip protectors 3-10
Total UF 1-11, 9-21, 9-50, 12-6, 12-8, 12-10,
12-15, 13-11
Total volume 1-11, 9-9
TPD 1-11
Training 4-1, 8-1
Transfer set 11-25, 12-19, 13-5
Traveling 6-1
Troubleshooting 18-1
Tubing indentations 3-10
Turn me off 13-10
Types of alarms 18-4
U
UF 1-11, 5-4, 9-2, 9-7
UF per cycle 9-24, 9-33, 9-53, 9-62
UF target 10-15
UF target alarm 10-15
Ultrafiltration (UF) 1-11
Universal precautions 1-11, 3-2
Unscheduled replenish 19-14
Up/Down button 5-12
Uremia 1-11
V
Valves 5-6
Verify I-Drain 12-2, 12-3
Verify patient line primed 11-20, 11-21,
11-23, 18-57
Voltage range 19-1
Volume
day fill 1-3, 9-14, 9-27, 9-41, 9-57
drain 1-5, 12-4, 12-10
fill 1-5, 9-10, 9-20, 9-36, 9-48, 12-12
initial drain 1-6, 12-6, 12-8
intraperitoneal 1-7
last fill 9-11, 9-16, 9-22, 9-31, 9-37, 9-43,
9-51, 9-60
night fill 9-15, 9-28, 9-42, 9-58
night Tidal 9-29, 9-58
recovered I-Drain 1-10
Tidal 1-11, 9-20, 9-33, 9-49, 9-53, 9-62
total 1-11, 9-9, 9-13, 9-19, 9-26, 9-35, 9-40,
9-47, 9-56
Volumetric accuracy 19-2
07-19-61-244 October 2, 2009 HomeChoice APD Systems Patient At-Home Guide
I-7
Index
W
Warnings 3-1, 4-1
Waste 1-12
WEEE 2002/96/EC 3-15
Weight 8-8
I-8
HomeChoice APD Systems Patient At-Home Guide October 2, 2009
07-19-61-244
24-hour Technical Assistance is available for the
HomeChoice and HomeChoice PRO APD Systems at
1.800.553.6898
07-19-61-244 October 2, 2009
Software version:
10.210
PATIENT GUIDE COVERS_Update121109.indd 2
Baxter Healthcare Corporation
Renal Division
McGaw Park, IL 60085
U.S.A
1.888.736.2543, press 4
12/11/2009 2:26:51 PM