baxter AK 98 User manual

AK 98
DIALYSIS MACHINE
QUICK REFERENCE GUIDE

Note: The contents of this training material are based on the AK 98 Dialysis Machine Operator's Manual for
software 3.xx (HC12839002). Reviewing this material does not replace the training given to you by your
healthcare provider, nor does it replace your responsibility to read and understand the full text of the
Operator's Manual prior to operating the machine. If there are differences between the actions described
here and the instructions contained in the Operator's Manual, then the information from the Operator's
Manual takes precedence.
Advanced Functions of AK 98 29

Profiling 29

Diascan 32

Isolated UF (Ultrafiltration) 34
Other Functions of AK 98 35

Concentrate Standby Mode (CSBM) 35

Reactivate Concentrate Standby Mode 35

Service Menu 36

Automatic Restart 37

Ultrafiltration (UF) Rate Limits 37

Blood Pressure Measurement (BPM)
Alarm Limit Setting 38

Actual Blood Flow 38
Tips for Using AK 98 39

Air Detector Activation 39

Conductivity Actual and Calculated -
C/P Values 39

Heparin Delivery 39

Restart Using the On/Off Button 39

Saline Loss 40

Surface Cleaning and Disinfection 40
Hemodialysis Basics 41

How Hemodialysis Works 41

The Dialyzer 41

Blood Access Types 42

Different Components of the
Hemodialysis System 42

The Blood Monitor 43

The Fluid Monitor 44

The Water Supply 45

Efficiency of Hemodialysis 45
AK 98 Configuration 03

Front and Side Panels 03

Back Panel 04

Buttons on the User Control Panel 05

Screen Overview 06
How to Use AK 98 07

Operation Start Up 07

Extracorporeal Circuit Preparation
and Line Connection 08
- Attaching the Arterial Blood Line 08
- Attaching the Priming Solution 09
- Attaching the Venous Blood Line 10
- Attaching the Heparin Syringe 11

Priming 12

Recirculation 13

Blood Pressure Monitor (BPM) 14

Manually Entering the Prescription 15

Retrieving Patient Prescription 16

Connecting the Patient 17

Connect Patient After Concentrate
Standby Mode (CSBM) 18

Starting the Treatment 18

Stopping the Treatment, Rinseback,
and Disconnecting the Patient 19

Emptying the Dialyzer and BiCart 20

Disconnecting the Blood Line and Dialyzer 20

Disinfection and Rinsing 21

Changing the Dialyzer and Blood Line
During Treatment 22

Replacing the BiCart Cartridge
During Treatment 22
AK 98 Troubleshooting 23

Alarm Indication 23

How to Pause Treatment 23

What to Do During a Power Outage 24

Manual Rinseback 24

Changing a Wet Transducer 25

Screen Guidance and Resolution 26
CONTENTS
2

1. Operator's panel
2. Air detector
3. Venous pressure transducer connector
4. Arterial pressure transducer connector
5. Blood pump
6. Priming bucket
7. Heparin pump
8. Arterial blood line clamp
9. Priming detector
10. BICART cartridge holder
11. Arm for dialyzer holder
12. Venous blood line clamp
13. Expansion chamber holder
14. Blood pressure monitor (BPM) connector
15.Blood line guides
16.Level adjustment knob
17.BPM cuff holder
18.Top tray
19.Infusion stand
20.Wand holder
21.Wand
22.Dialysate ports for dialysate lines
23.Dialysate line from machine to dialyzer (blue)
24.Dialysate line from dialyzer to machine (red)
25.Dialysate port for red concentrate connector
26.Dialysate port for blue concentrate connector
27.Concentrate connector, red
28.Concentrate connector, blue
AK 98 CONFIGURATION - FRONT AND SIDE PANELS
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3

1. Transportation handle
2. Air filters
3. Halt button
4. Battery charge
indicator
5. Battery connect
indicator
6. Over temperature
protection indicator
7. Inlet water tube
8. Outlet tube (drain)
9. Citric acid inlet tube
10. Remote panel contacts
(not used)
11. Ethernet port
12. USB port
13. External
communication port
14. Mains connection
15. Fuses
16. Main switch
17. Blood leak detector
18. Ultrafilter
19. Leakage detector tray
20. Potential equalisation
connection
AK 98 CONFIGURATION - BACK PANEL
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1. On/Off button: Press to turn the machine on or off. Press and hold for 3 seconds
while a disinfection program is running for the machine to automatically turn off
after the disinfection program is completed.
2. Schedule indicator: When lit blue, a rinse or disinfection program is scheduled to
begin automatically.
3. Main switch indicator: When lit green, the machine is connected to mains power
supply and the main switch (behind the machine) is on.
4. Mute button: Press to mute alarm or attention sounds. Press and hold to turn
alarm and attention sounds back on.
5. Blood pump up button: Press to increase blood pump speed.
6. Blood pump button: Press to start or stop the blood pump.
7. Blood pump down button: Press to reduce blood pump speed.
AK 98 CONFIGURATION -
BUTTONS ON THE USER CONTROL PANEL
1. On/Off button
2. Schedule indicator
3. Main switch indicator
4. Mute button
5. Blood pump up
button
6. Blood pump button
7. Blood pump
down button
5

17. Information tab
18. Treatment graph tab
19. Information field
20. Patient page
21. Functions button
22. Disinfection button
23. Blood button
24. Fluid button
25. Fluid bypass button
26. Ultrafiltration (UF) button
27. Treatment history page
28. Status bar
29. Monitor identifier (Nickname)
Note: Treatment overview fields
(11-15) are configurable.
Transmembrane pressure (TMP)
is also available.
1. Venous pressure control
2. Arterial pressure control
3. Machine state indicator
4. Time indicator
5. Blood path
6. Fluid path
7. Blood pressure monitor (BPM) button
8. Blood pressure monitor (BPM)
read out field
9. Diascan read out field
10. Diascan button
11. Blood flow rate
12. Total blood volume processed
13. Total heparin volume infused
14. Total UF volume removed
15. Ultrafiltration rate
16. Alarm tab
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AK 98 CONFIGURATION - SCREEN OVERVIEW
6

Operation Start Up
• The main power cable must be connected to the main power supply.
• The main switch must be turned on.
• The water supply must be connected to the inlet water and powered on.
• The outlet tube (drain) should be properly placed with an air gap between the dialysis machine and the drain.
• The dialysate lines should be connected to the dialysate ports.
• Acid concentrate, BiCart, dialyzer, bloodline, and saline must be ready for use.
3. Remove the red concentrate connector from the dialysate port.
4. Attach the white wand to the red concentrate connector. Place the
wand in the acid concentrate container.
5. Select the concentrate combination to be used from the preset options
on the screen.
6. Press the release buttons to release the latches. Open the BiCart
cartridge holder. Pull the upper latch out and up. Pull the lower latch
down.
7. Remove the caps from the BiCart cartridge and attach it narrow end
down.
8. While supporting the lower latch, press down the upper latch to secure
the cartridge.
9. Attach the dialyzer in the holder. If necessary, squeeze the spring-
clip to place the dialyzer in the holder. Move the dialyzer caps to the
dialysate ports on the dialyzer to prevent saline loss.
10. Hang the saline bag on the IV pole.
1. Gently press the On/Off button to turn on the machine.
2. Before a treatment can be started the dialysis machine performs a
functional check. Do NOT attach blood lines or open the blood pump
door until the blood pump button is flashing.
Pre-treatment Check
Functional Check
HOW TO USE AK 98
7

Extracorporeal Circuit Preparation and Line Connection - Attaching the Arterial Blood Line
1. Open the blood pump door. Press the center of the cover and pull
the tab.
2. Load the blood pump segment into the blood pump. Make sure
the arterial pressure transducer points down and the heparin line
is at the top.
6. Remove the protective caps and attach the end of the arterial blood
line to the dialyzer. Make sure the arterial blood line is securely
attached to the dialyzer.
7. Route the line through the line guide.
8. Insert the blood line into the arterial clamp (marked with a red dot).
9. Gently pull the blood line down to secure in place.
3. The blood pump segment collars must be outside of the pump
housing.
4. Hold the segment in place and close the blood pump door.
Do NOT push the segment into the blood pump rotors.
5. Gently press the blood line into the upper guide.
HOW TO USE AK 98
8

Extracorporeal Circuit Preparation and Line Connection - Attaching the Priming Solution
1. Attach the arterial blood line to one of the blood line holders in the prime
bucket. Keep the arterial clamp open.
2. Clamp the infusion line and spike the saline bag.
Ensure connection is secure.
3. Attach the arterial pressure transducer protector to the red arterial
pressure transducer connector. Turn to secure the connections -
transducer line to transducer protector and transducer protector to
transducer connector on the machine.
Note: Do NOT clamp the pressure transducer line.
HOW TO USE AK 98
9

Extracorporeal Circuit Preparation and Line Connection - Attaching the Venous Blood Line
1. Attach the venous blood line to one of the blood line holders in the
prime bucket. Close the clamp on the venous patient line.
6. Place the blood line into the venous clamp (marked with a blue dot).
7. Gently pull the blood line down to secure in place.
8. Make sure that the venous blood line is properly placed in the
priming detector and venous blood line clamp. The venous blood line
must be properly installed in the priming detector so that blood can
be detected at the start of treatment.
9. Attach the venous pressure transducer protector to the blue venous
pressure transducer connector. Turn to secure the connections -
transducer line to transducer protector and transducer protector to
transducer connector on the machine.
Note: Do NOT clamp the pressure transducer line.
10. Close clamps as indicated on the image.
2. While firmly pressing the center of the cover, pull the tab towards you
to open the air detector cover.
3. Pinch the venous drip chamber and place it in the air detector.
4. Adjust the position of the venous drip chamber such that the filter is
below the air detector and that the chamber extends above the top of
the air detector. While pressing the center of the cover, close the air
detector cover.
5. Remove the protective caps and connect the end of the venous
blood line to the dialyzer. Make sure the venous blood line is
securely connected to the dialyzer.
HOW TO USE AK 98
10

Extracorporeal Circuit Preparation and Line Connection - Attaching the Heparin Syringe
1. Attach the prepared syringe to the heparin line.
2. Prime the heparin line with the solution up to the point where the
arterial blood line starts. The luer lock must be properly attached.
3. Close the clamp on the heparin line.
4. Press the end of the piston on the heparin pump and pull out the
piston to extend it as much as possible.
Note:The locking wheel must be fully turned downwards
before you can insert the syringe into the heparin pump.
5. Insert the syringe into the pump. The plastic collar at the end of the
syringe must fit in the grooves of the pump. When using a syringe
with total volume less than 20 mL, a heparin pump adapter must be
installed to accommodate the syringe.
6. Push the piston back to its original position and insert the plastic flat
head of the plunger into the groove next to the locking wheel.
7. Turn the locking wheel upwards until you feel resistance.
8. Gently pull the plunger to check that the syringe is properly attached.
HOW TO USE AK 98
11

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Priming
1. Open the clamp of the arterial blood line.
2. Open the infusion line clamp(s).
3. Turn the dialyzer over so that the blue end is up. This helps
remove the air from the dialyzer.
4. Manually prime the pre pump segment of the arterial blood line by
gravity.
5. When the pre pump segment of the arterial blood line is primed
and priming fluid has reached the prime bucket, close the arterial
blood line clamp and open the venous blood line clamp.
6. Check that there are no kinks in the blood lines.
7. Press the flashing blood pump button to start the blood pump and
activate the priming.
11. When the blood pump stops, turn the dialyzer over so that the red
end is up.
12. If not already done, attached the dialysate lines to the dialyzer.
Connect the red dialysate line from the machine to the same side
of the dialyzer as the arterial blood line. Connect the blue dialysate
line from the machine to the same side of the dialyzer as the venous
blood line.
13. Press the Fluid Bypass button.
9. Once a small volume of priming fluid has reached the venous
chamber, adjust the level of priming fluid in the venous drip
chamber with the adjustment knob. The level should be well above
the air detector head.
10. To avoid unnecessary air detector alarms during set up, wait to
activate the air detector until all air has been removed from the
circuit.
Note: The air detector is automatically activated when Connect
patient is selected.
HOW TO USE AK 98

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Recirculation
When priming is complete, the option for Recirculation will appear.
1. Press Recirculation.
2. Connect the patient ends of the bloodlines using the recirculation
connector. Ensure both patient bloodline clamps are open.
3. Check that the clamps on the infusion line are open.
4. Start the blood pump.
5. Adjust the level of saline in the venous drip chamber using the
adjustment knob, as necessary. The level should be well above the air
detector sensor head.
6. When recirculation is complete, prior to stopping the blood pump,
ensure:
- Dialyzer is in treatment position (arterial end up)
- Machine is not in Concentrate Standby Mode
- Dialysate path is green
HOW TO USE AK 98

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The blood pressure cuff is connected to the side of the machine.
Single Blood Pressure Measurement
Press the BPM readout field. The machine will start taking the
measurement. The heart icon and BPM will start flashing while
measurement is taken.
Note: If you press the BPM field twice, the measurement will stop.
Results
The measured value will appear in the BPM measurement output field.
How to Stop Measuring:
Press the BPM measurement output field to stop taking the measurement
that is currently in progress.
Automatic Blood Pressure Measurement
1. Press the BPM button.
2. Select the Setup tab.
3. Press Auto mode.
4. Press the time interval.
5. Set the frequency of measuring blood pressure between
5-60 minutes from the blood pressure monitor.
6. Press OK.
7. Activate automatic blood pressure measurements. The machine will
start taking the measurement when activated.
Note: The clock symbol appears by the BPM icon on the status bar
when automatic blood pressure measurement is activated.
The BPM icon and clock symbol flash when a blood pressure
measurement is taken.
Measurement History
Blood pressure measurements will be recorded and saved in the log
during treatment. Measurement data will be displayed in the History tab.
1. Press the BPM button.
2. Select the History tab.
3. Press History.
Blood Pressure Monitor [BPM]
HOW TO USE AK 98

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Manually Entering the Prescription
Set Treatment Time
1. Press the time indicator on the screen.
2. Press treatment time.
3. Set the desired treatment time and press OK.
Set Ultrafiltration Goal
4. Press the time indicator on the screen.
5. Press UF volume.
6. Enter the patient’s ultrafiltration goal and press OK.
Check the calculated/resulting UF rate.
Set Heparin Values
7. Press the Blood button.
8. Select the Heparin tab.
9. Press the settings one at a time, then set up the desired
parameters, such as heparin bolus dose, heparin flow rate,
stop time, etc. according to the prescription.
10. If a heparin bolus dose is needed at the start of treatment,
press Heparin bolus dose and set a bolus dose (mL)
appropriate for the patient.
HOW TO USE AK 98

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The Patient button is filled in and has a check mark. This confirms the
machine is running with the patient prescription coming from the
EHR/EMR.
Note: The treatment parameters can also be entered manually in the
Patient menu under the Settings tab.
Retrieving Patient Prescription
HOW TO USE AK 98
Note: Applies only for bidirectional connectivity.
1. Press the Patient button.
2. Press the Patient ID bar.
3. Enter your ID and press OK.
4. Carefully check the correct patient data has been retrieved,
and then press Confirm to accept.
5. Review the prescription dialog box.
Shows the prescription parameters which have come from the
EHR/EMR. The other parameters are either your facility's settings,
or the machine default values.
Any parameter can be changed if needed by pressing the blue bars.
Shows the prescription parameters that have come from the
EHR/EMR and have been changed.
6. Verify that all the required treatment parameters have been
set correctly, and then press OK.

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HOW TO USE AK 98
Connecting the Patient
Note: Blood pump must be stopped after recirculation for the Connect
patient option to appear. Wait to stop the blood pump until the
dialysate line on the operator's panel is green.
1. Check that the venous line is correctly placed in the priming detector.
2. Press the Connect Patient button on the screen to enter patient
connection mode.
10. Once the blood passes through the dialyzer and blood is detected
by the priming detector, the blood pump will stop automatically.
11. The color of the blood path will turn red on the screen.
3. Clamp the infusion lines.
4. Clamp arterial and venous blood lines. Disconnect the arterial blood
line from the recirculation connector.
5. Connect the arterial blood line to the arterial access (needle or
catheter). Make sure the connection is tight and that there is no
leakage.
6. Check that there is no air in the venous blood line.
7. Connect the venous blood line to the venous access (needle or
catheter). Make sure the connection is tight and that there is no
leakage.
8. Check that all relevant clamps are closed to prevent blood loss.
9. Press the flashing blood pump button to start the blood pump.
The blood pump will start at the preset flow (default 100 mL/min).

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Starting the Treatment
Check that the blood path has turned red on the screen and that
the treatment time is counting down. If not, check if the venous
blood line is properly placed in the priming detector.
1. Press the flashing blood pump button to restart the blood pump.
2. Adjust the blood flow rate using the +/- buttons above and below the
blood pump button.
Note: To adjust blood flow rate quickly, hold down the +/- buttons.
3. Press the flashing ultrafiltration button to start ultrafiltration.
4. Initiate blood pressure and activate the auto mode and interval
time.
5. Check the arterial and venous pressures.
Note: The alarm limits can be set manually by pressing the
pressure controls followed by "Close alarm limits".
Note: If the alarm limits are not set manually, the arterial and
venous pressure alarm limits are automatically centralized
around the actual values after the preset time.
6. Check that the venous drip chamber is filled to the correct level and
that the clamp of the short line above the drip chamber is closed.
 Turn the dialyzer to treatment position if not already done so.
 Connect patient mode can only be entered if the correct
conductivity has been achieved (dialysate line is green).
 If Connect patient is pressed immediately following CSBM
deactivation, the message “Incorrect dialysate composition,
check dialysate. To close message, press Confirm” may appear.
 Wait to stop the blood pump until the dialysate line on the
operators panel is green.
 Press Connect patient and continue connecting the patient.
Connect Patient After Concentrate Standby Mode (CSBM)
HOW TO USE AK 98

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18
HOW TO USE AK 98
5. Close the clamp of the arterial blood line.
6. Disconnect the arterial blood line from the access.
7. Connect the arterial blood line to the rinseback line. Open the clamps
on the rinseback line, infusion line, and arterial blood line.
8. Close the clamp on the infusion line closest to the blood pump.
Note: Continue to monitor the venous needle and venous pressure
during rinse back.
9. Press the blood pump button to start the blood pump.
10. When the rinseback is completed and the blood pump stops, close
the venous blood line clamp.
Note: The blood pump will stop upon reaching the preset rinseback
volume or when the priming detector stops detecting blood.
11. Disconnect the venous blood line from the access.
12. Press Disconnect patient.
Note: The option to give additional rinse back volume will also be
available.
13. Confirm that the patient is physically disconnected from the machine.
14. Remove the venous blood line from the priming detector.
Stopping the Treatment, Rinseback, and Disconnecting the Patient
1. When the treatment is completed and the time reaches 0:00,
an attention (596 Treatment time expired) will appear.
Note: To end the treatment early, press the time indicator and
decrease the treatment time to 0:00.
2. Press the attention to confirm end of treatment.
3. Press the Rinse back button that appears in the Information field.
4. Press Confirm. The blood pump stops.

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Emptying the Dialyzer and BiCart
1. Rotate the dialyzer so that the blue connectors are up.
2. Remove the blue (outlet) dialysate line from the dialyzer and connect
to the blue dialysate port. The dialysate will drain from the dialyzer.
3. Once the dialyzer is empty, remove the red (inlet) dialysate line from
the dialyzer and connect to the red dialysate port.
Note: The machine will not provide an alert when the dialyzer is
empty, and it is not required to empty the dialyzer.
5. Drain the BiCart by following the on-screen instructions.
6. Pull the top of the BiCart cartridge holder latch outwards and lift it
upwards to remove the BiCart cartridge.
7. Close the BiCart cartridge holder latches.
Note: The "Drain BiCart" option will not appear on the screen if
the steps above are not followed in order. Always reference
the on screen instructions to ensure the option will appear.
Disconnecting the Blood Line and Dialyzer
1. Press the center of the blood pump door and pull the tab to open
the door.
2. Hold the arterial blood line just before the pump segment.
Pull the blood line outwards while rotating the blood pump
counter-clockwise to remove the blood line.
3. Press the center of the air detector door and pull the tab to open
the door, pinch the venous drip chamber and pull it out.
4. Disconnect and remove the arterial and venous blood lines.
4. Follow the instructions on the screen and disconnect the connector
from the concentrate supply and connect it to the port.
HOW TO USE AK 98