Mod 2 Edwards Aquarius

8/6/2019 Mod 2 Edwards Aquarius

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Module 2: Aquarius Training


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AQUARIUS TRAINING

TABLE OF CONTENTS

Lesson 1. Introduction to Aquarius Platinum

Lesson 2. Preparing Aquarius

Lesson 3. Treatment Mode

Lesson 4. Pressures, Alarms & Fluid Balance

These materials were created by Edwards Liesciences Corporation as part o the CriticalCare Nephrology Alliance. Seeking to provide CRRT proessionals with the highest caliber

o multidisciplinary expertise, products and services, the Alliance brings together the uniquestrengths o Baxter Healthcare Corporation, an expert in renal therapies, and Edwards, aleader in critical care.

Module 2: Aquarius Training


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Module 2: Learning Objectives

The material presented in this program is based on the Aquarius

Operators Manual, Platinum Sotware version 6 US and the

Aquarius v. 6 screens. The Operators Manual and the screens

provide the instructions necessary or the proper operation

o the Aquarius System. This training program is designed to

complement the Aquarius Operators Manual and screens. It

is not intended as a replacement. Please reer to the Operators

Manual and the screens or more detail.

The Aquarius System is indicated or continuous solute and/oruid removal in patients with acute renal ailure or uid overload.

It may also be used in Therapeutic Plasma Exchange (TPE)

therapies.

THE AQUARIUS SYSTEM

Understandtheset-up,primingandoperationoftheAquarius Hemofltration system

Understandpressuremonitoringandalarmtroubleshooting

Completethereturndemonstrationportionofthistrainingprogram

LEARNING OBJECTIVES


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Lesson 1: Introduction to Aquarius Platinum


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AQUARIUS PLATINUM DESIGN CONCEPTS

Patient saety

Innovation

Flexibility

Easeofuse

Consistentmessaging

Upgradableasnewneeds/featuresarise

INTERACTING WITH AQUARIUS PLATINUMThe operator interaces with Aquarius by turning andpushing the Main Selector button. This button is a rotaryswitch located below the display screen. It is used toselect and confrm dierent unctions and to modiytreatment parameters.

USING THE SELECTOR BUTTON:

Turn: to highlight the parameter

Push once: to select the parameter

Turn right: to

Turn left: to

Push once: to confrm new values

Main Selector button

Module 2: Lesson 1: Introduction to Aquarius Platinum


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Help screens will providedetailed inormation aboutindividual screens and allowdirect access to History

NAVIGATING BETWEEN SCREENS

The operator moves between screens by selecting a parameter and confrming the choice: Areyou sure messages indicate that the operator will need to confrm this choice beore movingorward. The deault choice is No.

Moves to the nextscreen

Moves back toprevious screen

Confrms theselected choice

Cancels the selectedchoice and movesback to previousscreen



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CONSISTENT MESSAGING

Aquarius uses clear and consistent messaging, delivered in yellow or red message boxes, toinorm and guide the operator through the screens. Example:

KEY FUNCTIONS OF THE AQUARIUS INTERFACE

Messages in a red

background describe the

alarm condition that is

currently underway and

needs the immediate

attention o the user.

Messages in a yellow box

may describe a set up

instruction, a parameter

that is being programmed

or an alarm that reminds

the user that something

needs to be done.

Blood Pump keyMute key

Clamp keyMain Selector button

Balance Start/Stop key



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INDIVIDUAL FUNCTION KEYS

The individual unction keys and their displayed unctions are explained below.

1. Operation status display

Three status lights indicate the dierent operation modes.

A. An illuminated red status light indicates:

Warning! Alarm or system error.

B. An illuminated green and yellow ashing status light indicates:

Caution! Heater sel test is running. Priming mode is not accessible.

C. An illuminated green and yellow status light indicates:

Caution! Treatment time has run down or Treatment was stopped.

Caution! Bag change required.

Caution! Anticoagulant syringe is empty.

Caution! Aquarius is in Preparation or Recirculation or Connection mode.

D. An illuminated green status light indicates:

Treatment is running. No alarms are active.

E. All three status lights illuminating one ater the other indicate:

Machine is perorming system test.



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2. Mute unction key

Pressing the Mute key enables the operator to silence the alarm signal or a period otwo minutes. The LED integrated into the key ashes. I the cause o the alarm cannot beremoved within the given period, the audible alarm is reactivated. I another alarm occursduring this period, the audible alarm is generated at once.

3. Clamp unction key

Pressing the Clamp key opens the return line clamp during air alarm to allow removal o air

bubbles rom within the tubing set. The LED integrated into the key ashes. When the air isremoved, treatment may be resumed by pressing the Blood Pump key. The return line clamp isautomatically reactivated ater one minute.

4. Main Selector button

Themainselectorbuttonisamulti-functionrotarybutton.Thesefunctionsinclude:

a) Selecting unction windows by turning the selector button

b) Confrming selected unctions by pressing the selector button

c) Selecting input parameters by turning the selector button

d) Opening the input window or the selected parameter by pressing the selector button

e) Raising the parameter input or the selected parameter by turning the selector button tothe right

) Lowering the parameter input or the selected parameter by turning the selector button tothe let

g) Confrming the entered parameter by pressing the selector button. The modifed parameteris displayed on the screen



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5. Balance Start/Stop unction key

Pressing the Balance Start/Stop key stops the fltrate and substitution/dialysate pumps. Thiscan be used to temporarily stop treatment, or example, to exchange bags. I an alarm occurs inthe fltrate and/or the substitution/dialysate circuits, the pumps stop and the LED integrated intothe key starts ashing. Ater correcting the cause o the alarm the pumps may be restarted bypressing the Balance Start/Stop key.

Balance Start/Stop key is also called Start Treatment key.

6. Blood Pump unction key

Pressing the Blood Pump key starts or stops the ow o blood through the blood circuit. I analarm occurs in the blood circuit, all pumps stop and the LED integrated in the blood pump keystarts ashing. Ater correcting the cause o the alarm the system is restarted by pressing theBloodPumpkeyagain.Filtratepump,pre-dilutionandpost-dilutionpumpsstartwithdelayinrelation to the blood pump.

The Blood Pump key is also used to immediately stop all pumps in case o an unpredictable

occurrence.



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Lesson 2: Preparing Aquarius


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POWER SUPPLYAquarius has two power supply switches.The Main switch, on the let side o the machineshould be set to position 1, the ON/OFF sot keyswitch is on the right side o the monitor displayscreen.

SYSTEM TEST

The system test takes approximately our minutes. When it is fnished, an audible alarm isgenerated and the green and yellow status lights are illuminated. The pumps stop in the correct

position or the tubing set to be installed. The operator can now proceed to set up.

Main Switch ON/OFF sot key

CAUTION: The Aquarius system test must be perormed beore tubing, bags, pressuresensors and solutions are placed on the machine. The pump doors must be closed.

Module 2: Lesson 2: Preparing Aquarius


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SETTING UP AQUARIUS

Select the therapy to be used and confrm1.

SCUF

CVVH

CVVHD

CVVHDF

Therapeutic plasma exchange(TPE)

2. Select the type o Aqualinetubing set to be used and confrm Aqualinetubing set or regular treatment-Bloodowratesfrom30-450mL/min-Extracorporealvolume100mL

AqualineStubing set or low blood ow treatment

-Bloodowratesfrom10-200mL/min-Extracorporealvolume61mL



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3. Place selected Aqualine on Aquarius

Follow the detailed instructions listed below to place the lines and flter on the machine

A. Place colored pump indicators in pumps. The colored pump holder segments are always atthe bottom o the pumps

NOTE:Alternatively,step-by-step,on-screeninstructionsor the placement o the linesand flters can be accessedin the Zoom graphic screenso Aquarius

Blood pump (red):

top let pump

Filtrate pump (yellow):

bottom let pump

Post-dilutionpump

(green): top right

pump

Pre-dilution/dialysate

pump (green): bottom

right pump



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B. Place automatic degassing chamber(ADU) in holder under green pumps.Ensure that the shortest line with theclamp is towards the back and thechamber cover is closed securelyaround the tubing

Chamber cover closed (B)

Line attached to ADU sensor (C)

C. Attach the line with the luer lock,hydrophobic flter to the ADU sensor.

The clamp should remain open



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E. Locate the return line chamber(also reerred to as the dripchamber) on the Aqualine,then insert the line underneath itthrough air detector channel andline clamp. Push and lock the airdetector

D. Insert heater coil into heater onthe right side o Aquarius (abovethe green scale) and close door

Return linechamber

Air detector

Return line clamp



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G. Insert blood leak chamber intothe blood leak detector on the let

side o Aquarius (above the yellowscale)

F. Attach the pressure domes to theour pressure sensors (Preflter,Filtrate, Return, Access) and closeclamps

Filtrate

Return

Access

Preflter



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2Module 2: Lesson 2: Preparing Aquarius

I. Attach fltrate line (short line romthe blood leak detector) to theclear luer lock fltrate port on thetop side o the hemoflter

H. Place prescribed hemoflter inflter holder and attach the redhemoflter connector to the redtop o the hemoflter and the bluehemoflter connector to the blue

bottom o the hemoflter


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CVVH:

J. Attach ree line (located on the Aqualineasitexitsthepre-dilution/dialysatepump)

SCUF,CVVHDorCVVHDF:

attach ree line to the port locatedabove the red end o the hemoflter

attach ree line to the dialysate port onthe bottom side o the hemoflter

NOTE: The line exiting thepre-dilution pump (bottom greenpump) is called the ree line. The reeline connection point determineswhat the therapy will be

Free line

Free line

connection

Free line

connection


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2Module 2: Lesson 2: Preparing Aquarius

L. Connect the red end o theAqualine to the prime collectionbag

NOTE: Aquarius primes with areverse ow through the bloodcircuit

K. HangemptyprimecollectionbagontheIVpolelocatedontherighttopsideoftheAquarius

M.Hangaone-literbagofprimingsolutionontheIVpole(usuallyheparinizednormalsaline)

InsertthespikedY-connectorprovidedwiththeAqualine into the priming solution bag

N. Remove the blue spiked end rom the

bloodline and connect it to one luerlockportoftheY-connector.(IfyouarenotusingaY-connector, connect theblue spiked end o the bloodline to thepriming solution.)


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26 Module 2: Lesson 2: Preparing Aquarius

O. Hang empty fltrate bag(s) on

yellowfltrate scale and connectthe fltrate line (long line out oblood leak detector) to the bag(s)

P. Hang prepared solution(substitution/dialysate) on greensubstitution scale and connect the

substitution/dialysate line

NOTE: Aquarius uses a singlesolution source that is split bythe machine and delivered asboth dialysate and substitution

solution, depending upon thetherapy chosen. Up to our bagso solution may be used at onetime. I using more than one bag, amultiport maniold will be required.

To ensure proper, simultaneousemptying o multiple bags, all

clamps must be open.

NOTE: Ensure that an equalnumber o bags is used on thesubstitution/dialysate scale andthe fltrate scale. Use empty5-liter bags on the ltrate scale.For example, if TWO 2.5-literbags are used on the substitution/dialysate scale, use TWO 5-liter

empty bags on the fltrate scale


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4. Prepare anticoagulant syringe

B. Select the volume in the syringe andconirm. Wait until the syringe drivermoves to the correct position

A. Aquarius may use a 50 mL or 60 mLsyringe flled to a maximum o 50 mL.Only use the heparin syringe typethat the Aquarius System has beencalibrated to use (or example, a BD50 cc syringe). The Aquarius Systemmust be calibrated or the particulartype o syringe you are using by acertifed technician. A list o approvedsyringes is available in section 6.5o Aquarius Operators Manual. The

syringe size that should be used isshown at the right o the Preparesyringe screen


WARNING: Clamp anticoagulant linei no anticoagulant is used!


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D Install syringe into pump

E. Prime anticoagulant line by selecting and confrming Prime anticoagulant line. Each press o

the selector button delivers one mL

F. Program heparin inusion rate

Syringe attached

Syringe in pump

C. Attach syringe to the anticoagulantline on the tubing set



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PRIMING AQUARIUS

1. Select Next to go to Priming

A. Check all lines or proper connection and open all clamps

WARNING: When No anticoagulant is selected, the clamp on the anticoagulant line MUSTremain closed!

B. Confrm that the correct solutions are used

WARNING: The solutions used or CRRT with Aquarius are prescription uids. To ensure

patient saety, please check that the prescribed solutions have been selected and properlyprepared

2. Select Start priming

A. The priming procedure requiresabout 800 mL o saline and takesapprox. 9 min (Aquarius displaysthe message Priming. Pleasewait and the clock counts downtozero)

B. Thepre-andpost-dilutionlinesare primed with uid rom thesubstitution/dialysate bag(s).

The blood circuit and the fltratelines are primed with uid romthe priming solution bag (usuallyheparinizednormalsaline)



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C. Lines being primed are highlightedand Access, Return and TMP

pressures are displayed

D. Priming starts at 80 mL/min orthe frst 6 minutes (approximately500 mL) then increases to 150mL/min

.

E. When priming is completed, youwill hear an alarm and see themessage Priming completed

F. I needed, options are available toreprime parts, or all o the circuit

G. I the priming procedure issatisactory, select Next andconfrm



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CLAMP & PRESSURE TEST

The Clamp & pressure test checks the clamp, the air detector, and the access, return and

pre-lterpressures

It MUST be done beore you can proceed to connection mode. Connect access and return

linestoasinglebagofnormalsalineusingtheY-connectorprovidedaspartoftheAqualine,

or any other appropriate connector

The test takes just a ew moments. I the test ails, ollow the instructions displayed on the

screen to determine the point o ailure. Check connections and select Retest

When Clamp & pressure test is completed, Aquarius switches to Start connection mode

Select Go to recirculationAquarius switches to Recirculation mode

Press the Blood Pump key to start the ow o saline within the tubing set. You are now

recirculating saline inside the circuit



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RECIRCULATION MODE

RecirculationmodecanbeenteredimmediatelyafterClamp&pressuretestorduringa

treatment when theres the need to disconnect a patient temporarily. Temporary disconnection

will be discussed in the Disconnection and End Treatment sections

Recirculation o normal saline through the circuit prior to patient connection may acilitate the

removal o air trapped in the circuit1

Recirculation may be continued through the blood circuit until connection is needed

Programming o prescribed parameters may be done during recirculation (recommended)

Select Go to programming at any time during recirculation to enter treatment parameters


1 Dr. Patrick Honore and Dr. Didier Journois


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PROGRAMMING AQUARIUS

Allparametersareprogrammed in thisscreen

Eachparametershows a yellowscreen that providesdetailed inormationabout the selected

parameter only

Programmingcanbedone ater priming,during recirculation,or immediately beoreconnection to thepatient. Parametersmay also be adjustedat any time duringtreatment

Select Previous toreturn to the mainscreen

SelectGotoconnection whenready to connect thepatient

USING THE SELECTOR BUTTON:

Turn: to highlight the parameter

Push once: to select the parameter

Turn right: to

Turn left: to

Push once: to confrm new values



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PROGRAMMING PARAMETERS

The parameters available include:

Description

This parameter is optional and may be left at 0:00 h:min, unless the fluid removal rate is setto 0 mL/hour. When set, the Aquarius will run for the indicated length of time and thendisplays the message 'Therapy target achieved by time'. The operator may now programmore time to continue the treatment or move to the disconnection phase

Enter the amount of fluid that is prescribed for the patient to lose per hour

Enter the amount of fluid to be removed. After this goal is achieved, the Aquarius will displaythe message 'Therapy target achieved by fluid loss'. If there is a fluid loss rate set, then thisvalue must be programmed

Available in CVVH and CVVHDF modes only, this is the amount of fluid that will be deliveredpost-filter

Available in CVVHD and CVVHDF modes only, this is the amount of fluid that will be deliveredas dialysate

Available in CVVH mode only, this is the amount of fluid that will be delivered pre-filter

The number of bags hanging from the substitution/dialysate scale. An equal number ofempty bags must also be hung from the filtrate scale

This is the infusion rate from the integrated anticoagulation syringe pump in mL/hour

If a bolus of heparin is prescribed, enter it here for immediate administration when in treat-ment mode

When set at 0, the fluid warmer will be off. It is adjustable from 35 to 39 C (95 to102.2 F). The warmer heats both substitution and dialysate fluid

Parameter



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CONNECTION MODE

SelectSingleConnectionorDoubleConnectionandfollowtheinstructionsonthescreen

PressBloodPumpkeytostarttreatment

Only the access line is attached to patients access port, initially, and theblood pump is started to discard the saline rom the circuit, up to the airdetector. A blood sensor, located inside the air detector, will automaticallystop the pump

Both access and return lines are simultaneously attached to the patientsaccess and return ports



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Lesson 3: Treatment Mode


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Module 2: Lesson 3: Treatment Mode 3

TREATMENT MODE

The Treatment screen displays pertinent inormation and allows the operator to monitor severalparameters throughout the therapy:

Blood ow

Cumulative totals o uid loss and substitution/dialysate since last total reset (heparin is notreset)

Pressures (Access, Return, TMP and Pressure Drop)

-SeedetailedinformationonPressuresinModule2Lesson4


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Module 2: Lesson 3: Treatment Mode40

Allows the operator to returnto the programming screenany time during treatment tochange parameters

Allows the operator toview additional treatmentinormation, with no ability tomake changes

Provides the ollowing options:-Viewhistory-Gotorecirculation

-Endtreatment-Changesyringe-Changetherapy

Screen selection choices:


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The history o the last three treatments is available. Data is visible as a list or a graph. Pressures,

programmed parameters, patient data and events are stored.


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DISCONNECTING PATIENT FROM AQUARIUS

The patient may be disconnected rom the Aquarius by selecting and confrming Recirculation orEnd treatment rom the Options screen.

Disconnecting the patient rom the Recirculation screen allows temporary disconnection ora limited period o time. The flter, lines, bags and solutions all remain on the machine andthe blood pump runs in recirculation mode until the patient is ready to be reconnected to thesame circuit

Disconnecting the patient rom the End treatment screen will mean the patient treatment willend. The flter lines, bags and all solutions must be removed rom the machine and Aquarius mustbe turned o. A new set up will be needed i the patient therapy is to be continued

REMINDER: When disconnecting patients rom Aquarius, there may be circumstancesin which blood should NOT be returned to the patient. These circumstances mayinclude, but are not limited to: cardiac arrest, uid overload, major blood leak, a circuitthat was primed with blood or albumin, hemolysis or a clotted circuit. Always checkwith the prescribing physician.2

NOTE: The ollowing supplies may be needed:

1. One bag o normal saline or rinsing blood back to patient

2. Two saline syringes and the prescribed anticoagulant to lock the vascular

catheter

3. Caps or the vascular catheter

CAUTION: Always ollow hospital policy or standard precautions. Gloves, mask and aace shield should be worn when connecting or disconnecting blood lines rom patientsand removing lines rom Aquarius

2 Dr. Noel Gibney


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RECIRCULATION MODE FOR TEMPORARY DISCONNECTION

Go to the Options screen and select

Thisoptionstartsthetemporarydisconnectionofthepatient.Thescreenmenuguidestheoperator through the disconnection procedure

On-screendirectionsguidetheoperatorthroughtheaccessandreturndisconnectionprocess

Volumeofreinfusionuidisdisplayed

AlltreatmentparametersarestoredinHistory


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END TREATMENT MODE

Beore ending treatment,please record all pertinentdata rom the Treatmentscreen

REMINDER: Once youconrm the End treat-ment selection, you willnot be able to go back

To end the treatment anddisconnect the patient romthe Aquarius, go to theOptions screen and select

Follow instructions on thescreens to disconnect thepatient rom the Aquarius

The volume o fuid used toreturn blood to the patientwill be recorded on thedisconnection screens as thereinusion volume in milliliters


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Ifsystemhasclottedandanycircuitpressureisgreaterthan400mmHg,followon-screen

instructions or relieving pressure

Remove Aqualine and bags rom Aquarius

WARNING: Never switch o the Aquarius beore the tubing set is completely removed

is highlighted. Push the selector button to turn the Aquarius o

WARNING: Removing Aqualine under high pressure conditions may lead to a blood leak omembrane rupture in pressure domes


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Lesson 4: Pressures, Alarms and Fluid Balance


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Module 2: Lesson 4: Pressures, Alarms & Fluid Balance 4

AQUARIUS PRESSURE MONITORING

All extracorporeal circuits are run by pressures. Aquarius uses our pressure readings to monitorand control the system. Three pressures (Access, Return and Pre-lter) monitor the blood sideand one pressure (Filtrate) monitors the fuid side. All our pressures are used in combination tohelp you manage the treatment saely and eectively.

ACCESS PRESSURE

Typically monitors the negative pressure

generated to remove blood rom the patient

Access pressure may be positive under

certain conditions (example: ECMO)The patients catheter and Aquarius

blood fow rates aect this pressure

Measuringrange:-250to+100mmHg

Upperalarmlimit:automaticsetting

between-50and+100mmHg

Lower alarm limit: automatic setting

between-250and-100mmHg

Alarm window size during treatment:

+/-100

mmHg

around

the

actual

value

Displayed

on

the

Treatment

screen

RETURN PRESSURE

Monitorsthepositive pressure generated

to return the blood to the patient

The patients catheter and Aquarius

blood fow rates aect this pressure

Clottingincircuitaffectsthispressure

Measuringrange:0to+350mmHg

Upperalarmlimit:automaticsettingbetween110and350mmHg

Loweralarmlimit:automaticsettingbetween10and250mmHg

Alarmwindowsizeduringtreatment:+/-100mmHg

DisplayedontheTreatmentscreen


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Module 2: Lesson 4: Pressures, Alarms & Fluid Balance50

PRE-FILTER PRESSURE

Monitorsthepositive pressure

generated in the circuit immediately

beore the blood enters the

hemolter

Bloodowrateandreturnpressure

aect this pressure

Highestpressurepointinthecircuit

Arisingpre-lterpressuremaybe

indicative o lter clotting

Upperlimit:+400mmHg

Lowerlimit:-100mmHg

DisplayedontheMorescreen

FILTRATE PRESSURE

Monitorsthenegativeand/orpositive

pressure generated in the ltrate

compartment o the hemolter. Thisaects the movement o fuid across

the membrane

Arisingltratepressuremaybe

indicative o lter clotting

Bloodowratesanduidowrates

aect this pressure

Upperlimit:+400mmHg

Lowerlimit:-400mmHg

DisplayedontheMorescreen


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CalculatedusingReturn,Pre-lterandFiltratepressures

Calculatedas:ReturnPressure+Pre-lterPressure _

2

TMPisacombinationofthetotal

pressure exerted on the membrane

(positive pressure inside the bers and

negative pressure outside the lters)

Upperlimit:+400mmHg(CRRT)

Upperlimit:+100mmHg(TPE)

Lowerlimit:-30mmHgDisplayedontheTreatmentscreen

PD (PRESSURE DROP)

Calculatedusingpressurelossfromtop

to bottom o hemolter

Lengthofhemolteraffectspressure

Calculatedas:

Pre-lter Pressure Return Pressure

DisplayedontheTreatmentscreen

TMP (TRANSMEMBRANE PRESSURE)

Filtrate Pressure


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AQUARIUS ALARMS

The Aquarius saety mode is determined by the nature o occurring alarms:

Alarm type Aquarius safety mode

Alarms in blood circuit Stops all pumps

Closes return line clamp

Generates visual and audible alarms

Alarms in filtrate / dialysate circuit Stops filtrate pump

Stops pre-dilution pump and post-dilution pump

Generates visual and audible alarmsSystem error Stops all pumps

Closes return line clamp

Generates visual and audible alarms

Alarmsignalsareaudible and visual

Thestatuslightschangefromgreentored,yellow,oracombinationdependingonthetypeof

alarm

Cause o the alarm is displayed in a message box in the lower let corner o the screen AlarmsmaybesilencedfortwominutesbypressingtheMutekey

BloodcircuitalarmsareclearedbypressingtheBloodPumpkey.Oncethebloodpumphas

beenrestarted,presstheBalanceStart/Stopkeytorestarttheuidpumps

FluidcircuitalarmsareclearedbypressingtheBalanceStart/Stopkey


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BLOOD CIRCUIT ALARMS

Generatesaudibleandvisualalarm

Stopsallpumps

LEDinBloodPumpandBalanceStart/Stopkeyashes

Closesreturnlineclamp(ifairdetectedorreturnpressuredropsbelowlowerlimitof

+10mmHg)

FLUID CIRCUIT ALARMS

Generatesaudibleandvisualalarm

Stopsalluidpumps LEDinBalanceStart/Stopkeyashes

BloodPumpcontinuestorun

SYSTEM ALARMS

Generatesaudibleandvisualalarms

Stopsallpumps

LEDinBloodPumpandBalanceStart/Stopkeyashes

Closesreturnlineclamp(ifairdetectedorreturnpressuredropsbelowlowerlimitof

+10mmHg)

NOTE: ABalancealarmoccurswhen a50mL (20mLwith useof AqualineSdierence is detected between the fuid volume pumped and the scalemeasurement o the substitution or ltrate solutions. This volume may result in anadditional50mL(20mL)infusiontothepatientor50mL(20mL)ofuidremovedrom the patient i a tubing line is kinked or blocked. Correct the cause o the alarmandpresstheBalanceStart/Stopkeytoresumetreatment

WARNING: I repeated balance alarms occur, stop treatment to protect the patient rom

excessive fuid removal or overload. Call technical support to resolve the problemDonotusethemachineuntilithasbeenrepaired


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TROUBLESHOOTING SYSTEM ERRORS, ALARMS AND MESSAGES

System Errors: Red indication

I the ollowing system errors are not corrected ater system test and i during treatment nocorrection is possible, please call technical service to repair the Aquarius.

During the system test (after switching the system on) andalsoduringoperation theAquarussystem automatically perorms tests to check the saety-critical components. I errors occurduring these tests, the system switches to the saety mode and generates a system errormessage.ThiserrormessageappearswiththeabbreviationCPU1(controlprocessorunit1)orCPU2.

Display: Cause: Options for error removal:

Accesssensor Access pressure values deviatefrom limits.

Control system and protectivesystem values deviate fromeach other (outside of limits)

During clamp/pressure test nopressure increase is detected

Restart system (no tubing must be installed). If theerror cannot be reset, put system out of operationand notify technical support.

Access pressure dome may not be connectedcorrectly (ensure by pressing the dome firmlytowards the access transducer)

ADC/Voltage Voltage supply or AD-converterfailure

Restart system (no tubing must be installed). If theerror cannot be reset, put system out of operationand notify technical support.

Air detector Air detector test failed. Press blood pump key. If error cannot be reset, putsystem out of operation and notify technical support.

Backup

No dates at the backup Restart system (no tubing may be installed). If theerror cannot be reset, put system out of operationand notify technical support.

Balance filtration Check filtration scale

Values between protective andcontrol system deviate fromeach other (outside of limits).

Actual values are outside oflimits.

Restart system (no tubing may be installed). If theerror cannot be reset, put system out of operationand notify technical support.

Balance substitution Check substitution scale

Values between protective andcontrol system deviate fromeach other (outside of limits).

Actual values are outside oflimits.


BLD (Blood leak detector) Blood leak detector does notwork properly.

Press the Blood pump key. If the system errorcannot be reset, put system out of operation andnotify technical support.

*Rev. A - 12/2007

Notes:



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Clamp doesnt closeClamp doesnt open

Clamp test failed.

Clamp does not close.

Clamp does not open.

Correct tubing set position in clamp.

Press blood pump key. If the error cannot be reset,put system out of operation and notify technicalsupport.

CODE Controller CPU program code

test failed Master CPU program code test

failed

Restart system (no tubing may be installed). If the

error cannot be reset, put system out of operationand notify technical support

Commu front system Data transfer to display systemdefective.

Set up safety mode for the patient.

Switch system off and on again after approx.1 minute (no tubing must be installed). If the errorcannot be reset, put system out of operation andnotify technical support.

Commu protection system Error during data transfer.

Power supply for protectivesystem is defective.

Press blood pump key or Balance Start/Stop key.

Switch system off and on again after approx.1 minute. If the error cannot be reset, put systemout of operation and notify technical support.

EEPROM Master CPU calibration datatest failed

Controller CPU calibration datatest failed

Restart system (no tubing may be installed). If theerror cannot be reset, put system out of operation

and notify technical support

Error1 CPU Master CPU Register test failed

Controller CPU Register testfailed

Restart system (no tubing may be installed). If theerror cannot be reset, put system out of operationand notify technical support

Error2 CPU Master CPU RAM test failed

Controller CPU RAM test failed


Error3 CPU Master CPU jump test failed

Controller CPU jump test failed


Blood pump Flow rate test failed.

Blood pump drive defective.

Blood pump is not stopped.

Actual value of number ofrevolutions deviates from setvalue outside of limits.

Switch system off and on again after approx. 1minute (no tubing must be installed).

Press blood pump key.

If the error cannot be removed, notify technicalsupport.

Error blood detection Blood at optic sensor(airdetector)



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Notes:



Heater Master hasnt pass the systemtest


Operation mode The data transfer valuesregarding the operation modedeviate between master- andcontroller CPU.

Press blood pump key to start a new check.

If the alarm appears again, call technical support.

Postdilution pump Flow rate test failed. Postdilution pump drive

defective.

Postdilution pump is notstopped.


Switch system off and on again after approx.1 minute (no tubing may be installed).

Press Balance Start/Stop key.

If the error cannot be reset, put system out ofoperation and notify technical support.

Program run Program failure Master CPU

Program failure Controller CPU


Filtration pump Flow rate test failed.

Filtrate pump drive defective.

Filtrate pump is not stopped.


Switch system off and on again after approx. 1minute (no tubing must be installed).


If error cannot be reset, notify technical support.

Heparin pump Actual values of control andprotective systems deviate fromeach other (outside of limits)

Actual values deviate fromlimits

After selftest: Restart system (no tubing must beinstalled). If the error cannot be reset, put systemout of operation and notify technical support.

During treatment:

1. Check the Heparin line is not clamped.

2. Go to "Options" and "Change Syringe", followingthe on-screen text. Please Note: You DO NOT haveto remove the syringe during this process

3. If problem persists, program the pump to 0,clamp the line and remove the syringe. If problempersists, end treatment and call technical service.


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Notes:



Predilution pump Flow rate test failed.

Predilution pump drivedefective.

Predilution pump is notstopped.

Actual value of number ofrevolutions deviates from setvalue outside limits.

Switch system off and on again after approx.1 minute (no tubing must be installed).


If the error cannot be reset, put system out ofoperation and notify technical support.

Return sensor Return pressure values deviatefrom limits.

Values between protectivesystem and control system

deviate from each other(outside of limits).

During clamp/pressure test nopressure increase is detected


Clamp pressure test:o Press domes firmly towards the transducer.

Return and pre filter domes must be connectedcorrectly

o Insert tube into return line clampo Ensure that there is no leakage between blood

pump and return line clamp

Sensor Voltage Voltage supply or AD-converterfailure


Software version Different Software versiondetected at master andcontroller


Timer Timer difference betweenmaster and controller > 20%

Restart system (no tubing may be installed). If theerror cannot be reset, put system out of operation

and notify technical support.TMP sensor Filtrate and/or prefilter pressure

values deviate from limits.

Values between protectivesystem and control systemdeviate from each other(outside of limits)


Vcc Master/communication RAM, EPROM or EEPROM aredefective.

Switch system off and on again after approx.1 minute. If the system error cannot be reset, putsystem out of operation and notify technical support.

XRAM Master CPU extern RAM failed

Controller CPU external RAMtest failed



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Notes:


Alarms: Red IndicationI the Aquarius system detects an out-o-range condition during the system test or duringoperation or i parameters exceed or drop below the respective limits, an alarm message isgenerated and the Aquarius system switches to the saety mode.

Display:

Cause:

Options for error removal:

High accesspressure

Low accesspressure

Access pressure has exceededthe upper alarm limit.

Access pressure has droppedbelow the lower alarm limit.

Check access blood line, including access and pre-filter sensors, for kinks or occlusions.

Check position of patient access.

Check blood flow rate.

Air Detected Return tubing line contains air ormicro-foam.

Make sure that tubing line does not contain air.

Check access and filter connections for sources of airleaks.

When you clear the Air Detected alarm, make surethere is no air or foam trapped in the line between thereturn detector chamber and the patient end.

To remove air from the tubing line:Step1. Open the return line clamp.Step 2. Remove all air from the tubing set.Step 3. Close the return line clamp.Step 4. Resume treatment by starting the bloodpump.

Warning! If the air detected alarm does notclear and air is visible in the venous de-aerationchamber, disconnect the patient from the instrumentand recirculate per your centers procedure.

Note: You may see micro-bubbles smaller than the airdetector sensitivity.

Balance system off The balance system has been offfor 5 minutes.

Switch on


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Display:

Cause:


15 seconds.

Clamp heparin line The Heparin syringe has beenremoved

Clamp Heparin line

Degassing chamber missing The substitution degassingchamber is not inserted or thesensors are defective.

Insert the substitution chamber properly. Ensure thechamber is in contact with the sensor of the holder. Ifthis doesnt help switch off heater to end the

treatment. Then call technical service.High filtrate pressure

Low filtrate pressure

Filtrate pressure exceeds or fallsbelow the alarm limits.

Check pressure sensor.

Check tubing set for narrow sections.

Check filter and exchange if required.

Check blood flow-to-fluid removal or blood flow-toturnover ratio.

Filtrate flow failure The number of revolutions of thefiltrate pump exceeded or fell

below the alarm limits by 5%.

Restart treatment

If problem persist call a repair technician

Heparin syringe missing A Heparin rate has beenprogrammed and no syringe hasbeen inserted in the plunger.

The Heparin syringe is not

inserted properly

Insert Heparin syringe if Heparin is needed

Set Heparin rate to zero ( No Heparin required)

Balance Alarm

Check substitution line

Or

Balance alarm

Check filtration line

Balancing deviates from the setvalues entered by the operator.

Check flow rates of the pumps.

Check fluid removal and turnover input parameters.Note: Potentially pumps can't deliver program withvery high volume because of pressure peaks.

Check bag hanging on scale.(Filtration or substitution)

Check tubing set for narrow sections.(Filtration or substitution lines) .

Blood leak Filtrate / plasma contains blood. Check filter for blood leak and exchange filter ifrequired.

Check pressure conditions.

Blood flow failure The number of revolutions of thepump exceeds or falls below the

alarm limits by 5%.

Restart blood pump.

If problem persist call technician

Blood pump off The blood pump was manuallyswitched off for 1 minute.

Press blood pump key to switch blood pump onagain.

Check transducer connections The pressure domes have notdetected any pressure change for

Ensure the domes are properly connected.

Notes:



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Notes:


Display: Cause:


Indication battery high At the power fail indication batteryhigh voltage is detected

Change battery

Control charging voltage

Control AD-converter/CPU

Keyboard failure A key press longer than60 seconds. detected by master-cpu.

The keyboard needs repair

Line/substitution failure A substitution deviation is detectedthat influences the patient balance

Check lines

Check clamps

Check bags

Check for leakages

Master key transfer A key press longer than 60

seconds. detected by master-cpu.

The keyboard needs repair

The communication cable is defective

Main battery high At the main battery high voltage isdetected

Control charging voltage/unit

Control/change battery

Control AD-converter/CPU

Post-dilution failure The number of revolutions of thePost-dilution pump exceeded or

fell below alarm limits by 5%.

Restart treatment

If problem persist call technician.

Pre-dilution failure The number of revolutions of thePre-dilution pump exceeded or fell

below alarm limits by 5%.

Restart treatment

If problem persist call technician.

Pump door One of the pump doors open Check if one of the pump doors is open

Close the door

High pre-filter pressure

Low Pre-filter pressure

The pre-filter pressure exceedsupper alarm limit. Check pressure sensor. Check filter and exchange if required.

Check blood flow.

Check tubing set for narrow sections.

High return pressure Return pressure exceeds or falls Check return line for connection, kinks or occlusions.

Low return pressure below the alarm limits. Check return pressure transducer.

Check blood flow rate.

Check position of patient access.

Syringe removed The Heparin syringe has beenremoved

Check the heparin syringe


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Notes:


Display:

Cause:


High Temperature

Temperature controller high (Fluidpumps will not run)

A high temperature is detected inthe substitution degassingchamber

The substitution solutiontemperature is above40 C

The plate temperature of theheater is above 57C

Check the substitution line for kinks

Open heater door to cool the heater down.

If the alarm disappears the pump will startautomatically

Low temperature The substitution fluid temperaturehas been below 33C for morethan 10 minutes.

Check the heater bag

Check substitution temperature

Temperature controller High temperature of the heater atthe controller

Open heater and cool down the plate temperature

Restart treatment

Turn over failure The substitution volumecalculated by pump revolutionsdeviate more than 350g from thesubstitution volume measured onthe scale

Check lines

Check clamps

Check bags

Check for leakages

High TMP

Low TMP

TMP exceeds or drops belowrespective alarm limits.

Check pressure sensor.

Check tubing set for narrow line sections.

Check blood flow-to-fluid removal or blood flow-to-turnover ratio.


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Notes:


Messages: Yellow Indication

I the Aquarius detects out-o-range conditions or reminders that do not conorm to the intendeduse o the system, the operator gets detailed inormation dened or the individual conditions andthe system switches to the saety mode.

Display:

Cause:


Ensure the return tubing does not contain air.

Ensure the return tubing is installed properly in theair detector sensors clamping mechanism and isnot scratched or damaged.

After correcting the error, Select and confirmPrevious, then perform the clamp/pressure testagain to proceed.

Air detected, Clamp/Pressuretest disabled

The air detector detected air in thereturn line.

Warning!If the air detected alarm cannot becleared, discontinue treatment and donot return the extracorporeal blood tothe patient.

Anticoagulant off The Heparin rate is programmed tozero.

If Heparin is not required proceed to next screen.

If Heparin is required, insert a syringe containingHeparin and program the desired Heparin rate.

Balance initializing Scales and fluid pumps initializewhen the balance system is started.

This is just a reminder

Occurs each time the balance system is turned ON

Balance system off The balance system is off, all fluid

pumps are stopped.

Correct the cause and switch the balance system

on again.Blood detected

(Blood pump stops)

During the connection orrecirculation phase blood isdetected in the return line

The blood pump stops and starts now only for 5seconds again. Switch to treatment mode

Blood pump off The blood pump was manuallyswitched off.

Press blood pump key to switch blood pump onagain.

Change substitution bag

Change filtrate bag

The filtrate bag has reachedmaximum permissible weight or thesubstitution solution bags do notcontain solution.

Replace empty substitution solution bags with fornew bags filled with solution

Replace full filtrate bags with empty bags

Check access transducer The access/ return dome is notproperly connected.

During clamp and pressure test no pressureincrease is found when the clamp is closed


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Notes:


Display:

Cause:


Exchange filter and set The assumed filter life time of 72hours has been exceeded or thetotal using time for the actual tubingset is more than 80 hours.(Including priming, connection,recirculation and treatment time)

Exchange filter and tubing set

Disconnect and start a new treatment with new filterand a new tube system

Function not available During treatment the Off key isused

To switch off the machine, select End treatment,perform the disconnection program until theAquarius off mode

Filt./effluent bag change soon Filtrate/effluent bag change in lessthan 10 minutes

Prepare the Filtrate/effluent bag change

Heater cools down If balance system has stopped for aprolonged period, the heater platetemperature is above 43C.

The pumps stop until the temperature is in a safecondition (below 42 C). This may take up to 10min. The pumps will start automatically.

Heater self test running.

! Wait

Heater Selftest is in progress when

the start-priming screen is reach.

Wait until heater Selftest is completed.

When heater Selftest is finished, the yellow lightupper the screen become fixed (green diode stillfixed during and after heater Selftest)

Heparin syringe missing The Heparin syringe is not in theHeparin pump.

nsert a Heparin syringe in Heparin pump or program

the Heparin rate to zero.

Check degassing chamber The degassing unit system hasdetected a pressure issue.

- After Selftest: Degassing pressure sensor ordegassing module defect. Don't use the Aquariusmachine and call technician.

- During use: Pressure sensor detects less than -300 mmHg. Degassing Filter is wet. Clamp thepressure line, disconnect filter from sensor and usea syringe to dry it. Reconnect the line and unclampit.

Check lines The postdilution pump has beenstopped for longer than 3 min toregulate the fluid loss.

Check the substitution line and the filtration line ifthe bags are opened, all clamps are removed andthe tubes and bag inputs are not kinked.

End of Treatment End of Treatment Disconnect patient or reprogram patient parameter


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Notes:


Display: Cause:


No fluid chamber detected The substitution degassingchamber is not inserted.

Insert the chamber correctly

Power failure The Aquarius machine hasdetected a power failure

Reconnect the Aquarius to main power supply

Return the blood to the patient and start a newtreatment if power from main power supply isavailable

Please program Hourly fluid loss or fluid loss total isnot programmed

Select programming mode and program both hourlyfluid loss and fluid loss total.

High filtration ratio 1. Fluid removal rate exceeds 33%of the blood flow rate.

2. Exchange of fluid or plasmaacross the membrane is too high incomparison to the blood flow rate.

3. The post dilution substitution rateis higher than what is acceptable forthe current blood flow rate.

Decrease fluid removal or plasma exchange rate

Increase blood flow rate

Evaluate ratio of pre vs. post dilution substitution

solutions.

Indication battery low Power failure indication (beep)battery is low

The battery is automatically charged if you go onwith this treatment.

This message indicates that in the event of a power

failure the Aquarius will beep less than 2 min

Insert BLD chamber The blood leak detector has notbeen inserted into the blood leakchamber.

Insert the chamber

Reprime to correctly fill up the chamber.

Ensure no scratches or marks are present on theAqualine chamber

Insert tube

Insert tube to air detector

The air detection system is notoperational after priming

Insert correctly return line into the air detectionsystem.

Make sure that the air detection system is wellinserted, if not push it back firmly.

Ensure the green light of the clamp key is lighting.

Main battery low After a power failure, the mainpower supply battery must becharged.

The battery is automatically charged if you go onwith this treatment.

This message indicates that in the event of a powerfailure the Aquarius will run less than 2 min

Negative UF A negative UF is programmed This is just a reminder

No bag No bag was hung on the scale Hang empty collection bag and/or substitutionsolution bag on the scale


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Notes:


Display: Cause:


Please wait The balance system is stopped This is an indication that the system will startautomatically after some minutes.

Program dialysate In CVVHD dialysate rate is notprogrammed.

Select programming and program a dialysate rate.

Program goal Treatment goal is not programmed. Select programming and program either time, fluidloss and fluid loss total, or both.

Program treatment pumps In CVVH/CVVHDF pre- and post-dilution/post-dilution and dialysateare not programmed.

Select programming and program pre- and post-dilution or post-dilution and dialysate rate.

Pump door open One of the pump doors is open. Close pump door(s).

Read error help instructions To solve the alarm furtherinformation is needed Further information is available from the helpscreens.

Return pressure low The return pressure is below 10mmHg

During the first minute of treatment this is areminder.

Syringe empty. Go to OPTION tochange

The syringe located in the Heparinpump is empty.

Clamp Heparin line.

Take syringe out of pump and disconnect from line.

Fill new syringe with Heparin.

Enter syringe volume and confirm.

Place syringe in pump and connect line.

Confirm

Subst./dialysate bag changesoon

Substitution/dialysate bag changein less than 10 minutes

Prepare Subst./dialysate bag change

Too much weight Too many bags are on the scale. Ensure that the same number of substitution

solution and filtrate bags hang on the scale hooks. Note: The maximum number of bags on the scale is

4 substitution solution and 4 filtrate bags.


68/69Module 2: Lesson 4: Pressures,Alarms & Fluid Balance66

Notes:


Notes:

AQUARIUS FLUID BALANCE

ProgrammedpatientuidremovalwillberecordedhourlyontheTreatmentscreenasacumulative value

Non-Aquariusinsandoutsforthepatientmustbecalculatedandcontrolledbytheuser

UFvariationismonitoredanddisplayedintheMorescreen.Theaccuracyis50mLforregularcircuits,20mLforlowvolumecircuits

ResettotalsintheProgrammingscreenresetsallcumulativetotalsforuidloss,anddialysate and substitution fuid. Treatment clocks are also reset. These values are located ontheTreatmentscreen.

Values are programmed in theProgrammingscreen

Dialysateand/orsubstitutionuidare automatically removed by the

Aquarius

WhenprogrammingHourlypatientuidloss,aTotaluid

lossMUSTalsobeprogrammed.Programming the time is optional

Treatmentproceedsuntilaprogrammed target is achieved

WhenPatientuidlossissetatzero, time must be programmed

NOTE: Aquarius records all fuids as a cumulative number rom the start o treatment

NOTE: When the target

is reached, the message

Therapytargetachieved

by fuid loss (or time) is

displayed. The target can

be reprogrammed and

the treatment continued

NOTE: Anticoagulant volumes are NOT reset


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Caution:Federal(U.S.)lawrestrictsthisdevicetosalebyoronthe

order o a physician or other licensed practitioner. For sae and

proper use o this device reer to the Operators Manual.

Aquarius is distributed in the U.S. by:Baxter Healthcare Corporation

Edwards Liesciences, Edwards, the stylized E, Aquarius,

AqualineandAqualineSaretrademarksofEdwardsLifesciences

CorporationandareregisteredintheUnitedStatesPatentand

Trademark ofce Baxter and Critical Care Nephrology Alliance

Mod 2 Edwards Aquarius

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Transcript of Mod 2 Edwards Aquarius