Transonic Systems recommends that the Meter and Sensors be sent in for calibration annually. Why: These are precision measurements and Transonic Systems is the only firm, which can perform such certifications and calibration. In addition, there may be updates that apply to your equipment that are performed as routinely returned that either improves the equipment performance or quality.
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Only in AV fistulae. When the arterial needle faces the incoming access flow (points toward arterial anastomosis), the best mixing conditions are created when the lines are reversed.
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You can expect to see a variation of 100 ml/min in flows < 1 L/min. For access flows > 1 L/min, a 10% difference between the first and second access flow measurement (made within 5 minutes of one another) can be expected. If the second measurement falls outside these criteria, a third measurement should be taken and the outlying measurement can be discarded. The remaining two measurements are then averaged for a final access flow value.

Access flow depends on a number of variables such as systemic blood pressure, the respiratory cycle, and coughing which can alter measurements taken even within minutes of one another. Despite these factors, the overall reproducibility of access flow measurements made with the Transonic Monitor is excellent.
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0% Recirculation occurs when Access Flow < Pump Flow.

Indeed, as a rule of thumb you will find that access recirculation (AR) exists when access flow (AF) is less than pump flow (Qb). Natural (baseline) access flow is the blood flow that is shunted between the access artery and vein. As it withdraws blood, a hemodialysis pump produces a negative pressure which actually helps the natural flow through the access.

Therefore, a dialysis pump may increase baseline access flow. When blood lines are reversed to measure access flow, the pump pushes flow against the natural access flow. This may decrease baseline access flow. Although rigorous testing of HD01 access flow measurements in the reversed line position demonstrates that these minor differences between measured access flow and baseline access flow have no clinical significance (see Transonic Hemodialysis Publications HD7T, HD40A, HD7A, HD27V, HD9A) , they are responsible for two exceptions to the recirculation rule (AR exists when AF< Qb). These two exceptions show Zero recirculation even though access flow is less than pump flow. They are:

1. Significant narrowing (stenosis) between the needles.
This condition presents when measured access flow (AF) is significantly smaller (difference _ 200 ml/min) than pump flow (Qb) when Zero access recirculation (AR) is detected:

Example: Zero AR at Qb = 400 ml/min, AF = 120 ml/min

When this relationship between pump flow and Zero access recirculation exists, one can conclude that there is a significant narrowing (stenosis) between the needles. The stenosis causes considerable flow resistance. In normal line position, the pump simply bypasses the stenosis because the arterial needle is located before the narrowing and the venous outflow needle is located after the narrowing. A mid-access stenosis never produces access recirculation. There still can be adequate pump flow for hemodialysis, although baseline access flow is close to zero and the access is in trouble.

2. Significant inflow and/or outflow narrowing (stenosis). This condition exists when access flow is slightly smaller (difference _ 150 ml/min) than pump flow when Zero access recirculation is detected:

Example: Zero AR at Qb = 400 ml/min, AF = 350 ml/min
Here, one can conclude that there is an inflow (arterial) and/or outflow (venous) stenosis creating the low access flow. This is also caused by the effect of the dialyzer pump on baseline access flow. Suppose the pump flow prescription is 400 ml/min and baseline access flow is 380 ml/min. Suppose also, that the pump flow has a 10% (of pump flow) effect on baseline access flow. Then, with dialysis lines in normal position, access flow becomes 380 + 40 = 420 ml/min. A recirculation measurement will indicate Zero recirculation because pump flow is less than access flow (400<420). When the access lines are reversed with pump flow at 300 ml/min, access flow may decrease by 10% of pump flow (30 ml/min). The HD01 Monitor would thus register

AF = 380 - 30 = 350 ml/min.

Conclusion
Trust your access flow measurements! Do not rely on an absence of recirculation. A vascular access may be severely compromised even when there is no sign of recirculation.
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Zero percent (0%) recirculation accompanied by a small access flow indicates that there is a clinically significant stenosis between the dialysis needles. At a normal line position, the pump flow simply bypasses the stenosed access so no recirculation was registered.
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The specified operating system is Windows XP although it will run on Windows 2000.
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When this message appears you need to look at your battery indicator lights. This message is a warning letting you know that your battery is almost drained. To correct this, plug your power supply into the monitor and charge the battery.
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The signal strength indicator is located in the upper left corner of the Delivered Flow and Dilution Measurement screens and at the upper right corner of the dilution measurement protocol reminder screens. The signal strength indicator has five ascending bars:

• Blank = No Signal: No measurement can be performed. Contact Transonic.
• Red = Poor Signal: No measurement can be performed. Contact Transonic.
• Yellow = Marginal Signal: Verify correct sensor placement, tubing selection, and adequate couplant. Proceed to measure.
• Green = Good Signal: Proceed to measure.

That is an indication you either do not have the Sensor connector fully seated or the EPROM in the connector is corrupt or has been wiped out.
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The HD03 Add Patient function is provided only to enter basic patient information. If possible, patients should be added using the HD03 Administrator’s detailed Add Patient function and then synchronized to your Data Transfer Module.
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This is done through the HD03 Administrator software. Go to “Database Operation”, get the drop down menu from the menu, and select “Update Tubing”. Once selected a window will open allowing you to update the tubing list from the Transonic web site. When the tubing list is finished downloading to the Administrator, you will get a message saying “to complete the update you have to synchronize your DTM to the Administrator”.
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You will lose any unsynchronized new patients and/or new measurements. Synchronize often and regularly. Patient confidentiality will not be compromised because all sensitive patient data is encrypted.
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Shut off your system and reboot in order to regain normal functionality. The AC power supply had a ±1 KV line power spikes. This caused the Data Transfer Module to reset to protect the data, This should not happen often at all in a Clinical or Hospital setting because the line power in these settings is carefully controlled.
If it happens frequently, bring it to the attention of your building maintenance department. This should not occur if the system is running off the battery and not plugged in. If this occurs while the system is running on the battery, contact your Transonic Customer Service Representative.
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Yes. You can synchronize a DTM with multiple HD03 Administrator databases, but it is not recommended. You should use the HD03 Administrator’s XML Export and Import functions for this.
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Nothing. Your new measurements and/or new patients will still be on your Data Transfer Module, but they will not be in your HD03 Administrator’s database. If you last synchronized within the past week and if you have other patients scheduled for the next day, they will show up in “Today’s Patients” list tomorrow.
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Seven days from the date of synchronization.
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This message occurs because there is an interruption of the ultrasound signal.
Solutions:
Is there damage to the 15-pin connector?
Check that sensors are connected to the blood tubing.
Check that the hinged door is closed tightly.
Check that there is Vaseline between the sensor and tubing.
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This message appears when the sensors have not been connected to meter. If they are connected and “NO PR” is still displayed check solutions.
Solutions:
Check that the flow sensor is an H4E.
Check that you have sensors connected to meter.
Is the 15-pin connector damaged?
If all of the above check out ok then it could be an indication that the EPROM in the 15-pin connector has been damaged in some way or a problem with the meter.
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Go to the Hemodialysis Homepage and scroll down. On the right hand side you will see Tubing List – Instructions for downloading, underneath that you will see tubings.csv and Updates.txt. If you click on the Updates.txt it will open and you will find what the latest tubing list is. To download the tubing list follow the Instructions for downloading.

If you need assistance contact Transonic Systems.
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Note: sensors need to be connected to meter and meter powered on before opening software. If you copied it to a floppy disk, just insert into the floppy drive and when the HD02 software opens, click on update tubing’s list.

For systems running version 1.4.5 software or later:
You can copy to floppy or burn to CD.
When the HD02 software opens, click on Update’s Tubing.
A window opens that allows you to select the location of the file.
In the (Look in) box click on the down arrow and you will get a drop down menu.
Select the appropriate drive, when it opens you should see the tubing’s.CSV file.
Click on the file once to highlight it, then click open and tubing list will load.

If you need assistance contact Transonic Systems.
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Please refer to Section VI in the HD02 Operators Manual. This section takes you through the Administrative functions of the software including Reports. If you still need assistance contact Transonic Systems Inc.
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First check that the time and date on your Laptop is correct. That can be found in the lower right-hand corner, next drag the arrow down to the right-hand corner and place it on the time. You should see the date pop up. If the date is wrong then the measurements that you did will be found under that date.

Suggestion- Write that date down before changing to correct date.
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These messages occur because the software doesn’t recognize that the meter is connected to the laptop.

HD02 - RS232 communications:
13. Check the connection between the Sensors and Meter with power on and software open.
14. Check the 9-pin RS232 communications cable between the Meter and Laptop.
15. Check that no other software has been installed on the Laptop.
16. Has the communication port (Comport) selection been changed? (Most are set to Com1)
17. Check the 9-pin connector for damage.
18. Have you replaced the 9-pin RS232 communications cable?
19. (Correct cable is 9-pin RS232 straight through cable)
20. Check the Meter or Laptop connectors for damage.

HD02 and Step-up-to-02 – USB communications:
21. Check the connection between the Sensors and Meter with power on and software open.
22. Check the USB communications cable between the Meter and Laptop.
23. Check that no other software has been installed on the laptop
24. Has the communications port (Comport) selection been changed? (Check HD02 Operators Manual under Check Com Port Settings, in the HD02 software look in Setup to determine if they match if not change it in Setup and click ok)
25. Check your USB cable for damage.
26. Check the Meter or Laptop connectors for damage.
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These messages occur because there is an interruption of the ultrasound signal.

Solutions:
Is there damage to the 15-pin connector?
Check that sensors are connected to the blood tubing.
Check that the hinged door is closed tightly
Check that there is Vaseline between the sensor and tubing.
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This message appears when the sensors have not been connected to meter. If they are connected and “Flow Sensor?” is still displayed check solutions.

Solutions:
Check that you have sensors connected to meter.
Check that you have the correct sensors connected? (Remember H4D for HD01 and H4E for Step-up)
Is the 15-pin connector damaged?
If all of the above check out ok then it could be an indication that the EPROM in the 15-pin connector has been damaged in some way or a problem with the meter.
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Note: The HD02 and the Step – Up – To – 02 systems will give you a reminder message (shows up on the laptop when it is time.

Transonic Systems recommends that the Meter and Sensors be sent in for calibration annually.

Why: These are precision measurements and Transonic Systems is the only firm, which can perform such certifications and calibration. In addition, there may be updates that apply to your equipment that are performed as routinely returned that either improves the equipment performance or quality.
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The Flow-QC® tubing set provides a safe injection port for rapid injection of the Cardiac Output measurement bolus. A bolus injection at another site, such as the bubble trap, would become too long and the software program may not be able to separate the timing of the first pass of the saline bolus from subsequent passes.

The Flow- QC® tubing set also provides a Transonic-controlled, consistent measurement environment. The ultrasonic and mechanical properties of these tubing sets are controlled to guarantee measurement accuracy, eliminate measurement viability from blood line brands, and reduce the need for periodic sensor calibration. Use of these tubing set is therefore also highly recommended for access flow studies.
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These parameters are needed to calculate the patient’s body surface area (BSA) and thus Cardiac Index (CI). The Cardiac Output measurement protocol can be executed without these values, but the software would not calculate the CI and Central Blood Volume Index (CBVI).
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You may skip the entry of pressures, but then the software will not calculate Peripheral Resistance (PR).
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Injecting 30ml of saline over 6 seconds increases the outflow rate of the venous blood line temporarily by 300ml/min. Lowering the pump setting reduces the chance of pump storage during venous pressure elevation and also reduces the chance of the saline injection triggering recirculation.
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The transit-time of ultrasound changes with temperature. When CO is measured, the saline bolus travels through the cardiovascular circuit before returning to the arterial line ultrasonic sensor. Saline must be pre-warmed to body temperature so there will be no additional thermal changes to the saline indicator bolus on its passage through the body.
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The Transonic bag warmer is provided to warm and maintain the saline at a temperature of 33-38?C. Never use a microwave to warm the saline.
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The 30ml injection is made into the injection port on the venous side of the Flow- QC® tubing. It must be injected in one single pass fairly rapidly (4 to 7 seconds). Software automatically identifies and reports injection errors (direct recirculation. micro-bubble, incorrect saline temperature).
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Transonic indicator dilution technology has a repeatability of ±4%. This means that two consecutive measurements may vary an average of 4% from their mean. Also, CO varies during the courses of a respiratory cycle, over the course of the hemodialysis treatment, and with the patient’s level of arousal.
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