Preventive Maintenance Dialog

A. DATA INFO

CUSTOMER Syafira TANGGAL RENCANA 25 Agustus 2022

DESKRIPSI Dialog+ Evolution TANGGAL PELAKSANAAN 17 Juli 2022

ARTICLE NO. 710200C JAM PELAKSANAAN 10:51:37

NO. SERI 240078 TEKNISI Hendra Prabowo

SOFTWARE 9.12
B. ALAT UKUR YANG DIGUNAKAN

NO. NAMA ALAT MEREK TIPE NO. SERI

1 Hemodialysis Meter
2 Timbangan Digital Kris Chef EHA501-31P C13120597217
3 FSU Ver. 2.00 swissbit 7703864 611
4 Multi Meter Digital Sanwa CD800a 15075012195
5 Pressure Guage
C. KONDISI RUANGAN

PARAMETER TERUKUR
Suhu 25 °C
Kelembapan Nisbi 55 %
D. AKSESORIS

NO. DESKRIPSI ARTICLE NO. NO. SERI P/F

1 Applied Accessories/Disposables : Applied line system Name (blood line)
E. PEMERIKSAAN KONDISI FISIK DAN FUNGSI ALAT ( QUALITATIVE TASKS )

NO. DESKRIPSI P/F

1 Disinfection/Decalsification was Performed
Machine : clean/complete; no damages/moisture influences or loose assemblies; no moveable parts touching tubings or wires;
2
casters are moveable; type plate legible
3 Clean interior space and exterior surfaces
4 Suction tubing for disinfection and concentrate exchanged
5 O-rings at suction rod exchanged
6 Balance chamber – no visible leakages
Check tight seat and damages of mains supply (power supply cord, strain relief), potensial equalisation cable, staff call/data lines
7
(if prsent) and connectors
8 Tubing connectors , clamps and couplings (internal/external) are assembled correctly
9 O-rings and tubings at the dialyzer couplings exchanged
10 Tight seat of boards and connectors (incl. mains connection in switch mode power supply)
11 Exchange dust filter of fan (rear door)
12 Filter (FVD, FB, FK, FBK1/2, FBIC, FEP) exchanged
Filter level regulation module (HFA, HFV, HFE (HFS if present)) exchanged Option present {Filters are not included in the
13
maintenance kit, if necessary order separately.}
14 BIC Cartridge Holder (Option present)
15 BIC Cartridge Holder : O-rings exchanged
Battery on PC motherboard exchanged (after operating period of 4 years) {Battery is not included in the maintenance kit, if
16
necessary order separately.}
17 Monitor : no restriction of motion of rotation; touch membrane/keyboard membrane not damaged
18 Check non-return valve RVDA (at approx. 400 mbar +/- 50 mbar or 300 mmHg +/- 37 mmHg)
19 Check non-return valve DDE (at approx. 400 mbar +/- 50 mbar or 300 mmHg +/- 37 mmHg)
20 Check non-return valve RVFPE (at approx. 1300 mbar +/- 50 mbar or 975 mmHg +/- 37 mmHg)
21 Check non-return valve RVFPA (at approx. 1300 mbar +/- 50 mbar or 975 mmHg +/- 37 mmHg)
22 ENDLF sensor : Visual inspection
23 BICLF sensor : Visual inspection
24 BIC piston pump : Visual inspection
25 KP piston pump: Visual inspection
26 UF piston pump: Visual inspection
27 Blood leak detector BLD test passed
28 Check blood leak detector and calibrate if necessary {BLD version 3 or version 4}
29 Set summer/winter time {TSM, Treatment Support, System Configuration, if applicable in this country}
30 Blood Pump : Check function, movability, noise rating
31 Blood Pump : Check roller/one-way bearing; clean and lubricate shaft slightly if necessary
32 Blood Pump : Alarm cover switch
33 Venous Tubing Clamp SAKV : Function/gap checked, set gap 1.4 (+ 0.1 mm) if necessary
34 Switch on machine : Self test passed
35 Power Fail Function : Check function, duration of a constant audible alarm > 1 minute
36 Safety Air Detector SAD : Test alarm function (visual/audible) passed
 37 Monitor : Function of the keys, display illumination, OSDs (for Dialog+) and touch screen OK
38 Monitor : Image display OK
39 Battery Option (Option present)
Battery Option : Activate audible alarm {The machine must be in therapy mode. Disconnect mains plug: the buzzer from the
40
SMPS-MC gives three signaling tones as an indication that the machine is running in battery mode.}
41 Disinfection : Performed by responsible organization {user, inform responsible organization}
42 Disinfection : Performed by service technician
Customer specific parts or information on the machine (e.g. stickers/labels) were removed during the technical service
43
inspection/preventive maintenance or repair
44 New labeling must be performed by responsible organization (user)
F. PENGUKURAN KESELAMATAN LISTRIK ( SAFETY TEST )

BATAS
NO. PARAMETER TERUKUR BATAS ATAS P/F
BAWAH
1 Measure Mains Voltage 220 Volt 200 Volt 240 Volt
Protective Earth Resistance at Measurement points - Exterior : Potential equalisation bolt,
2 0Ω 0Ω 0,3 Ω
rinsing bridge (dialyser inlet and outlet)
Protective Earth Resistance at Measurement points - Interior : Heater body (top), rear
3 0Ω 0Ω 0,3 Ω
door (top left corner), frame (rear), housing cover (top left), front door (top left)
Protective Earth Resistance at Measurement points - Monitor : one of the screws in the
4 0Ω 0Ω 0,3 Ω
front panel/housing
Equipment Leakage Current : During heat-up phase {all water connections and data lines
5 0 mA 0 mA 0,5 mA
must be connected during the check of the equipment leakage current}
Patient Leakage Current : Under normal conditions {at dialyser coupling}, conductivity at
6 0 μA 0 μA 10 μA
13 - 15 mS/cm
G. PENGUKURAN KINERJA ( QUANTITATIVE TASKS )

SETTING TOLERANSI TOLERANSI

NO. PARAMETER TERUKUR P/F
PADA ALAT BAWAH ATAS
1 Check non-return valve RVDA 400 mbar 400 mbar -50 mbar +50 mbar
2 Check non-return valve DDE 400 mbar 400 mbar -50 mbar +50 mbar
3 Check non-return valve RVFPE 1300 mbar 1300 mbar -50 mbar +50 mbar
4 Check non-return valve RVFPA 1300 mbar 1300 mbar -50 mbar +50 mbar
5 Degassing Pressure Sensor PE -400 mmHg -400 mmHg -10 mmHg +10 mmHg
6 Degassing Pressure Sensor PE -100 mmHg -99 mmHg -10 mmHg +10 mmHg
7 Dialysate Outlet Pressure Sensor PDA -400 mmHg -400 mmHg -10 mmHg +10 mmHg
8 Dialysate Outlet Pressure Sensor PDA 0 mmHg 0 mmHg -10 mmHg +10 mmHg
9 Dialysate Outlet Pressure Sensor PDA 400 mmHg 401 mmHg -10 mmHg +10 mmHg
Heparin Pump : Position {Drive fast forward to end position with 30 ml
10 80 mm 80 mm -15 mm +15 mm
syringe. Check display position in mm.}
11 Venous Tubing Clamp SAKV : Function/gap checked 1,4 mm 1,4 mm 1,4 mm 1,5 mm
12 Arterial Pressure PA -400 mmHg -400 mmHg -10 mmHg +10 mmHg
13 Arterial Pressure PA 0 mmHg 0 mmHg -10 mmHg +10 mmHg
14 Inlet Pressure PBE 0 mmHg 0 mmHg -10 mmHg +10 mmHg
15 Inlet Pressure PBE 400 mmHg 400 mmHg -10 mmHg +10 mmHg
16 Venous Pressure PV 0 mmHg 0 mmHg -10 mmHg +10 mmHg
17 Venous Pressure PV 400 mmHg 400 mmHg -10 mmHg +10 mmHg
18 Temperature : comparison measurement {at dialyser coupling} 37 °C 37 °C -1,5 °C +0,5 °C
19 Conductivity : comparison measurement {at dialyser coupling} 14,3 mS/cm 14,3 mS/cm -0,2 mS/cm +0,2 mS/cm
20 Ultrafiltration : comparison measurement at 15 min with UF rate 500 ml/h 125 ml 125 ml 121 ml 129 ml
HASIL PEMERIKSAAN

Status PASS
Catatan Machine Is Good Condition