What to do with a non-functioning Automated Peritoneal Dialysis (APD) machine with bags hanging at the sides and no heater?

Management of Non-Functioning APD Machine

When an APD machine is not functioning with bags hanging at sides and no heater working, the patient should immediately switch to manual exchanges (CAPD) until the machine can be repaired or replaced to ensure adequate dialysis and prevent complications related to missed treatment.

Immediate Actions

• Contact the dialysis provider/center immediately to report the machine malfunction and arrange for technical support or replacement 1
• Inspect all connections to ensure the machine is properly plugged in and all tubing is correctly connected 2
• Check if there are any error messages on the machine display that might indicate specific problems 2
• Do not attempt to repair the machine yourself, as improper handling can lead to further complications 2

Switch to Manual Exchanges

• Begin manual CAPD exchanges following your prescribed schedule until the machine is fixed 3
• Use the same dialysis solution concentration as prescribed for your APD treatment 3
• Follow proper aseptic technique during all connection and disconnection procedures to prevent peritonitis 1
• Document all exchanges performed manually, including dwell times, fill volumes, and drain volumes 1

Clinical Considerations

• Monitor for signs of fluid overload (weight gain, shortness of breath, swelling) as manual exchanges may not provide the same ultrafiltration as your APD prescription 3
• Be aware that long-duration dwells in manual CAPD may lead to less effective fluid removal compared to the shorter, more frequent cycles of APD 3
• If you normally use icodextrin for your long day dwell in APD, continue to use it for the appropriate dwell in your manual exchanges 3
• Pay particular attention to drain volumes to ensure adequate fluid removal is occurring 3

Prevention of Future Issues

• Ensure regular maintenance of your APD machine according to manufacturer's recommendations 2
• Have a backup plan in place for machine failures, including supplies for manual exchanges 4
• Learn to recognize early warning signs of machine malfunction (unusual noises, heating issues, alarm patterns) 2
• Keep contact information for technical support readily available 1

When to Seek Immediate Medical Attention

• If unable to perform manual exchanges properly 3
• If experiencing symptoms of volume overload (shortness of breath, significant swelling) 3
• If signs of peritonitis develop (cloudy effluent, abdominal pain, fever) 1
• If unable to maintain adequate fluid balance with manual exchanges 3

Follow-up

• Schedule a follow-up appointment with your nephrologist to assess the adequacy of your temporary manual exchange regimen 3
• Discuss with your healthcare provider whether any adjustments to your dialysis prescription are needed based on your clinical status during the machine downtime 1
• Consider having your peritoneal membrane transport characteristics reassessed if the machine malfunction persists for an extended period 3