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In the early 1980s, the equipment maintenance activities of the Biomedical Engineering Department at St. Mary's Hospital in Montreal relied on the support of one technologist only. Needless to say, the extensive maintenance workload for this university-affiliated community 300-bed hospital forced the management team to look for additional support from external service providers. During those years, equipment providers such as Hospal and Gambro were called in for emergency and corrective maintenance procedures. A routine preventive maintenance program did not cover the hemodialysis machines used in this 20-station dialysis unit. Three different hemodialysis machines were used in the same unit at the time: the Hospal Monitral Acetate only, the Gambro AK-10 and Drake Willock 4215. Bicarbonate modules were available on some machines, but far from all. In addition to caring for their patients with many getting sick during treatments due to the acetate treatment, the dialysis nurses also performed the first-line troubleshooting of equipment problems. Although service providers' hourly rates were much lower than today (around $60 per hour), someone needed to validate the seriousness of the problems before calling them in for support.

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When I was hired as the second Biomedical Engineering Technologist with primary responsibilities to the dialysis unit, my mandate included the implementation of a routine preventive maintenance program, as well as reduction of expensive emergency repair calls through external services providers. During the first six months of my employment, I basically lived at the hospital. My wife and one-year-old son still lived two hours away while our home was for sale. I was able to get a room in the old nursing school building adjacent to the hospital and spent hours in the hemodialysis unit, sometimes sitting in an empty chair watching the hockey game and other times just chatting with the patients and nurses. It was during that time while undertaking extensive equipment maintenance training from the manufacturers, that I started noticing the implication of the nurses in the initial troubleshooting process for equipment problems. Coming from a maintenance management position in the Canadian Air Force, where all maintenance tasks were so structured and regulated, I could not stop thinking how different but, yet, beneficial this approach was to our daily workload. In fact, I remember one occasion within my first few weeks when I was called in at bedside for a conductivity problem on the old Drake Willock system. While trying to isolate the source of the problem, an experienced nurse walking by suddenly stopped to open the back panel of the machine and gently pushed on the bicarbonate module and looked at me with a smile and added: ''This always happens every morning, it needs a little push to start the day.'' On a separate occasion, another nurse taught me how to resolve ultrafiltration problems on the AK-10 by varying the dialysate pressure in the system. Today's machines are sophisticated and we tend to forget how complicated and labour-intensive dialysis treatments were in those days and earlier. Nurses and technicians had to adjust the sensitivity of the blood leak detector on the Hospal Monitral machine.

I remember one occasion when the sensitivity had been adjusted too low and the ultrafiltration collection cylinder located on the front of the machine turned fully red before the alarm actually went off. On another day, we had to bypass the blood leak detector on a Drake Willock machine by taping the transmitter and receiver together to be able to finish the treatment. Who would actually do this today? Hemodialysis machines are way more sensitive and include so many sensors and controls that it has become more challenging for newer staff to understand the basics of hemodialysis.

At the end, within the first year of my employment, we were able to implement our scheduled preventive maintenance program (every 500 hours of operation) on all hemodialysis machines and the water treatment system. Our need for external maintenance support was reduced to a bare minimum; to a point where we missed the regular visits from the Hospal Regional Service Technician. The overall success of our venture was not only due to the work of the Biomedical Engineering Department, but very much so to the support we received from the dialysis nurses. I will always remember those times and the work we accomplished together. My son graduated from Ottawa University this year with a business degree in finance and we always talk about the importance of jumping on the teamwork bandwagon, as I know that teams can assemble members' skills and experience to achieve superior results compared to how well individuals produce working alone.

About the author

Gil Grenier is Technical Manager, Nephrology Program, The Ottawa Hospital, ON.

Gil's professional volunteer activities related to nephrology include:

CANNT--Published in the CANNT Journal: Grenier, G. (2005). Portable phones in hemodialysis units: Are we interfering? CANNT Journal, 15(2), 48-49.

Ontario Ministry of Health and Long-Term Care (MOHLTC)--Member of the Ontario Health Plan for an Influenza Pandemic (OHPIP) Chronic Kidney Disease Working group.

Chair of the Canadian Standards Association (C.S.A.) Technical Committee on Extracorporeal Circulation Technology.

By Gil Grenier, Technical Manager, Nephrology Program, The Ottawa Hospital
COPYRIGHT 2008 Canadian Association of Nephrology Nurses & Technologists
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2008 Gale, Cengage Learning. All rights reserved.

Article Details
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Title Annotation:1980s
Author:Grenier, Gil
Publication:CANNT Journal
Article Type:Column
Geographic Code:1CANA
Date:Jul 1, 2008
Words:856
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