Characterisation and management of therapy-interrupting system errors associated with the use of the HomeChoice cycler for automated peritoneal dialysis

Abstract

Methodological and technical education of nurses is required to address challenges of technology integration in peritoneal dialysis (PD). We analysed the nature of therapy interrupting system errors in automated peritoneal dialysis (APD) cyclers of a German PD reference care centre and provide applicable resolution proposals. We documented therapy interrupting system errors of HomeChoice Pro and HomeChoice Claria cyclers (Baxter, BX, Unterschleißheim, Germany) including the years 2015-2023. We systematically characterise and suggest resolution strategies to these errors based on routinely collected health data and user experience to safely guide nephrology professionals and patients during troubleshooting. The ‘reporting of studies conducted using observational routinely collected health data’ (RECORD)-statement was considered. We identified 49 different therapy interrupting system errors which were assigned to eight major categories: Errors associated to the pressure chamber (N=18), the Digitalboard/EEPROM (N=18, Electrically Erasable Programmable Read Only Memory), air in set (N=3), opening of the set’s door (N=3), those associated to the energy system (N=3), the heater system (N=3) and a variety of errors resulting in an abrupt termination or non-commencement of the treatment session without clear group assignment (undefined, N=1) or without sufficient documentation. In total, 138 error incidents were documented during the observational timeframe. In frequential order errors were attributed to the pressure chamber (21.74%,), and air in set (19.57%) where specifically error 2240 occurred in 17.39% of total cases, the Digitalboard/EEPROM (17.39%), the energy or battery (16.67%; No. 1032 in 19/23 cases), the set’s door (7.25%) and the heater (4.35%). In 17 cases (12.32%) no error number was documented by the patient or staff. One error cause was registered as undefined (0.72%). Overall, errors were rarely occurring in <0.25% of treatment sessions performed in the observational timeframe. These findings may be useful to guide training purposes for nephrology personnel and persons doing APD. For the manufacturer, the information provided may be helpful to improve error management and information transmission to the persons doing APD with the HomeChoice devices.