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Received January 10, 2024, accepted May 8 2024, date of publication May 31 2024.

Design a Mobile Application for the Maintenance of 
Hemodialysis Machines using Flutter Framework

By Badria Ibrahim Eisa, and Mohamed Yagoub Esmail

Sudan University of Science and Technologyi, Sudan 

ABSTRACT

The hemodialysis machine is an artificial kidney facilitating the hemodialysis process and is considered a crucial life-sustaining 
device. Any delays resulting from malfunctions or improper maintenance of these machines can significantly impact the dura-
tion of dialysis for patients.
In Khartoum state, numerous highly skilled biomedical engineers are employed at dialysis centers, each with varying experi-
ence levels. However, the current training workshops provided to them are inadequate in ensuring proper maintenance of the 
machines. Many engineers struggle to address daily malfunctions and face challenges when referring to service manuals.
The recent proliferation of mobile applications has proven beneficial in several fields, particularly healthcare. This project will 
utilize a specific framework to develop a mobile application tailored to maintain hemodialysis machines. The app is designed 
to assist biomedical engineers in their daily tasks, particularly those in junior positions. By leveraging Flutter frameworks and 
the Dart language, a hybrid language capable of unifying code across Android, desktop, and iOS platforms, the “HDservice App” 
was created. This application offers detailed information on four common models of machine malfunctions in Sudan, along with 
corresponding solutions. Biomedical engineers have successfully integrated the app into their mobile devices, utilizing it for 
maintenance tasks. Subsequently, they conducted an evaluation comparing the app’s effectiveness to that of traditional service 
manuals, yielding the desired outcome.

Keywords – Hemodialysis machine, Maintenance, Mobile application, Flutter framework.

Copyright © 2024. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY): Creative Commons - Attribu-
tion 4.0 International - CC BY 4.0. The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) 
are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is 
permitted which does not comply with these terms.

INTRODUCTION

There are approximately 100 service engineers in 
Khartoum state, overseeing 1591 machines as reported 
in the latest inventory from the National Center of Kidney 
Diseases and Surgery in February 2023. This significant 
number of engineers managing a large quantity of machines, 
each with varying levels of experience ranging from 1 to 
17 years, results in challenges related to supervision and 
training, particularly for junior engineers.

In the current landscape, mobile devices, such as 
smartphones and tablets, are prevalent among health-
care professionals, especially in light of the COVID-19 
pandemic. Given the common occurrence of malfunc-
tions in hemodialysis machines, there is an opportunity 
to consolidate maintenance procedures into a software 
package, such as a mobile app, to enhance the training 
program for engineers.

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Ibrahim Eisa, and Yagoub Esmail: Design a Mobile Application for the Maintenance of Hemodialysis Machines using Flutter 
Framework

Hemodialysis Machine:

A dialysis machine works to filter a patient’s blood. 
This process includes the removal of impurities and 
excess water.1

Hemodialysis machines have three basic functions:
1. Circulation of blood from the patient’s access through 

the dialyzer and back to the access using a blood pump 
and a disposable tubing set.2

2. Preparation of dialysate from purified water and one 
or more concentrates and circulation of that dialysate 
through the dialyzer using a system that also controls 
the rate of fluid removal.2

3. Monitoring for any loss of integrity in either the blood 
or dialysate circuit or any excursion of an operating 
parameter outside a predefined range.2

Fault in Hemodialysis Machines:

Mechanical and electrical faults first cause faults 
in hemodialysis machines due to these five elements: 
pumps, power, transducers and sensors, pressure, and 
conductivity.3

And secondly, errors can arise from human error, 
such as misuse during operation or improper patient 
connection by nurses. These issues could be mitigated 
by ensuring that procedures are not initiated without 
full knowledge, particularly since they directly impact 
patient care. Biomedical engineers should also support 
nurses by offering comprehensive machine usage and 
maintenance training.

Furthermore, machine-related faults can also occur, 
underscoring the critical role of biomedical engineers 
in preventing risks associated with faulty or unchecked 
equipment. They must fulfill their responsibilities diligently 
and ensure that these machines remain operational for 
as long as possible during their duty cycles. As previously 
mentioned, their involvement in dialysis procedures and 
hemodialysis centers is crucial, with specific roles including:
1. Gain a comprehensive understanding of the operational 

mechanisms of hemodialysis equipment.4

2. Engage in the dialysis apparatus’s operation, upkeep, 
repair, and sterilization.5

3. Take charge of ensuring the integrity of dialysis solu-
tions, which involves overseeing electrolyte levels, 
osmotic pressure and conducting assessments for 
microbial/endotoxin presence.5

4. Participate in collaborative endeavors to enhance dialy-
sis machinery and pioneer new treatment modalities 
with a proactive approach to disseminating findings 
through publications and conference presentations.5

Maintenance

Maintenance encompasses the activities undertaken 
to sustain equipment in its functional state, whether by 
averting its deterioration into a nonfunctional state or by 
restoring it to operation post-failure. This gives rise to a 
variety of maintenance practices that can be strategically 
planned to fulfill the maintenance goal, including preven-
tive, predictive, or corrective measures.6

In hemodialysis facilities, to prolong the lifespan and 
efficiency of the machines, a focus on preventive mainte-
nance is essential to reduce the frequency of corrective 
maintenance interventions.

Although disinfection procedures and decalcification 
are routinely conducted on weekends, the execution of 
corrective maintenance is lacking due to inadequate 
training programs, as highlighted in the identified issue.

Computerized Maintenance Management System 
(CMMS):

A CMMS is a sophisticated software solution that 
houses a comprehensive computer database containing 
vital information about an organization’s maintenance 
operations. Within healthcare technology management, 
the CMMS serves as a tool for streamlining the documen-
tation of all tasks associated with medical equipment, 
encompassing equipment scheduling, inventory supervi-
sion, corrective and preventative maintenance protocols, 
spare parts regulation, service agreements, and medical 
equipment notifications.7

Flutter Frameworks:

Reasons for Choosing Flutter Framework: Flutter is a 
cutting-edge application development framework developed 
by Google for building cross-platform mobile applications 



Ibrahim Eisa, and Yagoub Esmail: Design a Mobile Application for the Maintenance of Hemodialysis Machines using Flutter 
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J Global Clinical Engineering Vol.6 Issue 3: 2024  20

that can run on both iOS and Android operating systems. 
As detailed on the official website (https://flutter.io/), 
it was selected for its primary objective of simplifying, 
accelerating, and enhancing the development process.8

For end-users, programmers, and designers utilizing 
Flutter. Moreover, Flutter is a versatile programming 
language that enables the creation of a single codebase 
for Android, desktop, and iOS platforms. The preferred 
approach in this context involves leveraging the innovative 
Flutter framework with the Dart programming language.

THEORETICAL BACKGROUND

Mobile Applications in Healthcare:

Healthcare applications encompass various mobile apps 
designed to assist in various health-related tasks. These 
apps can range from lifestyle mHealth solutions such as 
fitness and meditation applications to more advanced 
products that heavily rely on technological advancements, 
like those created to aid medical professionals in diagnos-
ing and addressing complex medical issues.9

In a recent publication, a comprehensive framework for 
a smart mobile Internet-of-Things (IoT) healthcare system 
was proposed to monitor patients’ health risks using a 
smartphone and 5G technology.10 Web and mobile appli-
cations were developed to cater to the needs of patients, 
doctors, laboratory analysis, and hospital services. This 
study used these applications to collect physiological data 
such as body temperature, pulse rate, and oxygen satura-
tion levels. The physiological data were then processed 
using 5G technology, body sensors connected to Arduino 
boards, and Raspberry Pi boards.10

This innovative system provides real-time advice 
and alerts to doctors and medical assistants regarding 
changes in patients’ vital signs and significant environ-
mental changes. This enables medical professionals to 
take preventive measures swiftly, potentially saving lives 
in critical care and emergencies.10

Furthermore, mobile applications are sometimes uti-
lized in telemedicine technologies, such as the mHealth 
applications operating in India as detailed in a recent 
study. These applications offer features like online doctor 

consultations or offline doctor appointment bookings, 
serving as an effective medium for doctor-patient commu-
nication and leading to notable enhancements in patients’ 
health outcomes. The study involved a cross-sectional, 
observational, and web-based research approach.11

METHODOLOGY

Designing Questionnaires, Data Sorting, and 
Analysis

After data collection, the common issues and malfunc-
tions identified from questionnaires and experiences with 
various machine types were analyzed. Subsequently, the 
data was categorized into four groups based on machine 
types, each encompassing all relevant data and malfunc-
tions. These categories were then reviewed with the 
company’s expert engineers to identify suitable solutions 
from manuals. The identified issues were then condensed 
and organized into four groups based on the occurrence 
timeline, from machine startup to disinfection before the 
next patient. This systematic arrangement facilitated sorting 
errors and the implementation of appropriate solutions, 
preparing them for inclusion in the codes.

Selecting the Appropriate Code Editor

Initially, the coding environment on the computer must 
be set up. The Android Studio and the Flutter framework 
were utilized as the code editor. Subsequently, the Flutter 
was integrated into the Android Studio, and the preferred 
Android version was selected; in this case, Android version 
4.0.0 was chosen to ensure compatibility with devices 
possessing minimal specifications, thereby enabling 
widespread usage of the application. Constructing the 
Architecture of the Flutter Framework.

Constructing the Framework Architecture for 
Flutter

To construct a robust architecture, it is essential to 
incorporate a plugin for the Dart compiler, a separate 
plugin for code analysis, and yet another plugin for manag-
ing the Flutter developer workflow, encompassing tasks 
such as building, running, and debugging. These plugins 
can be seamlessly integrated within Android Studio for 
optimal efficiency.

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21 J Global Clinical Engineering Vol.6 Issue 3: 2024

Ibrahim Eisa, and Yagoub Esmail: Design a Mobile Application for the Maintenance of Hemodialysis Machines using Flutter 
Framework

Creating App Widgets

The user interface (UI) and widgets utilized in the 
design process were carefully crafted with a harmoni-
ous color scheme and intuitive interactive features to 
align with the primary project objectives. The diagram 
in Figure (1) below showcases the app's key buttons and 
navigation element illustrating how users will engage 
with the application.

Test Execution

The Dart language continuously self-evaluates the 
code to detect any errors before running the application. 
The final evaluation of the entire code and its structure 
is done through a specific function in the Android file 
named “test.” This function verifies the integrity of the 
code even in the absence of errors.

Application Execution

Prior to launching the application, a virtual device 
emulator must be created on the laptop to preview the 
simulated app. Once everything appears satisfactory, the 
application is named “HDservice.”

Creation of Application Icon

When developing any application, it is essential to have 
a unique logo that symbolizes the app's purpose. Once the 
logo is chosen, the image should be saved in PNG format 
using the website www.icongenerator.com.

APK Release

The final stage involves converting the application into 
APK format to make it accessible to a wider audience. The 
command “--release “generates two files that engineers 
can easily install on Android mobile devices to achieve 
the intended goal.

RESULTS AND DISCUSSION

The Data Obtained from the Questionnaire

The survey was completed by a cohort of 100 biomedical 
engineers, from which various data points were collected. 
These included the duration of training, ranging from one 
to six months, as well as the number of years of experience 
in the field of dialysis, as illustrated in Figure 2 below.

Moreover, the engineers encountered challenges in 
handling and interpreting service manuals due to several 
factors. To begin with, 71.1% expressed that insufficient 
training and workshops were provided. Additionally, 
17.8% reported a lack of company engineers available 
for guidance and training, while 11.1% found the service 
manuals unclear and written in complex language.

The second reason is related to the nature of the job 
itself. A total of 88.9% of respondents indicated no written 
guidelines for daily, weekly, and monthly maintenance, 
while 11.1% stated that such guidelines exist in their 
hospitals. In the event of new malfunctions, technicians 
typically follow a series of steps to address them, such as 
consulting service manuals, reaching out to colleagues, 

FIGURE 1. UI of the app.

FIGURE 2. The years of experiences.

http://www.icongenerator.com


Ibrahim Eisa, and Yagoub Esmail: Design a Mobile Application for the Maintenance of Hemodialysis Machines using Flutter 
Framework

J Global Clinical Engineering Vol.6 Issue 3: 2024  22

or contacting the company’s engineers. The comparison 
between the current procedures performed and the ideal 
procedures as perceived by the technicians is illustrated 
in Figure 3 below.

The disparity between the optimal solution and the 
current practice lies in the unavailability of the company’s 
engineers due to their obligations with the vast hemodi-
alysis centers and other responsibilities.

In line with the issue, the training workshops for engi-
neers have proven insufficient to adequately equip them. 
Over the past five years, 68.2% have only attended 1–2 
workshops, 25% have attended 3–4 workshops, and 6.8% 
have participated in more than 5 workshops.

The feasibility of the app concept was deliberated 
upon before its inception, with an overwhelming 89% 
expressing strong approval, while the remaining individu-
als exhibited varying degrees of disinterest.

The engineers anticipated that the app would serve 
as the ultimate solution during their work, with 64% 
endorsing this notion, marking a pivotal moment in the 
project’s initiation.

The successful launch of the HDservice App has come 
to fruition.

Subsequent data will elucidate the culmination of the 
preceding chapter, showcasing the app post-launch to offer 
the desired solutions or information. Figure 4 illustrates 
the app’s nomenclature and logo icon, epitomizing its 
purpose - the name conveys the provision of hemodialysis 

services, while the logo underscores the importance of 
maintaining the hemodialysis machine.

The subsequent figures will reveal the culmination 
of the previous chapter, displaying the app upon launch 
to provide the desired solution or information. Figure 4 
showcases the app’s name and logo icon, symbolizing the 
app’s purpose - the name signifies the provision of hemo-
dialysis services, while the logo conveys the importance 
of maintaining the hemodialysis machine.

The application has been meticulously programmed 
and will continue to be enriched with new information 
through collaboration between my supervisor and me. It 
has been intricately coded to operate seamlessly offline, 
thus circumventing the prevalent network issues in Sudan. 
This design choice aims to enhance user experience for 
biomedical engineers, facilitating their search for errors. 
However, online connectivity is required for users to 
communicate with us, the developers, to report errors or 
suggest solutions for inclusion in the subsequent version. 
The following diagrams depict the application's process 
to troubleshoot and resolve various issues.

FIGURE 3. Comparison between procedures of fixing errors.
FIGURE 4. The app’s name and logo.

FIGURE 5. First app’s screen.



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Ibrahim Eisa, and Yagoub Esmail: Design a Mobile Application for the Maintenance of Hemodialysis Machines using Flutter 
Framework

The illustration depicted in Figure 5 displays the initial 
interface of the application, also known as the welcome 
screen. This screen features the app’s title and a menu 
bar, which includes contact information as illustrated in 
Figure 6. The buttons in the center serve as a submenu 
that allows users to navigate to different screens within 
the app.

The illustration above provides a comprehensive app 
overview and offers guidance on identifying and resolv-
ing issues. Subsequent illustrations will further elucidate 
this process.

For instance, if an error occurs in a BBraun machine 
during a self-test, the engineer must first double-click on 

the hemodialysis machine icon (Figure 6). Following this, 
the engineer should double-click the self-test button in 
Figure 8. Once the self-test button is double-clicked, the 
engineer will be directed to Figure 9 to locate the error 
message or code.

The diagram provided above displays all the errors 
detected during the self-test. The list-view widget was 
utilized to ensure that the errors can be displayed with-
out any limitations in length, and can be expanded in the 
future. Each error message is represented as a widget 
known as a “card,” which, when clicked, will navigate the 
user to the corresponding solution screen, as illustrated 
in the upcoming diagram. The solution screen depicted 
in Figure 10 below provides detailed explanations for 
why the error occurred and the potential causes behind 
it, this applies to all the other cards and machines as well.

FIGURE 6. Contact information.

FIGURE 7. The section of water treatment unit.

FIGURE 8. The section of HD machines.

FIGURE 9. Scrolled list-view for self-test errors.



Ibrahim Eisa, and Yagoub Esmail: Design a Mobile Application for the Maintenance of Hemodialysis Machines using Flutter 
Framework

J Global Clinical Engineering Vol.6 Issue 3: 2024  24

Assessment Feedback

Following the utilization of the application, we sought 
to gain a comprehensive understanding of its functional-
ity, user satisfaction, and overall worthiness for further 
development. To achieve this, we conducted an online 
survey to assess user acceptance. The initial feedback 
revealed a strong acceptance rate of 89%, with the remain-
ing responses varying between disapproval and moderate 
interest, as depicted in Figure 11 below. Respondents 
highlighted the app’s user-friendly interface, which fa-
cilitated enhanced knowledge sharing and interaction 
between junior and senior users and provided valuable 
training on proper maintenance practices. This positive 
reception corroborated our objectives.

Furthermore, the application underwent evaluation 
by a panel of engineers at the Military Hospital, includ-
ing Eng. Salim Mohammed Musa, the chief engineer in 
Sudan and former technical representative of Gambro in 
Sudan, along with representatives from SAMASU Medical 
Company, the current technical agent of Gambro in Sudan.

CONCLUSIONS 

The advancement of technology, particularly mobile 
applications in healthcare, is highlighted in this article. 
The mobile applications suggested here aim to offer 
extensive services to aid training programs and provide 
maintenance information for biomedical engineers regard-
ing hemodialysis machines and water treatment systems. 
Using the Flutter framework to develop the app resulted 
in a user-friendly interface with a single code base for 
multiple platforms. The app’s classes facilitated the easy 
addition of new information, serving as a foundation for 
knowledge sharing and experience exchange.

Employing the “HDservice app” for maintenance pur-
poses enhances the expertise of biomedical engineers, 
enabling them to quickly identify the correct solutions 
without the need to consult colleagues. The app serves 
as a comprehensive guideline, akin to service manuals, 
thereby minimizing errors during maintenance proce-
dures. Navigating through the app’s interface to access 
information on different machines is swift, aiding in 
rapidly diagnosing malfunctions.

Furthermore, the app educates users on error solutions 
and fosters the sharing of experiences between seasoned 
engineers and novices. The authors will regularly update 
the app with new information based on user submissions, 
promoting continuous learning. The increasing integration 
of mobile applications in healthcare is anticipated, with 
this app serving as a pioneering platform for developing 
apps for other medical instruments.

ACKNOWLEDGMENT

I sincerely appreciate individuals who contributed to 
this project, particularly in the programming aspect, from 
inception: Eng. Alaa Yahia, Albaraa Omer, and a special 

FIGURE 10. The error’s solution.

FIGURE 11. The acceptance of HDservice App.



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Ibrahim Eisa, and Yagoub Esmail: Design a Mobile Application for the Maintenance of Hemodialysis Machines using Flutter 
Framework

thank you to Eng. Jabir Mohammed for his invaluable 
time, guidance, and advice.

I express immense thanks and acknowledgment to 
the engineers who provided information on dialysis ma-
chines: Motasim Almamoun, Eman Tag Alsir, and Yousif 
Mohammed. Additionally, I appreciate the support and 
encouragement from my colleagues and friends at Alnaw 
and Algazira Slang Hospitals for Kidney Diseases.

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