Journal of Industrial and Production Engineering

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The application of Taguchi methods to parameters

optimization for preventing coagulation in
artificial kidneys

Wen-Tsann Lin, Lien-Cheng Tsao, An-Jin Shie, Sue-Ting Chang & Te-Cheng
Yang

To cite this article: Wen-Tsann Lin, Lien-Cheng Tsao, An-Jin Shie, Sue-Ting Chang & Te-
Cheng Yang (2016) The application of Taguchi methods to parameters optimization for preventing
coagulation in artificial kidneys, Journal of Industrial and Production Engineering, 33:4, 247-252,
DOI: 10.1080/21681015.2016.1139006

To link to this article: http://dx.doi.org/10.1080/21681015.2016.1139006

Published online: 09 Feb 2016.

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Journal of Industrial and Production Engineering, 2016
Vol. 33, No. 4, 247252, http://dx.doi.org/10.1080/21681015.2016.1139006

The application of Taguchi methods to parameters optimization for preventing coagulation in

articial kidneys
Wen-Tsann Lina, Lien-Cheng Tsaoa, An-Jin Shieb*, Sue-Ting Changc and Te-Cheng Yangc
a
Department of Industrial Engineering and Management, National Chin-Yi University of Technology, Taichung, Taiwan; bCHINA-
ASEAN International College, Dhurakij Pundit University, Bangkok, Thailand; cKuang-Tien General Hospital, Taichung, Taiwan
(Received September 2015; revised December 2015; accepted December 2015)

This paper aims to illustrate an application of Taguchi method to identication of the setting optimized for factors affect-
ing coagulation in a hemodialyzer as the benchmark of operations for improved quality and reduced coagulation. In this
article, robust parameter designs based on Taguchi methods in association with discussions with the nursing staff apply
to the study for investigating the key variables inuential to hemodialysis. This paper attempt to improve the quality of
hemodialysis by identication of the optimal set of variables and levels involved. The results show that the defect rate
dropped from 35 to 8%. Thus, Taguchi methods that did improve the quality of hemodialysis are advised to apply to
prevention of clotting during hemodialysis.
Keywords: hemodialysis; hemodialyzer clotting (coagulation); Taguchi methods; transformation

1. Preface center of the hospital, and achieved the objective of

In the highly developed society, the services business
has to rm the robust competitiveness with high ef-
ciency and ne quality; furthermore, the time a customer
may wait for services proves how good the quality is.
Recently, the medical business confronted with the erce
competitiveness as well as the awareness of customers
urges respective medical institutions (hospitals) to tackle
issue on advancing both the quality of medical services
provided and the patients satisfaction received.
1.1. Context and motive
The dialyzer (hemodialyzer a.k.a. articial kidney in
charge of extracorporeal circuits) is a signicant medical
instrument that applies to a total population of more than
40,000 patients with renal failure (insufciency) in need
of hemodialysis to exclude solutes (uremic toxin) and
extra uid in Taiwan.
From the studies, the cardiovascular diseases claim
more than half of uremia patients lives where blood loss
is the major cause. Blood clotting (coagulation) during
the therapy not only leads to blood loss but also
breaches the effectiveness as well, so respective hospitals
strive for interventions for preventing coagulation in arti-
cial kidneys.
1.2. Purposes
The authors investigated the critical factors and levels by
discussing with the nursing crew in the hemodialysis
advanced competitiveness by improved quality and
reduced defect rate. In addition, Taguchi methods applied
to the settings optimized as the references for the indus-
try. The purposes are:
(1) To investigate the critical factorial levels in col-
laborations with the nursing staff and nd out
the optimized levels with the previous data via
Taguchi methods;
(2) To prevent blood clotting in articial kidneys for
advanced patients satisfaction and medical ser-
vices quality; and
(3) To secure the accurate dose of anticoagulant and
prevent breeding for keeping blood ow normal
to reach dialysis standards during the therapy.
1.3. Subjects and limitations
(1) Those receiving hemodialysis at the
hemodialysis center of the hospital via
outpatients since Jan. 2014 served as the
subject.
(2) The hemodialysis center of the hospital
offered the data meeting the factors and
levels needed by the study.
(3) The individuals involved in interviews and
discussions of the study included the
professional physicians and nursing crew in
the hemodialysis center of the hospital.

*Corresponding author. Email: s948904@mail.yzu.edu.tw

2016 Chinese Institute of Industrial Engineers
248 W.-T. Lin et al.

2. Literature review heparin-free hemodialysis, and to inject saline per 0.5

2.1. Hemodialysis 1 h for preventing coagulation in a hemodialyzer; and d.
To keep the blood ow sufcient and the contractive
A hemodialyzer plays the key role in homodialysis. The
pressure exceeding 100 mm Hg during the therapy.
articial semi-permeable membranes apply to envelopes
Enhanced education on antihypertensive administration
or more than 600015,000 micro hollow bers (cathe-
shall apply to those with bad control over blood pressure
ters) in general. The blood removed from the patient
[1,810].
runs to the inner layer of the catheters downward and
the dialysate (dialysis uid + RO water) runs to the outer
layer of the catheters upward when the blood and dialy- 2.2.2. Impacts
sate run in opposite directions. The extra uid in vivo
Clinically, the average coagulation rate in dialyzers is
can be removed and this is how hemodialysis works.
1% whereas that due to insufcient anticoagulants or
inadequate technical operation is 10.8%. During the ther-
2.1.1. Processes apy, it is necessary to observe coagulation in a dialyzer
and tubing closely at anytime, especially for those using
In the process of the therapy, two syringes are applied to
no anticoagulant. In such case, it is essential to avoid
the patient. One aims at blood draining out from the
any anticoagulant remained in vivo by cleansing tubing
patient to pass through the hemodialyzer (that cleans
soaked in the anticoagulant (750 ) with saline thor-
the blood) and another aims at sending the cleaned blood
oughly during the preparation for hemodialysis. Total
into the patient. Blood runs through the arterial end of
clotting >1/3 in a dialyzer deemed as coagulation in an
vascular catheters, and is brought to a hemodialyzer by
articial kidney requires to send the non-clotting extra-
the machine via artery circuits. The diffusion and ultral-
corporeal blood to the patient and replace the dialyzer
tration apply to replacement of kidneys that remove extra
and vascular tubing at once.
uid and uremic toxins. After that, the clean blood is
By some papers [1,7,9,10], the demerits brought by
sent to the patient through venous end of vascular cathe-
coagulation in a hemodialyzer include: undesired mate-
ters via venous circuits.
rial consumption (NT$ 1885/tube), extra fee of medical
Normally, the therapy lasts 45 h when the limbs
waste disposal, and unsuccessful hemodialysis that
with the syringes xed thereon are prohibited from
affects removal effectiveness. Blood loss due to clotting
movements so as to prevent any complications due to
in the dialyzer and tubing that might reach 200240 cc
syringes unxed. As the processes end, the wounds are
not only leads to clinical syndromes such as dizziness,
cured with pressed gauze for 1015 min xed by paper
drowsiness, palpitation in action, severe anemia, etc. but
tape. The xed gauze can be removed in 1224 h [13].
also causes unwanted worries and complaints of patients
and their relatives with distrust in medical care received
2.2. Coagulation in a hemodialyzer and doubts for dialysis safety. As a result, sound
interventions for preventing coagulation in the dialyzer
2.2.1. Causes
not merely help reduce procurement expenditures and
In hemodialysis, blood is removed from the body and waste disposal fees but also improve the quality of
circulated through an extracorporeal uid circuit (outside hemodialysis.
the body) by the velocity of 200300 ml/min, then
returned to the patient. Such processes that continue till
the end might trigger coagulation due to extracorporeal 2.3. Taguchi methods
circuits. Thrombosis as the formation of a blood clot (co-
Taguchi methods are statistical methods developed by
agulation) inside a blood vessel happens during
Genichi Taguchi in 1950 to improve the quality of man-
hemodialysis since platelets (thrombocytes) and brin
ufactured goods, and more recently apply to other elds
(protein) form a blood clot to prevent blood loss. Clini-
with multi-factorial orthogonal arrays. The advantage is
cally, coagulation in hemodialyzers results from causes
to employ few experimental data for broad experimental
like gas remained in a dialyzer, insufcient blood ow in
trend assays, which improve the processes and advance
vascular stula, insufcient dose of heparin, heparin-free
the quality of processing with efciency [12].
dialysis, hyper hematocrit, or transfusion via catheter cir-
cuits [6].
To prevent coagulation in a dialyzer, it is necessary
for onsite staff to perform the following steps indeed: a. 2.3.1. Application
To assess carefully whether the monitoring items of the Taguchi method is a statistical method pioneered by
hemodialyzer function normally and to exclude any Genichi Taguchi in 1950s to improve the quality of man-
irregularity at once; b. To exclude gas entirely in a ufactured goods, i.e. Taguchi quality engineering or
hemodialyzer as preparing it for a patient; c. To rinse a Taguchi design of experiments (DOE), or Robust Design
hemodialyzer with heparin at 30005000 units for method greatly improves engineering productively in a
 Journal of Industrial and Production Engineering 249

novel effective manner. Taguchi methods determine 2.3.3. Orthogonal array designs
parameter designs by experiments dened rather broadly: In a full factorial design, the trial times depend on the
those in laboratories, those on production lines in facto- factorial total. On the other side, orthogonal array
ries, or simulations by computers [25]. Konduk [7] designs acquire reliable estimates by few trials with
identied factors affecting adequacy of hemodialysis and robustness. Taking both the stability and cost issues into
relations between them using Taguchi Method (fractional consideration, engineers identify orthogonal arrays as a
factorial experiments) in order to be able to reach mean- critical tool for goods and processes designs [5].
ingful results among used parameters throughout mini-
mum of tests [7]. However, Konduk [7]s research
merely aimed at Kt/V (Kt/V is a number used to quantify 3. Case study
hemodialysis and peritoneal dialysis treatment adequacy) 3.1. Attributes
to discuss Urea Reduction Ratio in the medical treat-
The subject, the goal, the gure, and the defect were
ment. They did not consider coagulation in articial kid-
dened asfollows: a hemodialyzer repeatedly used, pre-
neys.
venting the coagulation in the subject, the quality attri-
bute, and coagulation >1/3 in a hemodialyzer,
2.3.2. Robust parameter designs respectively.
Robust parameter designs, introduced by Taguchi, are
experimental designs used to exploit the interaction 3.2. Factors and levels
between control and uncontrollable noise variables by
Instead Delphi methods and cause-and-effect charts were
robustication: nding the settings of the control factors
conventionally used, Taguchi methods apply to identi-
that minimize response variation from uncontrollable fac-
cations of key factors in order to avoid the negligence
tors. Control variables are those the experimenter has full
and blind points due to investigators personal conscious-
control over and noise variables are those easily con-
ness. Still, the parameters involved in coagulation in a
trolled by experimental settings. An orthogonal array is a
hemodialyzer are too many to be processed by Taguchi
table that improves the quality of manufactured goods or
methods since this would consume time and cost. In
of processes and therefore applies widely to other
terms of the literature, some are not control factors for
domains due to the repeatability of experimental out-
coagulation; furthermore, some are not t for alteration
comes by relative few trials and simple settings able to
since this might exert biased experimental outcomes, so
reduce the systemic susceptibility to noise variables with
the study refers Konduk [7]s suggestions to integrate the
advanced systemic robustness.
professionals applied to exclude the aforementioned fac-
Robust parameter designs exert the settings that mini-
tors and Taguchi designs of experiments applied to the
mize the mean and attributes of quality attributes and are
remains[5,7]. In the end, the authors obtained four fac-
the optimal methodology to improve the quality of man-
tors and three levels as shown in Table 1.
ufactured goods and advance the competitiveness with
technical improvement rather than scientic investigation
[11,1416]. In robust parameter designs, noise variables 3.3. Settings and assays
easily controllable in an experimental setting need not be
Three levels applied to four factors respectively with
removed but minimized by controlling the nonlinear and
eight degrees of freedom for experiments. A L9(34)
linear relations between control and noise variables with
matrix applied as shown in Table 2.
minimized response variation under factorial levels (i.e.
minimizing the response variation by nonlinear relations
and adjusting the mean to the estimate by linear rela- 3.4. Data
tions) similar to fractional factorial designs that aim at
The authors grouped the parameters involved into
decreased cost for improvement and increased quality of
defect-free and defect ones where the former referred to
goods [17].

Table 1. Table of factors and levels.

Parameter level
Factor 1 2 3
Anticoagulant dose (unit) 500 1000 1500
Blood velocity (ml/min) 200 250 300
Ultraltration sum (kg) 2 4 6
Catheter type Articial vessel Patients vessel Temporary catheter
Data source: The authors.
250 W.-T. Lin et al.

Table 2. L9(34) matrix. 3.6. transformation

A B
1 1
1 2
1 3
2 1
2 2
2 3
3 1
3 2
3 3
Data source: C.D. Su [12].
C D To verify the hypothesis and survey the repeatability of
the optimal setting (A1 B2 C2 D1), the authors con-
1 1 verted the gures obtained to the response dB value via
2 2
3 3 transformation advised by Taguchi. The equation is:
2 3  
1P
3 1 X 10  log10 (1)
1 2 p
3 2
1 3
According to the literature, the gure close to 0 or 100%
2 1 with the percentage attribute has a bad additive property.
The equations are:
A1 10=30 0:33 ! 3:08dB

coagulation >1/3 in a hemodialyzer. Ten trials applied to B2 8=30 0:27 ! 4:32 dB

each level and 90 samples were obtained. Table 3 shows
the data observed. C2 10=30 0:3 ! 3:68 dB

D1 8=30 0:27 ! 4:32 dB

3.5. Factorial effect and cumulative probability
The probability distribution of defects applied to determi-
nation of the factorial effect and Table 4 shows the effect
via computation. According to the data shown in Tables 2
and 3, the trial times of A1 the factorial level were 1, 2,
and 3 and the total was 3 + 2 + 5 = 10 and so on.
The preceding factorial effect of factor A identies
the ratios of defect counts where A1 failed to exceed A2
and A3, so A1 became the main factorial level (see Fig-
ure 1); the preceding factorial effect of factor B repre-
sented B2 as the main factorial level (see Figure 2),
where B2 was lower than B1 and B3; in particular, the
preceding factorial effect of factor C indicated C2 as the
main factorial level (see Figure 3), where C2 was lower
than C1 and C3; nally, the preceding factorial effect of
factor D indicated D1 as the main factorial level (see
Figure 4), where D1 was lower than D2 and D3. To
have a low defect rate in coagulation (low abnormal
ratio), the gures prove the optimized setting goes to
A1B2C2D1 and this served as the benchmark for subse-
quent coagulation rates.
T
37=90 0:41 ! 1:58 dB
where P as the ratio exerted by a factorial level, so we
estimated the obtained value of (A1B2C2D2) as:
X A1B2C2D1 XA1 XB2 XC2 XD1  2Xl
12:24
Thus, the estimate was 12.24. The equation:
3.08 + 4.32 + 3.86 + 4.322 1.58 = 12.24 dB. We
converted the estimate to the defect rate where
= 12.24, so we acquired the response probability as:
1
P X 5:6% (2)
1 1010
The estimate of the initial setting was obtained by the
equation and we acquired the defect ratio improved from
35 to 5.6%, a drastic drop. To identify the repeatability of
the setting optimized (A1B2C2D1), the conrmation
experiments applied, and the repeatability was identied
by the defect rate of 8% (4 defects out of 50 trials).

Table 3. Data observed.

NO Anticoagulant dose Blood velocity Ultraltration sum Clotted catheter Defect counts
1 500 200 2 1 3
2 500 250 4 2 2
3 500 300 6 3 5
4 1000 200 4 3 7
5 1000 250 6 1 4
6 1000 300 2 2 5
7 1500 200 6 2 8
8 1500 250 2 3 2
9 1500 300 4 1 1
Data source: The authors.
 Journal of Industrial and Production Engineering 251

Table 4. Table of factorial effect. 4. Concluding and suggesting remarks

A B C D In Taiwan, hemodialysis as a main therapy that applies
to the patients in need of long-term dialysis makes its
Level 1 10 18 11 8 quality a great concern. Still, coagulation during the ther-
Level 2 16 8 10 15
Level 3 11 11 17 17 apy due to personal negligence or parameters in need of
optimization damages the quality of medical services
Data source: The authors. provided. In the era when hospitals are available here
and there, it is necessary to have a robust competitive-
ness in a market full of erce competitors through the
medical services with high value added and high quality.
Taguchi methods applied to identication of the set-
ting optimized for factors affecting coagulation in a
hemodialyzer as the benchmark of operations for
improved quality and reduced coagulation. The setting
optimized consisted of the anticoagulant (500 units),
blood velocity (250 ml/min), ultraltration sum (4 kg),
and catheter (articial blood vessel) that improved the
Figure 1. Factorial effect of factor A. defect rate the most (dropping from 35 to 8%). The con-
Note: The dashed box indicates the main factorial level. rmation experiments that identied the high repeatabil-
ity matched 5.6% the probability estimated. The
preceding data prove the parameters setting optimized in
this study as the benchmark of coagulation in a hemodia-
lyzer for advancing the effectiveness and the quality of
medical services.
To summarize the conclusion above, the Taguchi
method in this study did improve the quality of
hemodialysis and facilitated the nursing staff to nd out
the optimized parameters for preventing coagulation in
articial kidneys. However, the study meets some
research limitations, which needs to be discussed: (1) the
Figure 2. Factorial effect of factor B.
study did not verify the performance of the proposed
Note: The dashed box indicates the main factorial level.
optimized parameters for articial kidneys; and (2) lacks
to connect patients health states.
Thus, there are three suggestions proposed for further
research: (1) developing a verication mechanism (ex:
articial neural network) examine the performance of the
proposed optimized parameters for articial kidneys; (2)
considering more key factors related patients health
states (ex: age, gender, and blood pressure) of coagula-
tion in articial kidneys for improving quality of
hemodialysis; and (3) integrating other scientic methods
(ex: Genetic Algorithm (GA) and Response surface
methodology (RSM)), it helps researchers to enhance the
Figure 3. Factorial effect of factor C.
Note: The dashed box indicates the main factorial level. quality of hemodialysis. These suggestions will improve
effectiveness of the Taguchi Method.

Acknowledgments
This study delivers acknowledgments to the 100-2410-H-167-
010-MY3 NSC project for support and resources.

Disclosure statement
No potential conict of interest was reported by the authors.
Figure 4. Factorial effect of factor D. Note: The dashed box
indicates the main factorial level.
252 W.-T. Lin et al.
Funding
This work was supported by Ministry of Science and Technol-
ogy of Taiwan [grant number 1002410-H-167010-MY3].
Notes on contributors
Wen-Tsann Lin is a distinguished professor in Department of
Industrial Engineering and Management at National Chin-Yi
University of Technology (NCUT). He received his PhD degree in
the Department of Industrial and Systems Engineering (ISE) from
Chung Yuan Christian University. He is also a founder of College
of Management, a chief of Techers Association at NUCT and a
chief of Chinese Society for Training Quality (CSTQ). His
research activities include: product data management (PDM),
knowledge management (KM), and TRIZ, taguchi methods, DOE,
big-date analysis, quality management, and service science.
Lien-Cheng Tsao is a graduate student at the Department of
Industrial Engineering and Management, National Chin-Yi
University of Technology (NCUT). His research activities
include: taguchi methods, articial neural network, and data
mining.
An-Jin Shie is an assistant professor in the China-ASENA
International College at Dhurakij Pundit University (DPU),
Thailand. He received his PhD degree in Industrial Engineering
and Management from the Yuan-Ze University (YZU), and has
been an adjunct professor at National Chiao Tung University
(NUCT), Tunghai University and National Chin-Yi University
of Technology (NCUT). His research activities include: TRIZ,
taguchi methods, DOE, big-date analysis, quality management,
patent search & analysis, and service science.
Sue-Ting Chang received her PhD degree in the Department of
Technology Application and Human Resource Development
from National Taiwan Normal University. Her 20-year career at
medical industry focused on : TQM, human resource manage-
ment, performance management and application of operations
research in medical service process management. Presently, she
is a Department of Administration director at Kuang-Tien Gen-
eral Hospital, and an assistant professor in Health Business
Administration Department at Hungkuang University. Her
research activities include: smart hospital medical service and
Quality management of medical industry.
Te-Cheng Yang received his Bachelors Degree of Medicine from
National Yang-Ming Medical University, Taiwan and the Mas-
ters degree of Clinical Medicine from National Taiwan Univer-
sity. His more than 25-year career at several hospitals focused on
diagnosis and treatment of kidneys disease and taking care of
ESRD patients under maintenance dialysis therapy. Presently, he
is a Chief of Section of Nephrology in Kuang-Tien general hospi-
tal and continued to dedicate to improving the procedure and
quality of hemodialysis. He has been pursuing research in tech-
nology and supply chain management of dialysis.
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