2 prismaflex crrt basic components - seg 2

1. PrismaFlex
®
STEPP
•Basic Components

2. Hemofilter
Basic Components in CRRT
CRRT
Blood Warmer
Vascular access
Anticoagulation
CRRT System
Solutions

3. Access: Location
•Internal Jugular Vein –
•Lower risk of complication
•Simplicity of catheter insertion
•Femoral Vein –
•Optimal site for immobilized patient
•Easiest site for insertion
•Subclavian Vein –
•Higher risk of pneumo/hemothorax
•Associated with central venous stenosis
A veno-venous double or two single lumen venous catheters

4. Access:
Important Considerations
•Refer to and follow the hospital protocol for
specific guidelines
•Vascular Access ADQI* recommendations:
•Aspirate and discard heparin before flushing
•20 to 30 CC syringe to assess patency
•Check for kinks/ clamps
*www.adqi.net

5. Anticoagulation
Commonly utilized:
•Heparin
•Citrate

6. Purpose of Warmers in CRRT
•Prevent heat loss
•Minimize calorie loss
•Patient comfort

7. Prismaflex Disposable Set
•Pre-connected, color-coded lines
•For ease in set loading
•Color-coded labels
• For easy hemofilter set identification
•5 or 9L effluent bag
•With drain port for quick emptying
•Single priming/effluent bag with Y-
connection
•Latex free

8. Prismaflex Disposable Set
•Single set for all therapy modalities
•Multiple sites for replacement fluid infusion
•Integrated pre-blood pump (PBP) infusion to the
access line
•High flow blood lines with minimal pressure drop
•Clear Plastic Pump Cover
•Easy visibility of blood/fluid pump segments
•Electrostatic Discharger Ring
•To minimize ECG artifacts
•Integrated Barcode Reader
•For set recognition and automatic alarm limit
settings

9. Prismaflex Disposable Set
•Pressure pods
•No blood-air interface to minimize clotting
•Patented Deaeration/Monitoring System
•Unique deaeration chamber with spinning cylinder
•Bottom to top flow propels air bubbles upwards for
automatic removal
•Post-replacement fluid layer eliminates air/blood
interface
•Return pressure monitoring
•Small blood volume ~8 ml

10. Prismaflex Disposable Set:
Specifications
1862000
1651000
1000
1000
Priming
Volume
(ml)
152
93
Blood
Volume
(ml)
0-8000
0-800075-400
1.4HF1400
75-400
1.15HF1000
8000-pre
6000-post
4000-pbp
0-800075-400
0.9M100
4000-pre
3000-post
2000-pbp
0-400050-1800.6M60*
Max Filtration
Capacity (ml/
hr)
DFR
(ml/hr)
BFR (ml/
min)
Surface
Area
(m
2
)
Sets
*Indicated for patients >11kg

11. Solutions for CRRT
Purpose
•Dialysate and/or Replacement – provide diffusion and/or
convection
•Depends on mode of therapy
•Removal of unwanted solutes
•Restores electrolyte and acid/base balance to patient’s blood.
Buffer
•Normalize blood pH
•Balances ongoing endogenous acid production
•Treat underlying metabolic acidosis/alkalosis
•Replace bicarbonate lost during CRRT

12. Gambro Solution Options
Use as dialysate solution Use as replacement solution
PrismaSol

13. Composition

14. PrismaSol
®
Composition

15. Preparation of Solution
5L ready-to-use solution obtained after breaking red
frangible pin between two compartments

16. Prismaflex ®
System
Overview
The Next Generation
Continuous Blood
Purification
Technology

17. The Prismaflex
®
System
•Communication Unit
•Flow Control Unit
•Fluid Control Unit

18. ®
Communication
Unit
•Interactive, color,
touch screen
•Machine status
lights

19. Interactive Display Screen
Step-by-Step Instructions
•12 in. colored touch-screen
•Displays a color-coded diagram of required actions

20. Status Lights
•Green - normal treatment conditions
•Yellow - advisory or caution alarm
•Red - highest priority alarm condition
needing immediate intervention
Give a general indication of operating conditions.

21. ®
Flow Control Unit
•Blood and fluid pumps
•Syringe pump
•Pressure monitoring
system
•Pinch valves
•Safety feature components
Prismaflex® Operator’s Manual Chapter 1, p.1-2

22. Effluent
Pre Blood Pump
Replacement
Blood
Flow Control Unit – Pumps
Syringe
Dialysate
Pinch Valves

23. Effluent
Filter
Return
Access
Flow Control Unit
Pressure Monitoring

24. Pressure Monitoring
Pressure Pods
To Software
Pressure
Sensor
Air side
Bloodline
Diaphragm
Pressure Pod
Fluid side
Front Panel
Prismaflex® Operator’s Manual Chapter 4-p52
Pressure Pod System
Return Pressure Monitor
Pressure Port
Monitor Line
Deaeration
Chamber

25. Blood Leak
Detector
Air Bubble
Detector
Return Line
Clamp
Safety Components
Deaeration
Chamber Holder
Bar Code
Reader
ECG Discharger
Ring

26. Flow Control Unit:
Deaeration Chamber
•Allows semi-automatic
air removal
•Post dilution fluid layer (~200mL/hr)
eliminates air blood interface

27. Flow Rates Summary
8L/hr 8L/hr 8L/hr 1L/hr PBP
8L/hr
0
2L/hr
450
UF,Con
CVVH
8L/hr
8L/hr
2L/hr
450
UF,Diff, Con
CVVHDF
0
8L/hr
2L/hr
450
UF,Diff
CVVHD
0 Replacement
0 Dialysate
2 L/hr Pt Fluid Removal
450 Blood Flow (ml/min)
UF Principles
SCUF
Note: Total Effluent Volume 10L/hr

28. ®
Fluid Control Unit
•Scales
•Effluent
•Replacement
•Dialysate/ 2
nd
replacement
•Pre-Blood Pump (PBP)
•Scale hook assemblies
•Color-coded tubing guides

29. Fluid Control Unit
•Scale hook assembly
•Slide-out bar tray
•Removable carrying bar
•Scales-
•Effluent
•Pre-blood pump (PBP)
•Dialysate
•Replacement