3 prismaflex basic setup operation

1. Prismaflexâ System
Basic Set-up

4. Facilitates electronic charting
Calculates therapy delivered

6. ®
Each softkey changes drawings appropriately

7. Blood Leak detector
(BLD)

8. Automatic loading with Bar Code Reader identifies filter set

10. Ensure correct connection of solutions
Recommended
priming volume
and syringe

11. Setup - CVVHDF

12. Setup - CVVHD

13. Setup - CVVH

14. Setup - SCUF

19. Priming only continues while key is pressed.
Make sure priming solution is adequate.

20. <Insert REPRIME screen>
•Requires one full bag of priming solution.
•Automatically primes all lines.
•Check effluent bag if change is required.

22. Press CONTINUE only if ready to start treatment.

24. Prismaflexâ System
Starting Treatment

30. Calculating Patient Fluid Removal
Net fluid removal hourly (physician order)
+ Non-Prismaflex intake (IV, TPN, etc.)
- Non-Prismaflex output (urine, etc.)
= Patient Fluid Removal Rate (set in Prismaflex)

32. Pre-Blood Pump (P.B.P.)
•Pumps solution into blood compartment at access
•Purpose:
•Direct pre-blood pump infusion of other solutions
•Optional pre-dilution replacement solution
•For anticoagulation
•Fluid volume automatically removed by effluent pump
•Do not include in calculation as patient intake
•PBP linked to blood pump
•Blood pump compensates for PBP infusion rate
•PBP rate must not exceed blood flow rate

34. Press ENTER after all flows are set.

35. Press Continue if settings are correct.

36. Press softkey and follow step-by-
step instructions.

37. Prismaflexâ System
Treatment
Management

38. Therapy
Mode
Pressures
& Limits
Pressure
Graphs
Main operating screen during treatment

39. Provides Filter and Vascular Access assessment parameters
Provides information on condition of filter.

40. Note: Advisory alarm occurs when blood pump/flow is stopped for >60 sec.

41. 200 ml
1000 ml
Pre
500 ml
1000 ml
200 ml
1000 ml
0.0 ml
Immediate
0.5 ml

43. Monitor cumulative fluid
balance hourly for accurate
fluid management.
Press to view a different time period

47. •Recommended Delivery of at least
200cc/hr post-filter replacement

48. Deaeration Chamber
•Monitor chamber level hourly with
routine I&O
•Important NOTE:
•Keep Blood at designated level on
deaeration chamber at all times.
•If fluid level is too high and return line clamps
off, fluid may enter machine through monitor
line
•If fluid level is too low, an “Air in Blood” alarm
may occur

49. Prismaflexâ System
Basic Alarm
Overview

50. Safety Feature Components
Air Bubble
Detector
Blood Leak
Detector
Return Line
Clamp
Blood/Patient
Sensor
Alarm Lights
Display screen
Pressure Monitors
Scales
Bar Code Reader
Syringe Pump
Pressure Monitors

51. Prismaflex Types of Alarms
Highest priority
Lowest priority
1
2
3
4
•Warning - Patient hazard
•Patient and System at risk
•Needs immediate action
•Treatment suspended
•Malfunction - Failure of safety system
•Patient and System at risk
•Needs immediate action
•Treatment suspended
•Caution - Informs operator of an action
•Patient and System not at immediate risk
•Needs action
•Treatment continues; Blood and syringe flows continue
•Advisory - Informs operator of an action
•Patient and System not at immediate risk
•Treatment continues; Blood and syringe flows continue

52. •Read Screen
•Follow Steps
•Check Manual
The THREE
Troubleshooting Commandments

53. Alarm Screens

54. Alarm Screens Softkeys
Silences alarm, beeps every 2 minutes
Repeats test for alarm condition
Overrides alarm for 60 seconds
Clears alarm and restarts pumps
Allows user to change set
Opens return line clamp
Allows user to view list of active alarms
MUTE
OVERRIDE
RETEST
CONTINUE
NEW SET
OPEN
CLAMP
EXAMINE
ALARMS
UNLOAD FLOW
RATES
DIS-
CONNECT
CHANGE
SYRINGE
MUTE

55. Pressure Monitoring
-50 to –150
+100 to +250
> +50 to -150
+50 to +150

56. Access Pressure
•Pressure created by pulling blood
from patient through access
•Access pressure usually negative
•Blood flow rate
•Blood source
(e.g., CVC, AV Fistula,
blood access device)
•Typical pressure:
-50mmHg to -150mmHg
Access
-50 to –150

57. Confirm positive range only
if connected to external blood device or AV Fistula

58. Positive range requires re-confirmation from
user.

59. Return Pressure
•Pressure created by returning
blood to patient through access
•Uses internal pressure sensor/
deaeration chamber monitor line
•Usually positive
•Typical pressure:
+50mmHg to +150mmHg
Return
+50 to +150

60. Return Line - Monitor Fluid Barrier (Code 20)
•Setup: Secure connection of fluid
barrier to return pressure port
•Monitor Deaeration Blood level in
deaeration chamber hourly during
treatment
•Adjust chamber if necessary
(SYSTEM TOOLS)
Wet fluid barrier may cause errors
in return pressure readings.
Maintain level

61. Filter Pressure
•Circuit pressure to push
blood into filter
•Most positive pressure
displayed
•Typical pressure:
+100mmHg to +250mmHg
Filter
+100 to +250

62. Effluent Pressure

•Pressure depends on:
•Therapy and UFR
•Typical pressure:
+50mmHg to -150mmHg
Effluent
> +50 to -150

63. Software Calculated Pressures
Prismaflex
calculates pressures
so you don’t have too!!

64. • Trans-membrane Pressure (TMP)
• Filter Pressure Drop (∆P Filter)

65. Trans-Membrane Pressure (TMP)
•Pressure exerted on filter
membrane during operation

•Reflects pressure difference
between fluid and blood
compartments of filter
•Calculated by Prismaflex software

66. Trans-Membrane Pressure (TMP)
Calculated and automatically recorded:
•Entering Run mode - blood flow is stabilized
• Blood flow rate is changed
• Patient fluid removal rate is changed
• Replacement solution rate is changed
Membrane permeability TMP

67. Filter Pressure Drop (ΔP Filter)
•Change of pressure from
blood entering filter and
leaving filter
•Determines pressure
conditions inside hollow
fibers
•Calculated and automatically
recorded:
•Entering Run mode
•Blood flow rate is changed
•Calculated by Prismaflex
software

68. Access and Return Pressures
Is it the Vascular Access??

70. Access Pressure Extremely Negative
Due to vascular access/catheter:
•Sitting against vessel wall
•Fibrin coating on outside of catheter lumens
•Clots on inside of catheter lumens
•Size is too small (Adults require 11 Fr or larger)
Other possible causes:
•Stopcocks inline with Prismaflex set
•Position of patient
Kinking bloodlines
•Ensure lines are unclamped

72. Return Pressure Extremely Positive
•Due to vascular access catheter:
•Sitting against vessel wall
•Fibrin coating on outside of catheter lumens
•Clots on inside of catheter lumens
•Size is too small
Adults require 11 Fr and larger
•Other possible causes:
•Stopcocks inline with Prismaflex set
Infusing something into Return side of the Prismaflex
circuit can increase Return Pressure
•Position of patient
•Kinking bloodlines
•Ensure lines are unclamped

73. Warning
Access Disconnection-Pressure is zero
•Disconnection
•Pressure pod not installed
properly
•Debris in pod housing
•BFR too low for vascular
access
•Pressure sensor failed
•Press MUTE
•Secure connection
•Press OVERRIDE
•Increase BFR
•Clean, reinstall, reposition pod
•Self-test or manually
•Consult screen display for
more info
•Follow hospital protocol if
unable to repair.
Possible Causes: Possible Solutions:

74. Warning
Return Disconnection-Pressure is zero
•Disconnection
•Pressure pod not installed
properly
•Dirty pod
•BFR too low
•Pressure sensor failed
•Press STOP
•Press MUTE
•Increase BFR
•Clean, reinstall, reposition pod
•Press OVERRIDE
•Follow hospital protocol if
unable to repair.
Causes: Solutions:

75. Advisory: “Cannot Detect . . .”
•Advisory: Cannot detect access: 0 to –10mmHg
•Use of large bore patient catheter
•Low blood flow for type of vascular access
•Self-clears if condition does not exist
•Advisory: Cannot detect return: 0 to +10mmHg
•Loose or disconnected return line
•Low blood flow for type of vascular access
•Loose or disconnected chamber monitor line
•Wet fluid Barrier filter

76. Hemofilter Pressures
Is it the Filter??

77. Filter Extremely Positive
•Line clamped, kinked
•High return pressure
•Clotting in filter has begun
•Pressure sensor failed
•Press MUTE
•Remove clamps or kinks
•Lower BFR
•Press CONTINUE
•Change set
Possible Causes: Possible Solutions:

80. Safety Features

81. Blood Leak Detected (BLD)
•Leakage of blood to the fluid side of the
hemofilter
•Other causes:
•Air in effluent line
•Effluent line not properly installed in BLD
•Myoglobin (trauma, burn, Rhabdomyolysis)
•Bilirubin (Liver failure, Hyperbilirubin) Conjugated only
•Debris in sensor housing

82. Blood Leak Detected: First Actions
•Confirm that line is properly installed
•Press OVERRIDE
•Press line into detector from the bottom up
•Press OVERRIDE
•Clean inside of detector with a lint-free cloth and
isopropyl alcohol
•Dry thoroughly
•Reinsert line

83. BLD Alarm: Normalize BLD
•Press SYSTEM TOOLS on Status screen
•Press NORMALIZE BLD soft key
•Follow instructions
•Observe or test effluent for blood
•If positive for blood, press END TREATMENT
•(Do not return blood,?) and set up new circuit .

84. Effluent Testing Do’s & Don’t’s
•When testing effluent, DO:
•Use a quantitative method:
•Run effluent as though it were blood
•Perform RBC count
•Results should be zero
•Run as Peritoneal cell count
•When testing effluent DO NOT:
•Use Hem-a-Stix or other urine dipstix
•Run effluent as urine sample

85. Air Bubble Detector
•Ultrasonic
•Located along return line
•Alarm activated by:
•air in blood
•micro air
Air Detector
Return Line Clamp

86. Considerations for Air Detector
•Monitor blood level in deaeration chamber hourly with
I&O
•Keep blood level at designated line on chamber
•Blood level too high with return line clamping may allow Blood
to enter fluid barrier and interior of control panel
•Fluid level too low may cause “Air in Blood” alarm

87. Air in Blood
Possible Causes:
•Improper connection
•Catheter
•Anticoagulation
•Replacement line
•Blood warmer connector
•Improper priming
•Return line not installed
properly
•Access pressure extremely
negative
Possible Solutions:
•Check and tighten connections
•Install return line properly
•Perform air removal procedure:
•Status Screen
•SYSTEM TOOLS
•ADJUST CHAMBER
•Lower blood flow rate
•Replace filter set

88. Warning: Wrong set loaded
•Occurs during SET-UP
•Re-select loaded filter
•Change filter set to prescribed therapy
•Check set-up and reposition filter set properly
•Re-load correct set
•Check that return line is tightly inserted into
pressure port or blue thing not tight enough
•Clean Bar Code reader window

89. Syringe Pump
•Malfunction: Syringe not loaded
•Occurs during setup
•Reload syringe in “CHANGE SYRINGE”
•RETEST
•Disable syringe function
•Advisory: Check syringe line - clamped line
•Occurs during setup and treatment
•All pumps stop (8 sec) to retest
•If unresolved, followed by next alarm
•Warning: Syringe empty/clamped
•Occurs during setup and treatment
•Unclamp syringe line
•Replace with filled syringe

90. Advisory: Time to Change Set
•Occurs after 72 hours or when 780 L of
fluid is processed
•Available in HISTORY SCREEN, then
CHANGE PERIOD

91. CRRT Scales
Inspect scale for
foreign object
Replace effluent bag
Bag is specifiedWarning (CAUTION):
Effluent bag full
Bag is empty or
supported
Bag is specifiedWarning (CAUTION):
Bag container empty
Change the effluent bag or
modify “Bag Volume”
Hang appropriate bag
Allow bag to hang freely
Hanging effluent bag does
not match set “Allowed
effluent volume”
No bag on scale or bag is
partially supported
Warning (CAUTION):
Effluent bag incorrect
Inspect scale component
and remedy, then close
properly
Specific scale
identified
Warning (CAUTION):
Scale open

92. CRRT Scales
Inspect bag/line for
patency
View history for flow
volume
May cause unsafe
fluid balance errors
Early notice of
clamped bag or line
immediately after a
bag change
Advisory:
Clamped bag

93. ®
Fluid Control Unit
Continuous Monitor feedback
Balances fluid between:
•Scales
•Software
•Pumps
“Incorrect Weight Change Detected”
fluid variance in Patient Fluid Removal
compare to the set Fluid Removal
rate

94. Determined by:
• Patient Size
• Patient condition
•Hemodynamic stability
Fluid Safety Guard
Setting Excess Patient Fluid Limit
100-400ml over
3hr
330 mlM100
HF1000
HF1400
100-200ml over
3hr
130 ml M60
RangeDefaultCRRT Set

95. Expected Variance in Fluid Removal
•Alarm condition that stops fluid pumps
•Treatment is stopped , then resumed
•Change bag interruption
A small amount of variance from set patient fluid
removal rate is normal due to interruptions in
treatment.

96. Incorrect Weight Change Detected
Causes:
•Frangible pin(s) in solution bags not completely broken
•Kinked or clamped fluid line
•Bags swinging on scale hook
•Leaking bags or bag lines not properly connected
•Foreign object on scales
•Partially supported bags (not hanging freely)
Occurs when weight on one or more scales does not
change according to set fluid flow rates.

97. What triggers the Incorrect Weight
Change Alarm?
•40ml+/- for immediate variance from operator set
patient fluid removal
•120ml variance in one hour from operator set patient
fluid removal

98. Incorrect Weight Change: Patient Fluid LOSS
If:
Dialysate, replacement, or PBP
flow is obstructed
Then:
Fluid may be pulled from patient
through blood side of filter

99. Incorrect Weight Change:
Patient Fluid GAIN
If:
Effluent flow is obstructed
Then:
Fluid may be infused to the
patient from blood side of
filter

100. Early Advisory Alarms
•Provides early notification of flow problems
•Prevents more serious alarm situation/s
•All fluid pumps are operational

101. Fluid Safety Guard
CAUTION: Incorrect Weight Change Detected
Identifies affected scale
Provides current information on unexpected patient
fluid loss or gained over a 3hr cumulative RUN time
 Operator-set fluid limit
Provides on-line troubleshooting instructions

102. End Treatment
•What causes the End Treatment Alarm?
The excess pt fluid loss or gain limit has
been met or exceeded.

103. Fluid Safety Guard
Excess Pt.Fluid Loss or Gain Limit Reached
•Provides instructions to END TREATMENT
•Treatment suspended; blood pump continues; fluid pumps stopped
•Assess patient’s fluid status and need for medical intervention/s

104. References and Further Reading
•Prismaflex Operator Manual
•Prismaflex Tutorial
•Prismaflex Training Guide Software v3.20

105. QUESTIONS?

106. Prismaflexâ System
End Treatment

107. STOP Softkey

108. End Treatment: Three choices
•End treatment
•Change set
•Recirculation

109. Return Blood
START RETURN activates blood
pump only when pressed.
When blood returned, press
CONTINUE.

110. Recirculate
•Temporarily disconnect
•Requires:
•Blood return
•Disconnect patient
•Circulate NS
•Re-prime set before
connecting patient
•Blood pump is activated
•Only immediate syringe bolus, if
syringe is activated during treatment
Note: Volume of NS recirculate adds to total blood/fluid processed
for filter. Advisory alarm to change set occurs at 780L.

111. End treatment
Procedure:
•Disconnect patient
•Unload and
remove filter set
•Disconnect bags
It is possible to end treatment with or
without returning patient’s blood.
End Treatment

115. Gambro is here to assist you
24 hours a day
7 days a week:
1-800-525-2623

116. References and Further Reading
•Prismaflex Operator Manual
•Prismaflex Tutorial