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Dialog+ SW 9.xx HDF Online. Technical Support International презентация
Содержание
- 1. Dialog+ SW 9.xx HDF Online. Technical Support International
- 2. HDF Online Upgrade to HDF Online
- 3. What does HDF Online offer? A
- 4. Combines two dialysis technics, Hemodialysis and Hemofiltration
- 5. HF B
- 6. HDF Online Concept PV PA
- 7. AAMI = American Association for
- 8. HDF Online Icon
- 9. HDF-Online Message: “Ratio gross UF rate/blood flow“
- 10. Increase of TMP at start of HDF
- 11. Example for post-dilution: body weight 81 kg weight
- 12. Hardware Components Substitution ports for infusing
- 13. HDF Online – Blood Side Preparation Inlet
- 14. HDF Online Therapy SAD RDV PV
- 15. HDF Online Reinfusion SAD RDV PV
- 16. Balance Chamber Principle Phase 1
- 25. Producing Substitution Fluid Balancing DF-Filter
- 26. DF-Filter OSP
- 27. HDF Online – Dialysate Distribution in the
- 28. Infusion Bolus – Patient Connection and Disconnection
- 29. DF Filter OSP
- 30. HDF Online – Hydraulics 1 Hydrophobe filter with adapter 2 Valve 3/2 way
- 31. Rinsing
- 32. HDF Online – Electronics Tests in TSM
- 33. HDF Online – Filter Testing DF, HDF
- 34. HDF Online – Filter Test Air is
- 35. HDF Online – Filter Tests DF, HDF
- 36. HDF Online – Filter Test DF,
- 37. Calibration RVDA and RVFPE
- 38. Calibration of RVFPA During the calibration pay
- 39. Calibration of DDE During the calibration
- 40. Change after 150 Treatments or 900 Hours
- 41. Maintenance Kit
- 42. Thank you very much for your attention.
Слайд 1Dialog+ SW 9.xx
HDF Online
Technical Support International
B. Braun Avitum AG
Service Training Documentation
Слайд 2HDF Online
Upgrade to HDF Online not possible
Downgrade to standard
machine not possible
All filters are always in use
All filters are always in use
Слайд 3What does HDF Online offer?
A safe procedure with a combination of
HD and HF.
High efficiency with diffusion and convection.
Online production of substitution solution.
Replacing saline for priming and disconnecting the patient.
High efficiency with diffusion and convection.
Online production of substitution solution.
Replacing saline for priming and disconnecting the patient.
Слайд 4Combines two dialysis technics,
Hemodialysis and Hemofiltration
High clearance of small molecules through
diffusion
High clearance of middle molecules through convection
High clearance of middle molecules through convection
mmHg
B
B
D
high-flux
Diffusion + Convection
Hemodiafiltration
Слайд 5HF
B
HD
B
D
B
D
HDF
mmHg
B
mmHg
D
B
D
low-flux
high-flux
high-flux
Diffusion
Convection Adsorption
Diffusion/Convection Adsorption
Types of Therapies
with HDF Online
Слайд 6HDF Online Concept
PV
PA
BLD
high-flux
PBE
Preadapter
BPA
OSP
Substitution port
Postdilution
Predilution
Слайд 7AAMI = American Association for the Advancement of Medical
Instrumentation
Ph. Eur. = European Pharmakopoe
CFU = Colony Forming Units
EU = Endotoxin Units
Ph. Eur. = European Pharmakopoe
CFU = Colony Forming Units
EU = Endotoxin Units
Microbiological Requirements
Слайд 9HDF-Online Message: “Ratio gross UF rate/blood flow“
Start therapy in HD
Mode
First reach correct blood flow
Change to HDF Mode
First reach correct blood flow
Change to HDF Mode
Supresses platelet activation
Lowers protein adsorption
Reduces hemolysis and clotting
Слайд 10Increase of TMP at start of HDF dialysis
hollow fibre
diffusive layer
A
high TMP in the beginning of therapy causes proteins to block the pores
The efficiency of the therapy is reduced
Blocking of the pores reduces the surface area
Even in UF Min the machine has a high Ultrafiltration
The efficiency of the therapy is reduced
Blocking of the pores reduces the surface area
Even in UF Min the machine has a high Ultrafiltration
Слайд 11Example for post-dilution:
body weight 81 kg
weight loss 3 kg
treatment time 5 h
Substituition volume
27 l/h
UF rate 6 l/h (100 ml/min)
nett UF 30 l
total UF 3 l
UF rate 6 l/h (100 ml/min)
nett UF 30 l
total UF 3 l
blood flow 300 ml/min
HDF-Online Message: “Ratio gross UF rate/blood flow“
In postdilution the ratio of total UF/blood flow can be max. 25-30%
In postdilution 30-40 L substitution volume
total substitution volume 1/3 of patient‘s body weight
In predilution 70-100 L substitution volume
30% of 81 = 27 l
27 l + 3 l weight loss = 30 l
30 l : 5 h = 6 l/h
6 l/h : 60 min = 100 ml/min
blood flow 350 ml/min
Example for a patient with 81 kg
Слайд 12 Hardware Components
Substitution ports for infusing of the substitution fluid pre-
or postdilution
Automatic priming of the tubing set with substitution fluid
2 DF filters to ensure clean substitution fluid
replaceable every 150 treatments or 900 hours
Automatic priming of the tubing set with substitution fluid
2 DF filters to ensure clean substitution fluid
replaceable every 150 treatments or 900 hours
Слайд 13HDF Online – Blood Side Preparation
Inlet
Outlet
SAD
RDV
PV PA
PBE
BPA HP
OSP (Online Substitution Pump)
SAKV
Слайд 16
Balance Chamber Principle Phase 1
Inlet Flow Pump
Balance Chamber
Air Separator LA
Outlet Flow
Pump FPA
Ultrafiltration Pump UFP
BLD
PDA
DDE
FPE
RVDA
Слайд 17
Inlet Flow Pump
Balance Chamber
Air Separator LA
Outlet Flow Pump FPA
Ultrafiltration Pump UFP
BLD
PDA
Balance
Chamber Principle Phase 1
DDE
FPE
RVDA
Слайд 18
Inlet Flow Pump
Balance Chamber
Air Separator LA
Outlet Flow Pump FPA
Ultrafiltration Pump UFP
BLD
PDA
Balance
Chamber Principle Phase 1
DDE
RVDA
FPE
Слайд 19
Inlet Flow Pump
Balance Chamber
Air Separator LA
Outlet Flow Pump FPA
Ultrafiltration Pump UFP
BLD
FPE
Balance
Chamber Principle Phase 1
DDE
RVDA
PDA
Слайд 20
Inlet Flow Pump
Balance Chamber
Air Separator LA
Outlet Flow Pump FPA
Ultrafiltration Pump UFP
BLD
PDA
Balance
Chamber Principle Phase 1
FPE
DDE
RVDA
Слайд 21
Inlet Flow Pump
Balance Chamber
Air Seperator LA
Outlet Flow Pump FPA
Ultrafiltration Pump UFP
BLD
PDA
Balance
Chamber Principle Phase 2
DDE
RVDA
FPE
Слайд 22
Inlet Flow Pump
Balance Chamber
Air Separator LA
Outlet Flow Pump FPA
Ultrafiltration Pump UFP
BLD
PDA
Balance
Chamber Principle Phase 2
DDE
RVDA
FPE
Слайд 23
Inlet Flow Pump
Balance Chamber
Air Separator LA
Outlet Flow Pump FPA
Ultrafiltration Pump UFP
BLD
PDA
Balance
Chamber Principle Phase 2
DDE
RVDA
FPE
Слайд 24
Inlet Flow Pump
Balance Chamber
Air Separator LA
Outlet Flow Pump FPA
Ultrafiltration Pump UFP
BLD
PDA
Balance
Chamber Principle Phase 2
DDE
FPE
RVDA
Слайд 26
DF-Filter
OSP
HDF Online Balancing Chamber
600ml/min
600ml/min
520ml/min
600ml/min
+ Patient UFP
80ml/min
80ml/min
80ml/min
+
Patient UFP
+ Patient UFP
600ml/min
FPE
FPA
Balancing
Postdilution
Predilution
Слайд 27HDF Online – Dialysate Distribution in the Filter
QB 300 ml/min
QB 290
ml/min
QUF 90 ml/min
QD 600 ml/min
QD 520 ml/min
QS 80 ml/min
QB 210 ml/min
QD 610 ml/min
DF Filter
HDF Filter
Слайд 28Infusion Bolus – Patient Connection and Disconnection
DF Filter
OSP
For infusion the balancing
chamber and
UF pump are stopped
UF pump are stopped
Free Flow Mode
Postdilution
Predilution
FPE
FPA
Слайд 29
DF Filter
OSP
FPE
FPA
UFP
HDF Online – Hydraulics
HFB
VDE
VDA
VBP
VSAA
VSAE
VDFF
VLA
VSB
DDE
RVDA
RVFPE
RVFPA
VBE
Postdilution
Predilution
Слайд 33HDF Online – Filter Testing
DF, HDF Filter Tests
DF Filter
PDA
DDE
RVDA
RVFPA
FPA
UFP
VDFF
VSB
VBP
VDE
VDA
VSAE
VSAA
VLA
VBE
FPE
RVFPE
Manometer
HFB
The hydraulic circuit
is tested with
VDFF, VSB, VSAE + VSAA
VDFF, VSB, VSAE + VSAA
H2O
FVD
FSU
FBK1
FBK2
500 mbar
400 mbar
650 - 750 mbar
500 mbar
1000 rpm
500 rpm
Free Flow Mode
Слайд 34HDF Online – Filter Test
Air is flushed from the DF-Filter
DF Filter
PDA
DDE
RVDA
RVFPA
FPA
UFP
VDFF
VSB
VBP
VDE
VDA
VSAE
VSAA
VLA
VBE
FPE
RVFPE
Manometer
HFB
H2O
FVD
FSU
FBK1
FBK2
500
mbar
150 - 250 mbar
1000 rpm
500 rpm
The hydraulic circuit is tested with
VDFF, VSB, VSAE + VSAA
Free Flow Mode
Слайд 35HDF Online – Filter Tests
DF, HDF Filter and Port Tests
DF Filter
HDF
Filter
PDA
DDE
RVDA
RVFPA
FPA
UFP
VDFF
VSB
VBP
VDE
VDA
VSAE
VSAA
VLA
VBE
FPE
RVFPE
Manometer
HFB
H2O
FVD
FSU
FBK1
FBK2
500 mbar
350 - 450 mbar
1000 rpm
500 rpm
The hydraulic circuit is tested with
VDFF, VSB, VSAE + VSAA
Free Flow Mode
Слайд 36
HDF Online – Filter Test
DF, HDF Filter and Port Tests
H2O
FVD
DF Filter
PDA
DDE
RVDA
RVFPA
FPA
UFP
VDFF
VSB
VBP
VDE
VDA
VSAE
VSAA
VLA
VBE
FPE
RVFPE
Manometer
HFB
FSU
FBK1
FBK2
500
mbar
400 mbar
-100 mbar
500 mbar
0 rpm
500 rpm
Слайд 37Calibration RVDA and RVFPE
RVDA 500 mbar
RVFPE 1.3 bar
Measuring point for both
calibrations:
flow 500ml/min and temperature 37 °C
flow 500ml/min and temperature 37 °C
without clamp for RVDA adjustment
with clamp the tube next to the FBK2 for RVFPE adjustment
Слайд 38Calibration of RVFPA
During the calibration pay attention to the following:
Both dialyser
couplings should be in a water filled container
The DF filters must be decalcified and free of air
Low level test 1.20 Settings: flow 500ml/min, temperature 37 °C
Clamp the tube next to the FBK2
The DF filters must be decalcified and free of air
Low level test 1.20 Settings: flow 500ml/min, temperature 37 °C
Clamp the tube next to the FBK2
RVFPA 1.3 bar
Слайд 39Calibration of DDE
During the calibration pay attention to the following:
Both
dialyser couplings should be in a water filled container
The DF filters must be decalcified and free of air
Low level test 1.20 Settings: flow 500ml/min, temperature 37 °C
The DF filters must be decalcified and free of air
Low level test 1.20 Settings: flow 500ml/min, temperature 37 °C
DDE 400 mbar
Слайд 40Change after 150 Treatments or 900 Hours
Follow the correct procedure
Chemical disinfection
with Tiutol® KF with the old filter
Empty the filter
Test for residual disinfectant
Change the filter
Reset the counter
Fill in the rinsing mode for 5 minutes
Citric heat disinfection
Empty the filter
Test for residual disinfectant
Change the filter
Reset the counter
Fill in the rinsing mode for 5 minutes
Citric heat disinfection
Слайд 42Thank you very much for your attention.
In case of any further
questions,
please do not hesitate to ask me.
It is a pleasure for me to answer you!
It is a pleasure for me to answer you!
