PrismaFlex ® STEPP

•Basic Components

Hemofilter

Basic Components in CRRT

CRRT

Blood WarmerVascular access

Anticoagulation

CRRT System

Solutions

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

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

Anticoagulation

Commonly utilized:

• Heparin

• Citrate

Purpose of Warmers in CRRT

• Prevent heat loss

• Minimize calorie loss

• Patient comfort

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

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

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

Prismaflex Disposable Set: Specifications

Sets Surface Area (m2)

BFR (ml/min)

DFR (ml/hr)

Priming Volume

(ml)

Blood Volume

(ml)

Max Filtration Capacity (ml/hr)

M60* 0.6 50-180 0-4000 1000 93 4000-pre

3000-post

2000-pbp

M100 0.9 75-400 0-8000 1000 152 8000-pre

6000-post

4000-pbp

HF1000 1.15 75-400 0-8000 1000 165

HF1400 1.4 75-400 0-8000 2000 186

*Indicated for patients >11kg

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

Gambro Solution Options

Use as dialysate solution Use as replacement solutionPrismaSol

Composition

PrismaSol®

Composition

Preparation of Solution

5L ready-to-use solution obtained after breaking red frangible pin between two compartments

Prismaflex ® System

Overview

The Next Generation Continuous Blood

Purification Technology

The Prismaflex® System

•Communication Unit

•Flow Control Unit

•Fluid Control Unit

®

Communication Unit

• Interactive, color, touch screen

• Machine status lights

Interactive Display Screen Step-by-Step Instructions

•12 in. colored touch-screen•Displays a color-coded diagram of required actions

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.

®

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

Effluent

Pre Blood Pump Replacement

Blood

Flow Control Unit – Pumps

Syringe

Dialysate

Pinch Valves

Effluent

Filter

Return

Access

Flow Control Unit Pressure Monitoring

Pressure Monitoring

Pressure Pods

To Software

PressureSensor

Air side

Bloodline

DiaphragmPressure PodFluid side

Front Panel

Prismaflex® Operator’s Manual Chapter 4-p52

Pressure Pod System

Return Pressure Monitor

Pressure Port

Monitor Line

Deaeration

Chamber

Blood Leak Detector

Air Bubble Detector

Return LineClamp

Safety Components

Deaeration Chamber Holder

Bar Code Reader

ECG Discharger Ring

Flow Control Unit:Deaeration Chamber

• Allows semi-automatic

air removal

• Post dilution fluid layer (~200mL/hr)

eliminates air blood interface

Flow Rates Summary

SCUF CVVH CVVHD CVVHDF

Principles UF UF,Con UF,Diff UF,Diff, Con

Blood Flow (ml/min) 450 450 450 450

Pt Fluid Removal 2 L/hr 2L/hr 2L/hr 2L/hr

Dialysate 0 0 8L/hr 8L/hr

Replacement 0 8L/hr 0 8L/hr

PBP 1L/hr 8L/hr 8L/hr 8L/hr

Note: Total Effluent Volume 10L/hr

®

Fluid Control Unit

• Scales

• Effluent

• Replacement

• Dialysate/ 2nd replacement

• Pre-Blood Pump (PBP)

• Scale hook assemblies

• Color-coded tubing guides

Fluid Control Unit• Scale hook assembly

• Slide-out bar tray

• Removable carrying bar

• Scales-

• Effluent

• Pre-blood pump (PBP)

• Dialysate

• Replacement