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Kidney Dialysis Monitor 
Research Report 
Gina Metssalu 
Piret Uustal 
supervised by: 
Ruth-Helene Melioranski 
Martin Pärn 
Sven Sõrmus 
in cooperation with: 
Tehnomeedikum / 
Tallinna Tehnikaülikool 
Biomeditsiinitehnika instituut 
spring 2014
Introduction 
The researchers' team of Technomedicum have worked out and 
patented a new optical method to monitor uremic toxins in the 
blood and through that raise the quality of the dialysis process. 
The task for our semester project is to design 
- the physical body for the new device (incl. the functions, case, 
semantics etc) 
- the communication between dialysis device and users (patient, 
nurse, doctor).
Backround 
Approximately 2.2 million end stage renal disease (ESRD) patients are treated worldwide, 1.5 
of them are haemodialysis (HD) patients and the growth of new patients is approximately 7% 
a year (1). Without the treatment the patients would die rather quickly (after ca 3-4 days) due 
to complications caused by excessive body water and uremic toxins in the body. A large part of 
patients’ life quality decrease and HD expenditures are related to hospitalisations and interventions 
due to the side effects causing high morbidity and mortality (2). Therefore, to improve well-being 
of the patients and cost effectiveness, the society is interested that adequate renal replacement 
therapy with high quality and minimum complications is offered. 
What is a dialysis? 
· Dialysis is the artificial replacement for lost kidney function. 
· Eliminating waste (diffusion) and unwanted water (ultrafiltration) from 
the blood 
· Well functioning kidneys filter all the blood in your body with 30 min. 
· 2 leading causes of kidney disease are high blood pressure and 
diabetes. 
· It is possible to live with only one kidney. 
The functions of the kidney 
Excretory functions 
- remove waste products 
- remove excess fluid 
- regulate acid-base balance 
- regulate electrolyte levels 
Secretory functions 
- regulate blood pressure (renin) 
- regulate red blood cell production (EPO) 
- regulate calcium uptake (active vitamin D)
Treatment Modalities 
Hemodialysis 
In hemodialysis, your blood flows through a machine that has a filter 
which cleans the blood. This machine is called a dialyzer or artificial kidney. 
Hemodialysis is usually done three times a week, several hours each session. It 
can be done at a dialysis center or at home. To get your blood into the dialyzer, 
two needles are inserted into your vein during each dialysis treatment. 
- hemofiltration 
- hemodiafiltration 
http://clinicindelhi.com/hemodialysis/
Treatment Modalities 
Peritoneal dialysis 
How does peritoneal dialysis work? 
A soft tube, called a catheter, is placed in your belly. This is done by minor surgery. This 
catheter makes it possible for you to easily connect to a special tubing which allows 
two to three quarts of a cleansing fluid to flow into your belly. The cleansing fluid is 
called dialysate. It takes about 10 minutes for the dialysate to fill a belly. When the filling 
is done, the catheter is capped so that it doesn't leak. The lining of a belly (called the 
peritoneal membrane) acts as a natural filter. It lets the wastes and extra fluid in blood 
pass through it into the cleansing fluid. At the same time, the lining of a belly holds 
back the important things a body needs, like red blood cells and nutrients. To do its job, 
the dialysate must stay in a belly for two hours or more, depending on body size and 
how much waste has to be removed. This time is called dwell time. After dwell time, 
cleansing fluid must be drained from body into an empty bag. In-and-out process must 
be repeated a number of times during the day, using fresh dialysate. PD can be done at 
home, at work, or while traveling. 
Two options: 
- Continuous cycling peritoneal dialysis or automated dialysis (CCPD) 
With CCPD, a machine called a cycler does the exchanges automatically while you sleep. 
You may also need to do one exchange during the day if your kidney function decreases 
further. 
- Continuous ambulatory peritoneal dialysis (CAPD) With CAPD, you do the exchanges 
yourself three to four times a day. 
http://sainternshipufs.blogspot.com/2012/06/4-5-june-2012-universitas-hospital.html
Treatment modalities 
Kidney transplant 
A kidney transplant is an operation that places a healthy kidney in your 
body. The transplanted kidney takes over the work of the two kidneys 
that failed, so you no longer need dialysis. 
If you have a transplant, you must take drugs for the rest of your life, to 
keep your body from rejecting the new kidney. 
Transplanted kidney usually works well 8-10 years, after that it needs to 
be replaced. 
Currently (2014) 99 000 people are in a waiting list of kidney donor in 
USA. Fewer than 17 000 receive one each year. 
Every day 14 people die waiting for a new kidney. 
Alternatives 
UCSF researchers today unveiled a prototype model of the 
first implantable artificial kidney, in a development that one 
day could eliminate the need for dialysis. 
3D printed Kidney - by Surgeon Anthony Atala. An 
early-stage experiment that could someday solve the 
organ-donor problem: a 3D printer that uses living cells 
to output a transplantable kidney 
Revital Cohen - Dialysis Sheep (2008) 
http://www.ucsf.edu/news/2010/09/4450/ucsf-unveils-model-implantable- 
artificial-kidney-replace-dialysis 
http://blog.sculpteo.com/2011/08/10/3d-printing-for-regenerative-medicine/ 
http://designculturelab.org/2011/08/06/dialysis-sheep-sacrificial-lambs-black- 
sheep-and-speculative-designs-publics/ 
http://www.medindia.net/ 
healthnews/kidney-transplantation-news. 
asp
Research Methodology 
Online research 
To map out the nature and need of dialysis, to learn the dialysis 
process in detail and to identify the problems that dialysis patients are 
experiencing. 
GIGAmapping 
Mapping out different aspects of dialysis and the problems related to it. 
Analysing their interconnections. Finding new connections between the 
parts of the process. (addendum A) 
On-site observation at the hospital 
To understand the interaction between the patient and the hemodialysis 
machine. 
To monitor the workload of nurses. 
To monitor the activities of the patients during the dialysis process. 
Interview with a patient and patient journey 
To recieve a feedback from the patient about the dialysis process. 
To map the level of his understanding of the process and the need for it. 
To understand patient’s daily schedule due to dialysis and his attitude 
towards it. 
The poll 
To get statistics. To map the level of patients understanding of the 
process. To measure the scope of the problem. To find out patients 
needs and expectations.
Overview of the research 
Reality in hemodialysis 
· 2,2 million ESRD patients worldwide (about 1,5 million HD 
patients) 
· 7 % annual growth rate 
· time consuming: 4-5 hrs, 3-4 times/week 
· Life expectancy if a person starts dialyse in the age over 75 
years: 25 % - 1 year 60 % - 5 years 
· Life expectancy if a person starts dialyse in twenties: 20 or in 
some cases even 30 years 
· complex medical and dietary regimen 
· expensive- ca 50 billion USD annually 
· complications 
Patient needs a 
dialysis process 
3-4 times in a week 
and it takes 3-5 
hours. 
Blood urea concentration over a time of period 
(several dilaysis) 
Wed Fri Mon Wed Fri 
Blood urea concentration mmol/l 
25 
20 
15 
10 
5 
-20 
30 
0
Overview of the research 
http://www2.nephrocare.com/global/en/ 
products/5008.html 
On-site observation at the hospital 
- Majority of the patients are under the care of nurse 
* safer environment 
* fear of doing hemodialysis at home 
- Newer hemodialysis machines have patient-friendly screens and 
operating principles and can be operated by the patients themselves. 
- Younger and more fit patients interact with new machine themselves. 
- During the dialysis the nurses are required to fill out patient records 
manually 
Newest machines at the 
hospitals now. Patient friendlier. 
Self service. 
Current machines at the hospotal. 
No patient-machine interaction takes 
place. 
Older machines. Currently stocked 
aways and used only if really needed.
KIDNEY DIALYSIS 
WHAT IS A DIALYSIS? 
Dialysis is the artificial replacement for lost kidney function. 
It is an artificial process of eliminating waste (diffusion) and unwanted 
water (ultrafiltration) from the blood. Kidneys do this naturally. If a kidney 
is failed or damaged and cannot carry out the function properly - a person 
may need dialysis. 
Kidneys filter all the blood in your body with 30 min. 
90 000 people die of kidney desease (more than Breast and Prostate cancer 
combined) 
Hospital 
Addendum A 
STAKEHOLDERS 
FAMILY EMPLOYER 
PATIENT 
HOSPITAL SUPPLIERS 
SYSTEM 
COMPETOTORS 
SELLING DIALYSIS 
MACHINES 
Patient 
2 leading causes of kidney desease are high blood pressure and diabetes. 
It is possible to live with only one kidney. 
BABY CHILD TEENAGER STUDENT HEMODIALYSIS AT THE HOSPITAL 
3-4 x week 
3-5 hours 
stuck to the machine 
wasted time 
painful 
vein infection 
For patients with other health problems and for elderly people 
MON TUE WED TH FRI SAT SUN MON 
under medical care 
less infection 
“social club” 
get out of house 
meet other people 
HEMODIALYSIS AT HOME 
PERITONEAL DIALYSIS 
For patients with no needles 
no pain 
suitable for kids 
flexible schedule 
less dietary restrictions 
doable at night 
easy to travel 
4 times in a day 
30 min 
risk of infection 
3 x week 
3-4 hours 
5-7 x week 
2 hours 
8 Home 
Doctor Nurse 
Data of dialysis effectiveness in 2 days 
Preparing the machine 
Sterilyzing flites 
Start pump and timer 
Measure blood pressure in every 30 minutes 
Removing the tubes from the patient in 3-5 hours 
Patient recovery 10-15 minutes 
Possible aftereffects 
PROCESS 
Measure: 
kg 
temperature 
blood pressure when standing and sitting 
Measure: 
kg 
temperature 
blood pressure when standing and sitting 
FACTS 
based on data of USA 
1 out of 10 people (over 18 years old) have reduced kidney function 
Currently (2014) 99 000 people are in a waiting list of kidney donor. 
Fiewer than 17 000 receive one each year. 
Every day 14 people die waiting for a new kidney. 
Today’s dialysis machines are far from perfect. Their efficiency is only 
around 10% of that of a functioning kidney, and when used three times 
per week, they are incapable of controlling unhealthy fluctuations in the 
concentrations of metabolites such as urea in the blood. 
Life expectancy if a person starts dialyse in the age over 75 years: 
25 % - 1 year 
60 % - 5 years 
Life expectancy if a person starts dialyse in twenties: 
20 or in some cases even 30 years. 
SCHEDUAL 
HEMODIALYSIS
FEELINGS QUALITY OF LIFE 
SCHOOL WORK 
VACATION 
http://designculturelab.org/2011/08/06/dialysis-sheep-sacrificial-lambs-black- 
Business - new device 
sheep-and-speculative-designs-publics/ 
by Piret Uustal I Gina Metssalu I 2014 
supervised by Birger Sevaldson 
STUDENT PARENT ELDERLY 
YOUNG 
WORKING 
PEOPLE 
fear 
uncertainty 
lack of motivation 
helplessness 
routine 
no freedom 
being a burden 
uselessness 
no finances 
uncertain of future 
depressing 
waiting 
allone 
what’s the point 
time lost 
want to enjoy the last years of your life 
8 % of all dialysises (in USA) 
with no other health problems 
infection 
6 x week 
6-8 hours 
Every other night 
6-8 hours 
Due to longer/more frequent dialysis: 
feel better 
less/no nausea 
less/no “washed out” feeling 
less/no headache 
less/no cramping 
fexible schedule 
more toxins removed 
risk of infection 
need long training 
need “care partner” (family member) 
need to hire a “care partner” 
POTENTIAL IDEA 
growing number of patients - 6 % in a year 
currently on dialysis - 3 million people 
currently on hemodialysis - 1.3 million peoplew 
Instant data of Dialysis quality 
SAVE TIME 
SAVE MONEY 
shorter tiem of dialysis 
new use of old machines (eg. in poor countries) 
See the future 
Be like others 
Feel useful 
Financial independence 
Do what you love 
Freedom 
Motivation 
Enjoy the life 
patient diary 
easy data handling 
data sharing Doctor-Nurse-Patient-Family member 
UCSF researchers today unveiled a prototype model of the first 
implantable artificial kidney, in a development that one day could 
eliminate the need for dialysis. 
3D printed Kidney - by Surgeon Anthony Atala. An early-stage 
experiment that could someday solve the organ-donor problem: a 3D 
printer that uses living cells to output a transplantable kidney 
Revital Cohen - Dialysis Sheep (2008) 
http://www.ucsf.edu/news/2010/09/4450/ucsf-unveils-model-implantable-artificial-kidney-replace-dialysis 
http://blog.sculpteo.com/2011/08/10/3d-printing-for-regenerative-medicine/ 
Alternatives 
HEMODIALYSIS 
MACHINE 
ADDED SCREEN 
ADDED SENSOR 
HOSPITAL 
FAMILY 
patient diary 
at home 
.............. 
................ 
.................. 
http://sainternshipufs.blogspot.com/2012/06/4-5-june-2012-universitas-hospital.html 
by Piret Uustal I Gina Metssalu I 2014 
supervised by Birger Sevaldson
Overview of the research 
Interview with a patient / patient journey 
Male I 81 years old I dialysis patient over 2 years 
- had kidney failure after heart surgery when he was given wrong medicine (overdose 
of Potassium) which injured his kidney functions. 
-kidney dialysis every Mon, Wed, Friday, from 8-12 
- patient himself is responsible monitoring his heart rate during the dialysis. If its too 
low or high the patient moves the position of the bed to raise his legs. 
- the patient is not aware of the effectiveness of the dialysis in the end of the process. 
He is not monitoring the display of the machine (even if there is screen it is not visible 
nor understandable for the patinet). 
- if the display would be visible and understandable to the patient he would be 
interested and positively influenced to see the effectiveness of the dialysis process. 
- the patient follows the remaining time of the dialysis process from the sepparate 
wall clock. He does not see the timer from the machine. 
- he feels fairly good after the dialysis. He walkes home 15-20 minutes and needs to 
sleep 2 hours to feel completely well. 
- the patient claimed that when he was sometimes placed under an older model of 
hemodialysis machine he did not feel comfortable and did not trust the effect of the 
dialysis as much 
- the inability to use restroom during the dialysis process is sometimes a problem 
Older hemodialysis machine
Overview of the research 
Patients 
In order to get overview of patients habits and their awareness of hemodialyses process 
we conducted a research among the hemodialyses patients in estonia. There is about 200 
regular HD patients and we got answers from 32. It makes ab 16 percent of all patients in 
Estonia. 
Age 
Working?
Overview of the research 
Patient awareness of the dialyses process 
44 % of the patients are not aware 
what is happening with their blood 
during the dialyses process 
64 % NOT aware what does the data 
displayed on the machine (such as 
Kt/v) means. 
79% NOT aware how clean is their 
blood after the dialysis. 
48% believe that knowing the results 
of the dialysis process effectiveness 
would influence them positively. 
80% following their blood pressure 
during the process.
Overview of the research 
Dialyses at home? 
80% NOT willing to do dialysis at 
home 
43% believes dialysis at home would 
affect their daily routine 
Main reasons: 
- no conditions 
- don’t dare 
- not sterile enough - live alone 
- fear of blood, needles and whole 
process 
25% would be more encouraged to 
have dialysis at home if the doctor 
has overview of the process in real 
time.
Findings 
Hemodialysis machine and sensor 
- The benefits of real-time measurement are obvious: if Kt/ V is only checked monthly or quarterly, it 
may be months before suboptimal dosing is discovered. By measuring online during every therapy, 
the new sensor is able to identify suboptimal dosing immediately, support timely adjustments in 
treatment parameters and also eliminate common process- related factors influencing the previous 
reference method (taking of blood samples). 
In medicine, Kt/V is a number used to quantify hemodialysis and peritoneal dialysis treatment adequacy. 
K - dialyzer clearance of urea 
t - dialysis time 
V - volume of distribution of urea, approximately equal to patient’s total body water 
Increase blood flow 
Improvement in clearance 
Positive effect on Kt/V 
There are 4 ways of how the doctor, nurse or patient can influence 
the Kt/V during dialysis process thanks to the costant information of 
dialysis quality given by new sensor:
High concentartion of substances 
Reduce blood flow Increase dialysate flow Longer dialysis time 
Improvement in clearance 
Positive effect on Kt/V 
Improvement in clearance 
Positive effect on Kt/V 
Improvement in clearance 
Positive effect on Kt/V
Findings 
Patient 
- The patient is interested in knowing and following the effectiveness of dialysis during the process. 
- The patient would be positively motivated if he was able to monitor the effect of the process. 
- Newer dialysis machine and a machine that is understandable to the patient raises trust towards the 
process and makes the patiet interact with the machine (more independence to the patient, less work 
to the hospital stuff)
Findings 
Doctors / Nurses 
-The ability to receive constant feedback of the patients dialysis quality eliminates the “guess work” of 
the nurses and doctors in setting the machine parameters before an during the dialysis process. 
The optimal dialysis process for each patient can be figured out faster and is based on reliable data. 
- The machine could ease the workload of nurses by automatically saving the information of the 
dialysis process (work that is now done manually). 
- In case the patient recives dialysis in a different clininc (e.g. while traveling) the data of the patients 
dialysis parameters will be available to the nurses and doctors in a new clinic as well. 
Nursing file what now is 
filled by hand for each 
patient
Findings 
Market 
- Older models of hemodialysis machines that have new sensor can be used in a more effective way. 
- Hemodialysis machines can be made avaialable to more patients. Older machines that would be 
otherwsie disregarded can be taken more clinics and to rural areas so the patient would not have to 
travel long distances to receive dialysis. 
- Less developed countries with older dialysis machines can offer better dialysis quality to their 
patients and make it avaialble to more people. 
- Lower costs than purchasing brand-new hemodialysis machines. 
Regulations 
- There are several laws and regulations in Estonia for producing, maintaining and handling medical 
devices (3), but as far as we talking about adding the new sensor only as a affix to outlet hose, then we 
are not influenced by them directly.
Findings 
Existing solutions 
The first integrated dialysis dose monitor in the world, utilising the UV-technology, is the Adimea system 
(Option Adimea, BBraun Avitum AG) (B. Braun Avitum AG 2010). The heart of the Adimea system is the 
optical sensor DiaSens, integrated into the HD machine, delivering values of real-time Kt/V or URR for 
the dialysis team during a treatment
Goal 
Increase patient motivation 
to take better care of their 
health through raising 
awareness of the dialysis 
process.
Focus 
The existing analysers are built in the whole kidney dialysis apparatus. The aim is to develop a 
standalone analyser which suits with dialysers produced by different companies. 
Today the procedure takes place in the hospital under the control of the medical personnel. The 
new system is connected with internet and should be able to work also in the other environments 
out of hospital and patient should be able to manage with it alone. 
The disadvantages of the existing methods for uremic toxins determination are utilization 
of disposables or chemicals, rather complicated and expensive measurement procedure. To 
overcome those difficulties, a monitoring system would be preferable. Recently a good correlation 
between ultraviolet (UV)-absorbance and several small removed waste solutes (urea, Cr, UA) has 
been found, indicating that UV-absorbance may enable monitoring of several uremic toxins linked 
to the malnutrition–inflammation complex syndrome and the risk factors of CVD. The obtained 
results demonstrate the possibility to follow a single hemodialysis session continuously and 
to monitor deviations in the dialysator performance by using UV-absorbance. The UV-method 
does not need blood samples, any disposables or chemicals, is fast, and allows continuous 
measurements of the standard dialysis adequacy parameters (e.g. Kt/V, URR). 
http://www.bbraun-avitum.ro/cps/rde/xchg/av-avitum- 
ro-ro/hs.xsl/7370.html 
http://www.cb.ttu.ee/ee/edu/DBB0070/Biooptics_HD_ 
public.pdf
Focus 
External sensor 
· Real- time measurement system 
· Photometric sensor that continuously measures light absorption in spent dialysate 
· Estimating the reduction of substances concentration, which is linearly related to their concentration 
in blood 
· Capable of delivering Kt/V in most treatment models, including HDF, HD and single needle treatment 
Advantages 
· continous, on-line monitoring. Other methods- once in every 25 min. New sensor every 6 
sec ( Kt/V) 
· no blood sampling 
· without any disposables or chemicals 
· evaluates delivery of prescribed treatment dose (Kt/V) 
· can estimate TRU, PCR, URR 
· possibility to measure other solutes besides urea 
· estimation until the target is achieved 
· no interference with dialysis machine’s operation
Values 
Values for patient 
Values How? 
- simple, 
understandable,always visible 
screen 
- blood result instantly shows if 
patient has been taking care of 
his health (eg. correct diet) 
- practice in the hospital, 
simplicity of the process and 
awareness encourages to do 
dialysis at home 
- aware what is happening 
- cares more of his/her health 
- independence
Values for nurse 
Values How? 
- patient data stored in the 
device and easily accessible 
when needed 
- most data saved automaticaly 
to the new screen during the 
process 
-machine setup based on exact 
blood data. Alarm if goal not 
achived. 
- easy data handling and storing 
- save time 
- easier setup of dialysis machine 
Values
Values 
Market 
Currently, there is about 600 000 old hemodialysis machines in the 
world. Many of these machines are in good condition, but miss certain functions 
limiting the treatment modalities a clinic can perform. 
Those functionality could be raised significally by adding them 
percise sensor and extra screen.
Concept in use 
Patient journey 
CHOOSE MACHINE 
Nurse waches and 
marks down the 
weight 
OLD MACHINE MANUAL PROCESS 
MACHINE TESTING 
AND SETUP 
ca 15 min 
INSTALL 
FILTER, TUBES, 
DIALYSATES 
CONNECT 
PATIENT WITH 
MACHINE 
CONNECT 
PATEINET TO 
MEASURE BLOOD 
PRESSURE 
(connect with 
machine) 
CHOOSE PROGRAM 
-Hemodialysis 
-Hemodiafiltration (HDF) 
- Ultrafiltration 
BLOOD PRESSURE 
starts screening in a 
patient page view 
MACHINE ADJUSTS 
AUTOMATICALLY 
ACCORDING TO 
PATIENT 
ALL SETUP MADE 
INSTANTLY 
CHANGES CAN BE 
MADE 
START 
(MACHINE) 
Can blood pressure 
be measured at the 
same time in 2 places 
(in dialysis machine 
and on NEW SCREEN) 
2 connections. 
So blood pressure 
could be followed 
from the screen. 
what happens if 
blood pressure will 
be shown only on 
NEW SCREEN. What 
changes in Dialysis 
machine? Does it 
affect anything? 
Is bloodpressure 
data usually saved to 
magnetic card also? Is 
it needed for that? 
MAGNETIC CARD 
WEIGH THE 
PATIENT 
NEW MACHINE 
1 
2 3 
4 5 6 
7 8 
Prebooks always new 
Weights herself and 
remembers it 
machine 
Sets up the machine 
parameters- with 
magnetic card 
Nurse prepares 
machine 
Connects herself-needles, 
sensors etc 
Patient chooses pro-gram 
Starts machine 
Start of new screen-automatically, 
after 
fluid starts flowing- 
TIME AND BLOOD 
PRESSURE as a 
screen saver 
BLOOD PRESSURE 
as a screensaver 
Just comes every 
mondey, wendsday 
and friday at 8 oclock 
Nurse prepares 
machine 
Nurse connects with 
machine 
Nurse sets up the 
machine 
Nurse choses 
program 
Nurse 
STARTs 
Machine 
Security code necessary? 
Nurse gets info 
about PREvIOUS 
SESSION 
PARAMETERS 
Start of new screen-automatically, 
after 
fluid starts flowing- 
TIME AND BLOOD 
PRESSUREin a 
patient page view 
CAN IT START AUTOMATICALLY 
AFTER FLUID 
STARTS RUNNING? 
PORTABLE SCREEN for 
INSERTING WEIGHT 
INSTANTLY already in 
“weighting Cabinet” 
JAAK, 62 
Pensioner. Doesn’t work, lives alone 
in Mustamäe. 
PIIA, 32 
Works as a project manager, studies 
administrative management in TTU-s 
master program. Mother of two chil-dren. 
Travels a lot 
HOME MENU-PATIENT 
SELECTION-INSERTING 
WEIGHT 
MACHINE NEEDS TO 
BE SET UP 
Piias actings Jaaks actings Nurses actings NEW SCREEN Ns- Piias acting Ns- nurse acting Ns- Jaak acting
SENSOR ALARM 
-change something 
HOW DOES 
PATIENT 
FEEL 
75% of GOAL 
FOOD DIARY 
SYNC 
NURSE ENTERS 
CHANGES TO THE 
SCREEN: 
- BLOOD FLOW 
-DIALYSATE FLOW 
- UF PROFILE +/- 
NURSE CHANGES 
PARAMETERS ON 
MACHINE: 
- BLOOD FLOW 
-DIALYSATE FLOW 
- UF PROFILE +/- 
DIALYSIS TIME 
ADJUSTS ON THE 
SCREEN GRAPH 
SAvE 
PROCESS 
PRINT 
DATA 
WHICH 
DATA 
NEEDS 
PRINTING? 
CAN CHANGE SETUP 
PARAMETERS 
-kg 
-dialysis time 
... 
In the case of independent patient - 
who fills out the paper sheet for nurses 
now? Is patient able to do this? 
Is all that data always needed? 
FEEL 
+ UNFASTEN THE 
PATIENT 
FEEL 
- 
low blood 
pressureT 
clogged fistula 
(MACHINE) 
arter/vein 
pressure 
blood sugar 
(MACHINE) 
cramps 
(MACHINE) 
headache 
(MACHINE) 
DISPLAYED : 
-previous dialysis data 
-usual setup parameters (kg, dialysis 
time) 
-medicaments 
-previous blood test results from lab 
- patient food DIARY 
CHOOSE PROGRAM 
-Hemodialysis 
-Hemodiafiltration (HDF) 
- Ultrafiltration 
9 10 
11 12 
13 14 15 
Takes the new Screen 
Inserts parameters 
to the New Screen 
Home menu- 
PATIENT SELECTION 
PATIENT 
PARAMETERS 
PRECISE GRAPH 
SCREEN 
progress is going on 
as predicted 
Usual time is up, but 
screen shows onlly 
75% of result 
Becouse of upcom-ing 
meeting chooses 
to finish anyway 
Suggestions to the 
next time 
Prebooks for the next 
time longer session Disconnects herself 
Waches his blood 
pressure 
Calls nurse when not 
feeling good 
Weights herself 
PRECISE GRAPH 
SCREEN 
lack of GOAL 
Nurse 
changes parameters 
AUTOMATICALLY 
SAvES ALL 
WIRELESS 
CONNECTION? 
GOAL 
gets better 
GOAL 
is achieved 
Nurse 
disconnects 
nurse inserts weight 
SAvE 
PROCESS 
PRINT 
DATA 
Nurse 
takes blood sample 
nurse inserts BLOOD 
TEST RESULTS 
Nurse waches and 
marks down the 
weight 
inserts weight
Interface structure 
Home menu 
Patient selection ô 
orders to stock? 
suggested parameters 
patient 1 
Blood pressure 
(+ time) 
as a screensaver 
suggested 
parameters 
WeigHt 
beforeô 
after ô 
WeigHt 
History 
edit 
patient info 
treatment 
plan 
Blood tests Food diary 
program 
-Hemodialysis 
-Hemodiafiltration ô- 
Ultrafiltration 
uF 
goal 
time 
4:00 ô 
patient 
inFo 
- name 
-barcode 
-doctors name 
-height 
-age 
-... 
History 
- date 
-trend graphs 
start 
treatment 
plan 
-medicaments 
-.... 
Food 
diary 
Blood tests 
-predictable graph 
-goal % 
-time % 
-blood pressure 
-uf rate 
-art press 
-ven press 
-... 
Back 
alarm 
- Blood FloW ô 
-dial. FloW ô 
- uF proFile ô 
FinisH 
suggestions 
WeigHt 
print 
The information measured by the sensor is instantly displayed on the screen. 
To map out the user interface and keeping in mind the goal for values we went 
through patients journeys and built the structure for user interface.
Display
Display 
Information displayed on the screen is translated into graphics so everyone, even 
elderly patient can grasp visually what is happening with their blood at this very 
moment. 
The most vital information for the patient ( blood pressure, % of the process 
effectiveness and time remained) is displayed as a screen saver. 
If it now, for example, happens that the patient has been eating nonproper food on a 
previous day, the result instantly shows on the screen. This will help him to understand 
and assess how his lifestile and diet can influence his health. And that, in turn, motivates 
him to take control over his health...and not leaving it to the doctors only.
Display 
Also the nurses will benefit of the new solution. It will make easier 
for them to set up the dialysis machine according to each patients 
needs. The setup data of the most effective process for this patient is already 
automatcally displayed and the nurse doesnt have to guess which process gives the 
most positive result to the patient. 
Nurses time is saved by not having to fill out papers by hand for each patient. All the 
data about the process wat now is edited by hand could be saved automaticallyby the 
screen and if paper version is still needed, it can be simply printed out.
Sensor case 
Process of ideas for sensor case
Dialysis Product & Interface
Dialysis Product & Interface

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Dialysis Product & Interface

  • 1. Kidney Dialysis Monitor Research Report Gina Metssalu Piret Uustal supervised by: Ruth-Helene Melioranski Martin Pärn Sven Sõrmus in cooperation with: Tehnomeedikum / Tallinna Tehnikaülikool Biomeditsiinitehnika instituut spring 2014
  • 2. Introduction The researchers' team of Technomedicum have worked out and patented a new optical method to monitor uremic toxins in the blood and through that raise the quality of the dialysis process. The task for our semester project is to design - the physical body for the new device (incl. the functions, case, semantics etc) - the communication between dialysis device and users (patient, nurse, doctor).
  • 3. Backround Approximately 2.2 million end stage renal disease (ESRD) patients are treated worldwide, 1.5 of them are haemodialysis (HD) patients and the growth of new patients is approximately 7% a year (1). Without the treatment the patients would die rather quickly (after ca 3-4 days) due to complications caused by excessive body water and uremic toxins in the body. A large part of patients’ life quality decrease and HD expenditures are related to hospitalisations and interventions due to the side effects causing high morbidity and mortality (2). Therefore, to improve well-being of the patients and cost effectiveness, the society is interested that adequate renal replacement therapy with high quality and minimum complications is offered. What is a dialysis? · Dialysis is the artificial replacement for lost kidney function. · Eliminating waste (diffusion) and unwanted water (ultrafiltration) from the blood · Well functioning kidneys filter all the blood in your body with 30 min. · 2 leading causes of kidney disease are high blood pressure and diabetes. · It is possible to live with only one kidney. The functions of the kidney Excretory functions - remove waste products - remove excess fluid - regulate acid-base balance - regulate electrolyte levels Secretory functions - regulate blood pressure (renin) - regulate red blood cell production (EPO) - regulate calcium uptake (active vitamin D)
  • 4. Treatment Modalities Hemodialysis In hemodialysis, your blood flows through a machine that has a filter which cleans the blood. This machine is called a dialyzer or artificial kidney. Hemodialysis is usually done three times a week, several hours each session. It can be done at a dialysis center or at home. To get your blood into the dialyzer, two needles are inserted into your vein during each dialysis treatment. - hemofiltration - hemodiafiltration http://clinicindelhi.com/hemodialysis/
  • 5. Treatment Modalities Peritoneal dialysis How does peritoneal dialysis work? A soft tube, called a catheter, is placed in your belly. This is done by minor surgery. This catheter makes it possible for you to easily connect to a special tubing which allows two to three quarts of a cleansing fluid to flow into your belly. The cleansing fluid is called dialysate. It takes about 10 minutes for the dialysate to fill a belly. When the filling is done, the catheter is capped so that it doesn't leak. The lining of a belly (called the peritoneal membrane) acts as a natural filter. It lets the wastes and extra fluid in blood pass through it into the cleansing fluid. At the same time, the lining of a belly holds back the important things a body needs, like red blood cells and nutrients. To do its job, the dialysate must stay in a belly for two hours or more, depending on body size and how much waste has to be removed. This time is called dwell time. After dwell time, cleansing fluid must be drained from body into an empty bag. In-and-out process must be repeated a number of times during the day, using fresh dialysate. PD can be done at home, at work, or while traveling. Two options: - Continuous cycling peritoneal dialysis or automated dialysis (CCPD) With CCPD, a machine called a cycler does the exchanges automatically while you sleep. You may also need to do one exchange during the day if your kidney function decreases further. - Continuous ambulatory peritoneal dialysis (CAPD) With CAPD, you do the exchanges yourself three to four times a day. http://sainternshipufs.blogspot.com/2012/06/4-5-june-2012-universitas-hospital.html
  • 6. Treatment modalities Kidney transplant A kidney transplant is an operation that places a healthy kidney in your body. The transplanted kidney takes over the work of the two kidneys that failed, so you no longer need dialysis. If you have a transplant, you must take drugs for the rest of your life, to keep your body from rejecting the new kidney. Transplanted kidney usually works well 8-10 years, after that it needs to be replaced. Currently (2014) 99 000 people are in a waiting list of kidney donor in USA. Fewer than 17 000 receive one each year. Every day 14 people die waiting for a new kidney. Alternatives UCSF researchers today unveiled a prototype model of the first implantable artificial kidney, in a development that one day could eliminate the need for dialysis. 3D printed Kidney - by Surgeon Anthony Atala. An early-stage experiment that could someday solve the organ-donor problem: a 3D printer that uses living cells to output a transplantable kidney Revital Cohen - Dialysis Sheep (2008) http://www.ucsf.edu/news/2010/09/4450/ucsf-unveils-model-implantable- artificial-kidney-replace-dialysis http://blog.sculpteo.com/2011/08/10/3d-printing-for-regenerative-medicine/ http://designculturelab.org/2011/08/06/dialysis-sheep-sacrificial-lambs-black- sheep-and-speculative-designs-publics/ http://www.medindia.net/ healthnews/kidney-transplantation-news. asp
  • 7. Research Methodology Online research To map out the nature and need of dialysis, to learn the dialysis process in detail and to identify the problems that dialysis patients are experiencing. GIGAmapping Mapping out different aspects of dialysis and the problems related to it. Analysing their interconnections. Finding new connections between the parts of the process. (addendum A) On-site observation at the hospital To understand the interaction between the patient and the hemodialysis machine. To monitor the workload of nurses. To monitor the activities of the patients during the dialysis process. Interview with a patient and patient journey To recieve a feedback from the patient about the dialysis process. To map the level of his understanding of the process and the need for it. To understand patient’s daily schedule due to dialysis and his attitude towards it. The poll To get statistics. To map the level of patients understanding of the process. To measure the scope of the problem. To find out patients needs and expectations.
  • 8. Overview of the research Reality in hemodialysis · 2,2 million ESRD patients worldwide (about 1,5 million HD patients) · 7 % annual growth rate · time consuming: 4-5 hrs, 3-4 times/week · Life expectancy if a person starts dialyse in the age over 75 years: 25 % - 1 year 60 % - 5 years · Life expectancy if a person starts dialyse in twenties: 20 or in some cases even 30 years · complex medical and dietary regimen · expensive- ca 50 billion USD annually · complications Patient needs a dialysis process 3-4 times in a week and it takes 3-5 hours. Blood urea concentration over a time of period (several dilaysis) Wed Fri Mon Wed Fri Blood urea concentration mmol/l 25 20 15 10 5 -20 30 0
  • 9. Overview of the research http://www2.nephrocare.com/global/en/ products/5008.html On-site observation at the hospital - Majority of the patients are under the care of nurse * safer environment * fear of doing hemodialysis at home - Newer hemodialysis machines have patient-friendly screens and operating principles and can be operated by the patients themselves. - Younger and more fit patients interact with new machine themselves. - During the dialysis the nurses are required to fill out patient records manually Newest machines at the hospitals now. Patient friendlier. Self service. Current machines at the hospotal. No patient-machine interaction takes place. Older machines. Currently stocked aways and used only if really needed.
  • 10. KIDNEY DIALYSIS WHAT IS A DIALYSIS? Dialysis is the artificial replacement for lost kidney function. It is an artificial process of eliminating waste (diffusion) and unwanted water (ultrafiltration) from the blood. Kidneys do this naturally. If a kidney is failed or damaged and cannot carry out the function properly - a person may need dialysis. Kidneys filter all the blood in your body with 30 min. 90 000 people die of kidney desease (more than Breast and Prostate cancer combined) Hospital Addendum A STAKEHOLDERS FAMILY EMPLOYER PATIENT HOSPITAL SUPPLIERS SYSTEM COMPETOTORS SELLING DIALYSIS MACHINES Patient 2 leading causes of kidney desease are high blood pressure and diabetes. It is possible to live with only one kidney. BABY CHILD TEENAGER STUDENT HEMODIALYSIS AT THE HOSPITAL 3-4 x week 3-5 hours stuck to the machine wasted time painful vein infection For patients with other health problems and for elderly people MON TUE WED TH FRI SAT SUN MON under medical care less infection “social club” get out of house meet other people HEMODIALYSIS AT HOME PERITONEAL DIALYSIS For patients with no needles no pain suitable for kids flexible schedule less dietary restrictions doable at night easy to travel 4 times in a day 30 min risk of infection 3 x week 3-4 hours 5-7 x week 2 hours 8 Home Doctor Nurse Data of dialysis effectiveness in 2 days Preparing the machine Sterilyzing flites Start pump and timer Measure blood pressure in every 30 minutes Removing the tubes from the patient in 3-5 hours Patient recovery 10-15 minutes Possible aftereffects PROCESS Measure: kg temperature blood pressure when standing and sitting Measure: kg temperature blood pressure when standing and sitting FACTS based on data of USA 1 out of 10 people (over 18 years old) have reduced kidney function Currently (2014) 99 000 people are in a waiting list of kidney donor. Fiewer than 17 000 receive one each year. Every day 14 people die waiting for a new kidney. Today’s dialysis machines are far from perfect. Their efficiency is only around 10% of that of a functioning kidney, and when used three times per week, they are incapable of controlling unhealthy fluctuations in the concentrations of metabolites such as urea in the blood. Life expectancy if a person starts dialyse in the age over 75 years: 25 % - 1 year 60 % - 5 years Life expectancy if a person starts dialyse in twenties: 20 or in some cases even 30 years. SCHEDUAL HEMODIALYSIS
  • 11. FEELINGS QUALITY OF LIFE SCHOOL WORK VACATION http://designculturelab.org/2011/08/06/dialysis-sheep-sacrificial-lambs-black- Business - new device sheep-and-speculative-designs-publics/ by Piret Uustal I Gina Metssalu I 2014 supervised by Birger Sevaldson STUDENT PARENT ELDERLY YOUNG WORKING PEOPLE fear uncertainty lack of motivation helplessness routine no freedom being a burden uselessness no finances uncertain of future depressing waiting allone what’s the point time lost want to enjoy the last years of your life 8 % of all dialysises (in USA) with no other health problems infection 6 x week 6-8 hours Every other night 6-8 hours Due to longer/more frequent dialysis: feel better less/no nausea less/no “washed out” feeling less/no headache less/no cramping fexible schedule more toxins removed risk of infection need long training need “care partner” (family member) need to hire a “care partner” POTENTIAL IDEA growing number of patients - 6 % in a year currently on dialysis - 3 million people currently on hemodialysis - 1.3 million peoplew Instant data of Dialysis quality SAVE TIME SAVE MONEY shorter tiem of dialysis new use of old machines (eg. in poor countries) See the future Be like others Feel useful Financial independence Do what you love Freedom Motivation Enjoy the life patient diary easy data handling data sharing Doctor-Nurse-Patient-Family member UCSF researchers today unveiled a prototype model of the first implantable artificial kidney, in a development that one day could eliminate the need for dialysis. 3D printed Kidney - by Surgeon Anthony Atala. An early-stage experiment that could someday solve the organ-donor problem: a 3D printer that uses living cells to output a transplantable kidney Revital Cohen - Dialysis Sheep (2008) http://www.ucsf.edu/news/2010/09/4450/ucsf-unveils-model-implantable-artificial-kidney-replace-dialysis http://blog.sculpteo.com/2011/08/10/3d-printing-for-regenerative-medicine/ Alternatives HEMODIALYSIS MACHINE ADDED SCREEN ADDED SENSOR HOSPITAL FAMILY patient diary at home .............. ................ .................. http://sainternshipufs.blogspot.com/2012/06/4-5-june-2012-universitas-hospital.html by Piret Uustal I Gina Metssalu I 2014 supervised by Birger Sevaldson
  • 12. Overview of the research Interview with a patient / patient journey Male I 81 years old I dialysis patient over 2 years - had kidney failure after heart surgery when he was given wrong medicine (overdose of Potassium) which injured his kidney functions. -kidney dialysis every Mon, Wed, Friday, from 8-12 - patient himself is responsible monitoring his heart rate during the dialysis. If its too low or high the patient moves the position of the bed to raise his legs. - the patient is not aware of the effectiveness of the dialysis in the end of the process. He is not monitoring the display of the machine (even if there is screen it is not visible nor understandable for the patinet). - if the display would be visible and understandable to the patient he would be interested and positively influenced to see the effectiveness of the dialysis process. - the patient follows the remaining time of the dialysis process from the sepparate wall clock. He does not see the timer from the machine. - he feels fairly good after the dialysis. He walkes home 15-20 minutes and needs to sleep 2 hours to feel completely well. - the patient claimed that when he was sometimes placed under an older model of hemodialysis machine he did not feel comfortable and did not trust the effect of the dialysis as much - the inability to use restroom during the dialysis process is sometimes a problem Older hemodialysis machine
  • 13. Overview of the research Patients In order to get overview of patients habits and their awareness of hemodialyses process we conducted a research among the hemodialyses patients in estonia. There is about 200 regular HD patients and we got answers from 32. It makes ab 16 percent of all patients in Estonia. Age Working?
  • 14. Overview of the research Patient awareness of the dialyses process 44 % of the patients are not aware what is happening with their blood during the dialyses process 64 % NOT aware what does the data displayed on the machine (such as Kt/v) means. 79% NOT aware how clean is their blood after the dialysis. 48% believe that knowing the results of the dialysis process effectiveness would influence them positively. 80% following their blood pressure during the process.
  • 15. Overview of the research Dialyses at home? 80% NOT willing to do dialysis at home 43% believes dialysis at home would affect their daily routine Main reasons: - no conditions - don’t dare - not sterile enough - live alone - fear of blood, needles and whole process 25% would be more encouraged to have dialysis at home if the doctor has overview of the process in real time.
  • 16. Findings Hemodialysis machine and sensor - The benefits of real-time measurement are obvious: if Kt/ V is only checked monthly or quarterly, it may be months before suboptimal dosing is discovered. By measuring online during every therapy, the new sensor is able to identify suboptimal dosing immediately, support timely adjustments in treatment parameters and also eliminate common process- related factors influencing the previous reference method (taking of blood samples). In medicine, Kt/V is a number used to quantify hemodialysis and peritoneal dialysis treatment adequacy. K - dialyzer clearance of urea t - dialysis time V - volume of distribution of urea, approximately equal to patient’s total body water Increase blood flow Improvement in clearance Positive effect on Kt/V There are 4 ways of how the doctor, nurse or patient can influence the Kt/V during dialysis process thanks to the costant information of dialysis quality given by new sensor:
  • 17. High concentartion of substances Reduce blood flow Increase dialysate flow Longer dialysis time Improvement in clearance Positive effect on Kt/V Improvement in clearance Positive effect on Kt/V Improvement in clearance Positive effect on Kt/V
  • 18. Findings Patient - The patient is interested in knowing and following the effectiveness of dialysis during the process. - The patient would be positively motivated if he was able to monitor the effect of the process. - Newer dialysis machine and a machine that is understandable to the patient raises trust towards the process and makes the patiet interact with the machine (more independence to the patient, less work to the hospital stuff)
  • 19. Findings Doctors / Nurses -The ability to receive constant feedback of the patients dialysis quality eliminates the “guess work” of the nurses and doctors in setting the machine parameters before an during the dialysis process. The optimal dialysis process for each patient can be figured out faster and is based on reliable data. - The machine could ease the workload of nurses by automatically saving the information of the dialysis process (work that is now done manually). - In case the patient recives dialysis in a different clininc (e.g. while traveling) the data of the patients dialysis parameters will be available to the nurses and doctors in a new clinic as well. Nursing file what now is filled by hand for each patient
  • 20. Findings Market - Older models of hemodialysis machines that have new sensor can be used in a more effective way. - Hemodialysis machines can be made avaialable to more patients. Older machines that would be otherwsie disregarded can be taken more clinics and to rural areas so the patient would not have to travel long distances to receive dialysis. - Less developed countries with older dialysis machines can offer better dialysis quality to their patients and make it avaialble to more people. - Lower costs than purchasing brand-new hemodialysis machines. Regulations - There are several laws and regulations in Estonia for producing, maintaining and handling medical devices (3), but as far as we talking about adding the new sensor only as a affix to outlet hose, then we are not influenced by them directly.
  • 21. Findings Existing solutions The first integrated dialysis dose monitor in the world, utilising the UV-technology, is the Adimea system (Option Adimea, BBraun Avitum AG) (B. Braun Avitum AG 2010). The heart of the Adimea system is the optical sensor DiaSens, integrated into the HD machine, delivering values of real-time Kt/V or URR for the dialysis team during a treatment
  • 22. Goal Increase patient motivation to take better care of their health through raising awareness of the dialysis process.
  • 23. Focus The existing analysers are built in the whole kidney dialysis apparatus. The aim is to develop a standalone analyser which suits with dialysers produced by different companies. Today the procedure takes place in the hospital under the control of the medical personnel. The new system is connected with internet and should be able to work also in the other environments out of hospital and patient should be able to manage with it alone. The disadvantages of the existing methods for uremic toxins determination are utilization of disposables or chemicals, rather complicated and expensive measurement procedure. To overcome those difficulties, a monitoring system would be preferable. Recently a good correlation between ultraviolet (UV)-absorbance and several small removed waste solutes (urea, Cr, UA) has been found, indicating that UV-absorbance may enable monitoring of several uremic toxins linked to the malnutrition–inflammation complex syndrome and the risk factors of CVD. The obtained results demonstrate the possibility to follow a single hemodialysis session continuously and to monitor deviations in the dialysator performance by using UV-absorbance. The UV-method does not need blood samples, any disposables or chemicals, is fast, and allows continuous measurements of the standard dialysis adequacy parameters (e.g. Kt/V, URR). http://www.bbraun-avitum.ro/cps/rde/xchg/av-avitum- ro-ro/hs.xsl/7370.html http://www.cb.ttu.ee/ee/edu/DBB0070/Biooptics_HD_ public.pdf
  • 24. Focus External sensor · Real- time measurement system · Photometric sensor that continuously measures light absorption in spent dialysate · Estimating the reduction of substances concentration, which is linearly related to their concentration in blood · Capable of delivering Kt/V in most treatment models, including HDF, HD and single needle treatment Advantages · continous, on-line monitoring. Other methods- once in every 25 min. New sensor every 6 sec ( Kt/V) · no blood sampling · without any disposables or chemicals · evaluates delivery of prescribed treatment dose (Kt/V) · can estimate TRU, PCR, URR · possibility to measure other solutes besides urea · estimation until the target is achieved · no interference with dialysis machine’s operation
  • 25. Values Values for patient Values How? - simple, understandable,always visible screen - blood result instantly shows if patient has been taking care of his health (eg. correct diet) - practice in the hospital, simplicity of the process and awareness encourages to do dialysis at home - aware what is happening - cares more of his/her health - independence
  • 26. Values for nurse Values How? - patient data stored in the device and easily accessible when needed - most data saved automaticaly to the new screen during the process -machine setup based on exact blood data. Alarm if goal not achived. - easy data handling and storing - save time - easier setup of dialysis machine Values
  • 27. Values Market Currently, there is about 600 000 old hemodialysis machines in the world. Many of these machines are in good condition, but miss certain functions limiting the treatment modalities a clinic can perform. Those functionality could be raised significally by adding them percise sensor and extra screen.
  • 28. Concept in use Patient journey CHOOSE MACHINE Nurse waches and marks down the weight OLD MACHINE MANUAL PROCESS MACHINE TESTING AND SETUP ca 15 min INSTALL FILTER, TUBES, DIALYSATES CONNECT PATIENT WITH MACHINE CONNECT PATEINET TO MEASURE BLOOD PRESSURE (connect with machine) CHOOSE PROGRAM -Hemodialysis -Hemodiafiltration (HDF) - Ultrafiltration BLOOD PRESSURE starts screening in a patient page view MACHINE ADJUSTS AUTOMATICALLY ACCORDING TO PATIENT ALL SETUP MADE INSTANTLY CHANGES CAN BE MADE START (MACHINE) Can blood pressure be measured at the same time in 2 places (in dialysis machine and on NEW SCREEN) 2 connections. So blood pressure could be followed from the screen. what happens if blood pressure will be shown only on NEW SCREEN. What changes in Dialysis machine? Does it affect anything? Is bloodpressure data usually saved to magnetic card also? Is it needed for that? MAGNETIC CARD WEIGH THE PATIENT NEW MACHINE 1 2 3 4 5 6 7 8 Prebooks always new Weights herself and remembers it machine Sets up the machine parameters- with magnetic card Nurse prepares machine Connects herself-needles, sensors etc Patient chooses pro-gram Starts machine Start of new screen-automatically, after fluid starts flowing- TIME AND BLOOD PRESSURE as a screen saver BLOOD PRESSURE as a screensaver Just comes every mondey, wendsday and friday at 8 oclock Nurse prepares machine Nurse connects with machine Nurse sets up the machine Nurse choses program Nurse STARTs Machine Security code necessary? Nurse gets info about PREvIOUS SESSION PARAMETERS Start of new screen-automatically, after fluid starts flowing- TIME AND BLOOD PRESSUREin a patient page view CAN IT START AUTOMATICALLY AFTER FLUID STARTS RUNNING? PORTABLE SCREEN for INSERTING WEIGHT INSTANTLY already in “weighting Cabinet” JAAK, 62 Pensioner. Doesn’t work, lives alone in Mustamäe. PIIA, 32 Works as a project manager, studies administrative management in TTU-s master program. Mother of two chil-dren. Travels a lot HOME MENU-PATIENT SELECTION-INSERTING WEIGHT MACHINE NEEDS TO BE SET UP Piias actings Jaaks actings Nurses actings NEW SCREEN Ns- Piias acting Ns- nurse acting Ns- Jaak acting
  • 29. SENSOR ALARM -change something HOW DOES PATIENT FEEL 75% of GOAL FOOD DIARY SYNC NURSE ENTERS CHANGES TO THE SCREEN: - BLOOD FLOW -DIALYSATE FLOW - UF PROFILE +/- NURSE CHANGES PARAMETERS ON MACHINE: - BLOOD FLOW -DIALYSATE FLOW - UF PROFILE +/- DIALYSIS TIME ADJUSTS ON THE SCREEN GRAPH SAvE PROCESS PRINT DATA WHICH DATA NEEDS PRINTING? CAN CHANGE SETUP PARAMETERS -kg -dialysis time ... In the case of independent patient - who fills out the paper sheet for nurses now? Is patient able to do this? Is all that data always needed? FEEL + UNFASTEN THE PATIENT FEEL - low blood pressureT clogged fistula (MACHINE) arter/vein pressure blood sugar (MACHINE) cramps (MACHINE) headache (MACHINE) DISPLAYED : -previous dialysis data -usual setup parameters (kg, dialysis time) -medicaments -previous blood test results from lab - patient food DIARY CHOOSE PROGRAM -Hemodialysis -Hemodiafiltration (HDF) - Ultrafiltration 9 10 11 12 13 14 15 Takes the new Screen Inserts parameters to the New Screen Home menu- PATIENT SELECTION PATIENT PARAMETERS PRECISE GRAPH SCREEN progress is going on as predicted Usual time is up, but screen shows onlly 75% of result Becouse of upcom-ing meeting chooses to finish anyway Suggestions to the next time Prebooks for the next time longer session Disconnects herself Waches his blood pressure Calls nurse when not feeling good Weights herself PRECISE GRAPH SCREEN lack of GOAL Nurse changes parameters AUTOMATICALLY SAvES ALL WIRELESS CONNECTION? GOAL gets better GOAL is achieved Nurse disconnects nurse inserts weight SAvE PROCESS PRINT DATA Nurse takes blood sample nurse inserts BLOOD TEST RESULTS Nurse waches and marks down the weight inserts weight
  • 30. Interface structure Home menu Patient selection ô orders to stock? suggested parameters patient 1 Blood pressure (+ time) as a screensaver suggested parameters WeigHt beforeô after ô WeigHt History edit patient info treatment plan Blood tests Food diary program -Hemodialysis -Hemodiafiltration ô- Ultrafiltration uF goal time 4:00 ô patient inFo - name -barcode -doctors name -height -age -... History - date -trend graphs start treatment plan -medicaments -.... Food diary Blood tests -predictable graph -goal % -time % -blood pressure -uf rate -art press -ven press -... Back alarm - Blood FloW ô -dial. FloW ô - uF proFile ô FinisH suggestions WeigHt print The information measured by the sensor is instantly displayed on the screen. To map out the user interface and keeping in mind the goal for values we went through patients journeys and built the structure for user interface.
  • 32. Display Information displayed on the screen is translated into graphics so everyone, even elderly patient can grasp visually what is happening with their blood at this very moment. The most vital information for the patient ( blood pressure, % of the process effectiveness and time remained) is displayed as a screen saver. If it now, for example, happens that the patient has been eating nonproper food on a previous day, the result instantly shows on the screen. This will help him to understand and assess how his lifestile and diet can influence his health. And that, in turn, motivates him to take control over his health...and not leaving it to the doctors only.
  • 33. Display Also the nurses will benefit of the new solution. It will make easier for them to set up the dialysis machine according to each patients needs. The setup data of the most effective process for this patient is already automatcally displayed and the nurse doesnt have to guess which process gives the most positive result to the patient. Nurses time is saved by not having to fill out papers by hand for each patient. All the data about the process wat now is edited by hand could be saved automaticallyby the screen and if paper version is still needed, it can be simply printed out.
  • 34. Sensor case Process of ideas for sensor case