8. Máy tự động LOAD quả lọc và nhận diện thông qua Barcode
Tránh để các đường dây bị gập trong
khi LOAD quả
Đảm bảo tất cả các cổng đo áp lực và
các đường theo dõi đều được kết nối
10. Đảm bảo kết nối các đường dịch đúng vị trí
Recommended
priming volume
and syringe
11. Setup - CVVHDF
Kết nối chạc chữ Y với túi dịch mồi, treo lên giá bên trái
Kết nối đường PBP với túi dịch PBP (chai HTM 0,9% 500ml), treo lên cân
Kết nối đường dịch thẩm tách (xanh) với túi dịch thẩm tách, treo lên cân
Kết nối đường dịch thay thê (tím) với túi dịch thay thế, treo lên cân
Kết nối về (xanh đậm) với túi dịch thải
12. Setup - CVVHD
Kết nối chạc chữ Y với túi dịch mồi, treo lên giá bên trái
Kết nối đường PBP với túi dịch PBP (chai HTM 0,9% 500ml), treo lên cân
Kết nối đường dịch thẩm tách (xanh) với túi dịch thẩm tách, treo lên cân
Kết nối về (xanh đậm) với túi dịch thải
13. Setup - CVVH
Kết nối đường dịch thay thê (tím) với túi dịch thay thế, treo lên cân
Kết nối chạc chữ Y với túi dịch mồi, treo lên giá bên trái
Kết nối đường PBP với túi dịch PBP (chai HTM 0,9% 500ml), treo lên cân
Kết nối đường dịch thẩm tách (xanh) với túi dịch thẩm tách, treo lên cân
Kết nối đường dịch thay thê (tím) với túi dịch thay thế, treo lên cân
Kết nối về (xanh đậm) với túi dịch thải
17. v e r i t y Vetup
P in ng so u on equ ed o h s se 0 m
Allowed syringe brand and size: BD 20 ml
01/Januap/70 0100
Unclamp any clamped lines
Ve6¶ all connections are correct and sec
Press PRIME to start automatic priming.
18.
19. Chức năng mồi quả chỉ tiến hành khi ta nhấn chọn phím prime
Chú ý luôn đảm bảo có đủ dịch mồ
20. <Insert REPRIME screen>
• Requires one full bag of priming solution.
• Automatically primes all lines.
• Check effluent bag if change is required.
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
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
50. Safety Feature Components
Display screen
Pressure Monitors
Air Bubble
Detector
Return Line
Clamp
Blood/Patient
Sensor
Blood Leak
Detector
Bar Code Reader
Syringe Pump
Pressure Monitors
Scales
Alarm Lights
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
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
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
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)
Màng lọc bị ướt có thể gây ra lỗi
đo áp lực đường v
• 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)
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
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
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
71.
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
Possible Causes:
•Disconnection
•Pressure pod not installed
properly
•Debris in pod housing
•BFR too low for vascular
access
•Pressure sensor failed
Possible Solutions:
•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.
74. Warning
Return Disconnection-Pressure is zero
Causes:
•Disconnection
•Pressure pod not installed
properly
•Dirty pod
•BFR too low
•Pressure sensor failed
Solutions:
•Press STOP
•Press MUTE
•Increase BFR
•Clean, reinstall, reposition pod
•Press OVERRIDE
•Follow hospital protocol if
unable to repair.
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
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
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
Warning (CAUTION):
Scale open
Specific scale
identified
Inspect scale component
and remedy, then close
properly
Warning (CAUTION):
Effluent bag incorrect
Hanging effluent bag does
not match set “Allowed
effluent volume”
No bag on scale or bag is
partially supported
Change the effluent bag or
modify “Bag Volume”
Hang appropriate bag
Allow bag to hang freely
Warning (CAUTION):
Bag container empty
Bag is specified Bag is empty or
supported
Warning (CAUTION):
Effluent bag full
Bag is specified Inspect scale for
foreign object
Replace effluent bag
92. CRRT Scales
Advisory:
Clamped bag
Early notice of
clamped bag or line
immediately after a
bag change
Inspect bag/line for
patency
View history for flow
volume
May cause unsafe
fluid balance errors
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 CRRT Set Default Range
M60 130 ml 100-200ml over
3hr
M100
HF1000
HF1400
330 ml 100-400ml over
3hr
95. Expected Variance in Fluid Removal
A small amount of variance from set patient fluid
removal rate is normal due to interruptions in
treatment.
• Alarm condition that stops fluid pumps
• Treatment is stopped , then resumed
• Change bag interruption
96. Incorrect Weight Change Detected
Occurs when weight on one or more scales does not
change according to set fluid flow rates.
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)
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
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.
