Dialog Plus Brief Instructions Aug 2008

Double Needle Therapy Enter the treatment parameters via the Parameter icon.

Switch the machine on. Select. The machine changes to the Preparation mode. The self-test of the dialysate (DFS) runs automatically.

Ultrafiltration

Limit values

Heparin

If necessary, after disinfection, check whether machine is free from disinfectant. Use suitable indicator strips. ■

When diskettes / Patient Therapy Cards are used, the patient parameters can be directly read in.

Connect concentrates and bicarbonate.

Insertion of blood line systems. To fill the tubing system with NaCl, start the blood pump with the + button below the monitor. The blood pump stops automatically after a preset filling volume.

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Dialysate

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Setting of treatment parameters

Check correctness of the patient data from Patient Therapy Card and confirm. or Check correctness of the patient data from diskette and confirm.

The following text is shown after a successfully completed test.

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Preparation

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Brief Instructions – Standard Dialysis: Double Needle Therapy

Brief Instructions – Standard Dialysis: Double Needle Therapy

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Follow the instructions on the screen and confirm.

Touch the Connect patient icon. After confirmation, another window is shown.

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The appearance of the window is dependent on the machine configuration. Check the filling on the blood and dialysate sides. Follow the instructions and confirm.

2x

Two short acoustic signals sound and the Enter button is illuminated. Check the patient data and confirm correct data input.

Connect both patient connections for circulation to the saline bag. The automatic self-test on the blood side starts. After completion, the machine additionally activates the UF pump for rinsing the dialysate side.

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Connecting the patient

To change the rinse parameters, touch the following icon.

00:00 (h:min)

After cancellation or expiration of the rinse time, the machine automatically switches to stand-by mode (if preset in the machine configuration). When the Connect patient icon is coloured, it can be switched into Therapy Mode.

To connect the patient, connect the arterial line and start the blood pump by pressing start/stop. During the connecting process, the pressure alarm limits are increased and the machine is in dialysis bypass. If the blood system is filled with blood up to the venous red sensor, the Patient connected alarm is triggered and the blood pump stops automatically. End the alarm with this button.

After connection of the patient venous line, press again this button.

Double Needle Therapy After touching the icons, the window „UF profile“ opens.

Deactivate the Bypass. The Bypass button is now no longer highlighted green.

It is possible to select preset UF profiles (numbered) or to create profiles individually. The desired UF rate can be set by the % button (100% = average rate) or by touching/moving a finger over the touch screen. The complete HD time is divided into 10 time intervals (bars).

Dialysis starts. Call up the treatment parameters with the Overview icon.

For sequential phases, touch desired time interval and set UF rate of interval. The sequential phase is activated by touching the button SEQ. Thereby the bar will be marked yellow. Leave the window by touching the O.K. icon. In sequential phases no hemodialysis is performed!

Acknowledge alarms after checking with 1 x = tone off, 2 x = continue treatment

Arterial Bolus If necessary, minimize ultrafiltration with the MIN-UF icon or switch to Bypass with the Bypass icon.

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Start the blood pump and adjust the blood flow with the + and – buttons on the monitor.

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Sequential therapy (Bergström)/UF profile

For the easy and rapid application of NaCl 0.9% - for example in the case of a decrease of blood pressure - select the function Arterial Bolus. This way you can administer an exactly defined bolus. The maximum bolus is 250 ml.

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Performing the haemodialysis

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Brief Instructions – Standard Dialysis: Double Needle Therapy

Brief Instructions – Standard Dialysis: Double Needle Therapy

During reinfusion, empty the bicarbonate cartridge .

To start the bolus press the Bolus icon.

Attend to the instructions on the screen and confirm. Then check the height of the venous blood level.

End of treatment/Reinfusion When the end of treatment time is reached, an acoustic signal sounds and the machine goes to Bypass. Touch the Terminate therapy icon. If set accordingly, the Reinfusion window opens automatically. Otherwise, touch the Reinfusion icon. The blood pump stops and the Reinfusion window is displayed.

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When the venous red sensor detects sufficient saline, the blood pump stops automatically.

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Disconnect the venous line from the patient. Empty the dialyzer. Follow the instructions and confirm. Touching the Empty dialyzer icon deactivates the blood pump. You cannot return to dialysis! Depending on the basic setting, the machine automatically saves the therapy data and, when Patient Therapy Cards or diskettes are used, queries whether the therapy data are to be saved as new default values. Save only when new setting values are to be accepted for the next treatment.

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Connect the patient arterial line to the saline bag. To start reinfusion, confirm with this button. The reinfusion volume is shown.

Insert the concentrate suction rods into the machine again, remove the bicarbonate cartridge and close the cartridge holder. To switch to disinfection, touch icon and choose disinfection menu. To continue see chapter disinfection.

Brief Instructions – Disinfection

Canceling a running disinfection To cancel an already started disinfection, press the Exit icon and confirm operation.

Start disinfection by pressing the respective icon. Thermal

Central thermal

Long chemical

Central chemical

Short chemical

The main disinfectant for chemical disinfection is preset (usually Citric Acid 50%).

If the machine already contains disinfectant, the required compulsory rinsing is performed automatically. If this is not the case, the screen starts Disinfection rinsing and a different type of disinfection can be selected, for example.

Central rinse

Central disinfection programs include the water inlet/dialyzer outlet hose and must be timed to coincide with the RO equipment.

End of disinfection The following information is displayed after disinfection:

Automatic switching off and on When the Auto switch-off icon is activated, the machine is switched off automatically. To start the Auto Off and Auto On functions of the machine, activate the Auto On icon.

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If the basic setting has been selected accordingly, the machine goes directly to Preparation mode after the end of disinfection.

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by selecting this item in the program selection.

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If the machine is not yet free of disinfectant, continue to rinse the machine and test again.

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Disinfection

Follow the instructions and confirm.

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Start after the completion of therapy by pressing the Disinfection icon

Brief Instructions – Disinfection

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The settings are accepted with the Activate field. The Auto Off function is automatically activated by confirmation with this button.

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Setting of the time for a possible Night action (the machine is switched off after disinfection)

The respective parameters for the next disinfection are set via the fields Time, Type of Disinfection, Disinfectant and Date.

After the successful disinfection, the machine is switched off automatically and switched on again automatically at the time specified.

Day action (the machine remains on after disinfection).

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Setting of disinfection mode and disinfectant (e.g. Long chemical with 50% citric acid) by selection of respective field on the screen. To save the changes, touch the OK icon.

Do not set the main switch on the machine to "Off"!

Disinfection error list for the ongoing disinfection Weekly disinfection program To set the weekly program, touch the icons.

For immediate information and troubleshooting during an ongoing disinfection, a list of all previously occurred warnings/alarms can be shown.

Brief Instructions – HDF/HF Online Therapy

Insert the arterial and venous lines. Leave the drain bag at the end of the venous line for the time being.

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In addition, insert the substitution line into the substitution pump. Do not yet connect the short end of the substitution line. Pay attention to the correct flow direction.

Connect concentrates and bicarbonate. Follow the instructions for action that are highlighted yellow on the screen.

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Now connect the patient connection of the arterial line with the connection of the substitution line which is marked red.

Call up the parameters for HDF-Online via the Parameter icon and the Online icon.

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For postdilution: Connect the long end of the substitution line to an inlet piece of the venous drip chamber.

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For predilution: Connect a predilution adapter between the arterial line and the dialyzer.

Select HDF/HF, the machine automatically changes to PREPARATION. If necessary, after disinfection, check whether machine is free from disinfectant. Use suitable indicator strips. ■

All values shown can be changed as required.

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To perform an HDF in predilution mode, additionally select the Predilution field.

HDF/HF Online Therapy

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Switch on the machine.

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Set-up

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Preparation

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Brief Instructions – HDF/HF Online Therapy

Filling the system with Online solution

Connecting the Patient

When the Online solution has been processed and tested, a white information field is shown.

After touching the Connect patient icon, the following screen is shown

Follow the instructions on the screen and confirm. ■

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2x

Adjust the level in the venous drip chamber. The dialyzer is filled with a preset rinse volume and rinsed. The blood inlet is at the bottom.

Check the patient data and confirm correct data input. ■

Confirm the information field ("Is the blood line system filled with NaCl..."). The appearance of the window depends on machine configuration. Turn the filter so that the dialysate inlet is at the bottom. The filter should be turned after the rinsing volume is reached.

Connect the arterial line to the patient. The system is filled with blood.

A manual stop of the blood pump, an alarm or deactivation of Bypass causes the cancellation of the Connect function via the return port (recognizable by the rising venous pressure).

If required, increase the level in the venous chamber. When the Connect patient icon is active, the machine has been successfully tested and is ready for therapy.

and two short tones are to be heard and the button is lit.

To be able to continue connection, activate the Connection icon in the HDF parameter window. ■

The venous red sensor automatically stops the blood pump.

Brief Instructions – HDF/HF Online Therapy

Start the blood pump again and set the blood flow. Only after the desired blood flow is reached, deactivate the bypass to reduce the risk of filter clotting.

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The HDF therapy begins and the therapy time runs. The substitution pump starts to run automatically, all monitoring devices are activated.

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To start the bolus, change to the HDFOnline parameter window and press the Inf. Bolus button. Confirm. The administered bolus volume is displayed.

Deactivation of HDF therapy/change to HD or HF ■

BYPASS or MIN-UF during a therapy ■

If Bypass is activated during a treatment, the substitution pump stops. If MIN-UF is activated during a treatment, the substitution pump continues to run.

If necessary, administer a Bolus (50 – 250 ml) with the solution produced by the machine.

During treatment, switch off HDF by selecting the HDF field again and change to HD or select HF. The dialysate and substitution flows are automatically adapted.

End of treatment Touch the Terminate therapy icon. If set accordingly, the reinfusion window opens automatically.

UF/blood flow ratio To draw attention to excessive coagulation of the blood, the ratio Blood flow : Total UF is automatically calculated and displayed. This value should be between 25% and 28%. When 30% is reached, you will be informed with a warning (dependend on machine configuration).

For reinfusion with Online solution, connect the arterial end to the connection of the substitution line which is marked red and confirm. It can also be closed off with a 0.9% NaCl bag as usual.

HDF/HF Online Therapy

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Bolus output with HDF-Online

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Now remove the patient venous line from the return port and connect with the needle to the patient. Close the cover of the return port until it latches.

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Brief Instructions – HDF/HF Online Therapy

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The blood pump continues to run until the venous red sensor detects saline solution or the blood pump is stopped. The administered reinfusion volume is shown.

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Empty the bicarbonate cartridge and the dialyzer only when the patient has been disconnected from the machine.

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Save the dialysis data and start disinfection. Start of disinfection after therapy end or after filter change by touching the Disinfection icon and selection of the disinfecion mode. To continue see chapter disinfection.

Disinfection/Online filter change By touching the Folder icon, the symbol for the Online filter change and the Filter draining icon empty and replace the filter. A filter change must always be followed by a disinfection.

Brief Instructions – Single-Needle Cross-Over Therapy (SN-CO)

Machine setting Touch the Parameter icon as well as the SN icon.

Insert arterial and venous line system: Route the lines leading to the patient through the respective clamps.

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Do not yet insert the line segment of the 2nd (venous) blood pump. Make sure that the 2nd pump segment is above the pump.

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Connect the PBS pressure sensor and the other pressure sensors.

Select SN-CO. The preset limit values for the arterial and venous control pressure are set automatically.

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Insert the 2nd pump segment into the venous pump.

Filling ■ PV

Level in venous expansion chamber

PA

Level in arterial expansion chamber

It is also possible to select SN-CO before connecting the patient.

Recommendations for blood pump rate and phase volume

Connecting the patient Change to therapy mode by touching the Connect patient icon. Confirm the patient data! ■

The connection of the PBS pressure transducer should always be performed before the blood-side self-test. If the setting of SN-CO should be required after begin of treatment, confirm the PBS values shown then.

Adjust the liquid level in the arterial and venous chambers according to the drawing.

Start the blood pump, fill the system with blood and then connect the venous line to the patient.

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Start the blood pump with 100 – 120 ml/min when connected to a fistula.

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When connected to a central venous catheter, start with 150 ml/min.

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Single-Needle Cross-Over Therapy

Set-up

Brief Instructions – Single-Needle Cross-Over Therapy (SN-CO)

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Check of the phase volumes, blood flow and pressure values via the SN icon

Optimum control pressures: Arterial mmHg Venous mmHg Central catheter / good fistula

bis -200

Warnings and alarms ■

Recommended control pressures

360 bis 390

Fragile fistula

bis -150

300

Initial punctures

-120 bis -150

250 bis 300

By setting control pressures that are far apart, a larger phase volume is achieved, closer limits result in a smaller phase volume. ■

If the phase volume is too small, slowly decrease the blood pump speed in small steps.

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The phase volume reacts to: - Change of blood flow - Change of control pressures - Height of blood level in the chambers - Pressure changes in the shunt - Stop of blood pump when alarms occur

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During dialysis, monitor the fluid in both chambers (if required, regulate fluid level) and the size of the phase volume (if necessary, correct blood flow).

The same as for the TMP window, the phase volume is monitored with relative and absolute limits that adjust themselves automatically. If the lower relative phase volume is undercut, an alarm is triggered with older software versions. If this warning occurs frequently, change the blood flow for a short time. This renews the setting of the limit window. The warning Lower relative phase volume too low is obsolete as from software versions ≥ 8.20

Phase volume

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Target value for phase volume, approx. 30 – 35 ml

For all other exceeding of limits, an alarm is triggered. In case of phase volume alarms always check the system for air inflow, confirm only after checking. Optionally correct blood flow.

Termination ■

Leave the 2nd pump segment in the venous blood pump. Activate the Reinfusion icon to extend the alarm limits.

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Check the height of the venous blood level and adapt as required.

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Terminate the therapy in the usual way.

Brief Instructions – Single-Needle Valve Therapy (SN-V)

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Setup and filling ■

Insert the arterial standard line; lead the arterial line through the arterial clamp (SAKA).

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Use a special venous line for the SN valve with 100 ml pressure compensation chamber, as this enables a higher phase volume and thus a clearly increased efficiency of treatment. If the SN valve dialysis is not planned, the standard line can remain in place. For efficiency improvement, the venous level must be reduced here before the beginning of the SN valve therapy. Fill the liquid level in the venous chamber only up to approx. 40% so that an adequate phase volume can be achieved.

Machine setting

The SN valve mode can also be activated during treatment.

Connecting the patient Change to therapy mode by touching the Connect patient icon. Confirm patient data! ■

Connect the arterial line and fill the system with blood; the SN valve mode has already been automatically activated.

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Start the blood pump depending on the vein condition and increase slowly.

Phase volume Touch the Parameter icon as well as the SN icon. Select SN valve.

By setting control pressures that are far apart, a larger phase volume is achieved, closer limits result in a smaller phase volume.

Single-Needle Valve Therapy

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The preset limit values for the arterial and venous control pressure are entered automatically.

Brief Instructions – Single-Needle Valve Therapy (SN-V)

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Recommendations for phase volumes

Control and monitoring

With small venous air trap (30 ml): 12 – 18 ml ■

The SN valve has a combined pressure and pressure/time control. The optimum and adapted return time is set automatically.

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It is possible that the lower arterial limit value (min PA) has to be adapted.

With large venous pressure compensation chamber (100 ml): 15 - 25 ml The phase volume reacts to: - Change of blood flow and control pressures - Height of blood level in venous chamber

Setting of control pressures: ■

- Pressure changes in the shunt ■

In addition, the phase volume can be optimized by adapting the BP speed. If the difference between the control pressures is smaller, the phase volume becomes smaller, however, switching to the arterial phase is achieved quicker and the medium blood flow thus increased.

- min PV 120 - 150 mmHg - max PV 350 mmHg

Termination After selection of the Terminate therapy icon the Reinfusion window is opened automatically if preset accordingly. Otherwise, it must be manually selected so that reinfusion starts in double-needle mode. The pressure limit value windows expand and the reinfusion volume is displayed. ■

Before start of the reinfusion, always check the height of the venous blood level and increase the blood level, if required.

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Disconnect the patient as usual.

Icons are control buttons on the touch screen used for operating the dialysis machine. Depending on the displayed window, different icons are available, which all represent a specific action. By touching an icon, the respective action is carried out.

Call up overview

A list of the most important icons is provided below.

Call up respective parameter window

Leave window and accept data

Set treatment parameters

Leave window without accepting data

Return to program selection

Call up help function for explaining the icons

Create (format) floppy disk/therapy card

Call up history of current disinfection

Read patient data from disk/therapy card

Call up service screen

Save patient data to disk/therapy card

Switch off all icon functions for 10 sec to allow cleaning of monitor

Select further setting options

Set brightness of monitor

Reduce value

Leave current window

Increase value

Overview Icons

Overview of Icons

Overview of Icons

Red symbol: error symbol during reading of patient data from floppy disk/therapy card

Filter data (only active if option DF filter has been installed or if the machine is equipped with HDF-online)

In profile window (except for UF profile): open numerical keypad for resetting the profile to a setting

Dialysis on main connection – dialysate flows through dialyzer

Call up key pad for entering numerical values

Dialysis Bypass – no dialysate in dialyzer

Give heparin bolus

Connect patient to online substitution

Give arterial bolus

Start Reinfusion

Call up window for setting arterial bolus

Call up and set substitution data (option)

Call up dialyzer rinsing program with simultaneous ultrafiltration

Call up bag change HDF (option)

Empty dialyzer – dialysate is siphoned out of the dialyzer

Change or empty bicarbonate cartridge (option)

Call up and set heparinization data

Change to Therapy mode

Reset filter, empty (option DF filter)

Change to Therapy end mode

Disinfection from water supply – inlet

Call up linear profile in case of specified start and end values

Disinfection from water supply – discharge

Call up exponential profile in case of specified start and end values

Call up and set dialysate data

Start brief disinfection/cleaning

Activate stand-by

Start disinfection program

Call up and set ultrafiltration data

Start central rinsing

Call up minimum ultrafiltration

Activate automatic switch-on of dialysis machine at the programmed time

Call up and set pressure limits

Activate automatic switch-off of dialysis machine after disinfection

Call up single-needle selection and settings

Change settings for HDF-/HF-online

Call up ultrafiltration profiles

Call up disinfection history of last 150 disinfections

Call up profile settings for the respective parameter

Delete ABPM measured values list (option)

Overview Icons

Overview of Icons

Overview of Icons

Start ultrafiltration without dialysate (sequential therapy) Start ultrafiltration with dialysate

Timer /stop watch

Suppressed warning sounds during preparation

B. Braun Avitum AG Schwarzenberger Weg 73–79 34212 Melsungen Germany Tel +49 (56 61) 71-26 24 Fax +49 (56 61) 75-26 24 W. 03.08.08/1

No. 708 0125A Edition: 08/2008

e-mail: [email protected] www.bbraun-dialysis.com