1. Safety Features

2. 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

3. 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

4. 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.

5. 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

6. Air Bubble Detector Ultrasonic Located along return line Alarm activated by: air in blood micro air Air Detector Return Line Clamp

7. 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

8. 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

9. 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

10. 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

11. Advisory: Time to Change Set Occurs after 72 hours or when 780 L of fluid is processed Available in HISTORY SCREEN, then CHANGE PERIOD Occurs after 72 hours or when 780 L of fluid is processed Available in HISTORY SCREEN, then CHANGE PERIOD

12. 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 specifiedBag is empty or supported Warning (CAUTION): Effluent bag full Bag is specifiedInspect scale for foreign object Replace effluent bag

13. 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

14. ® 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

15. Determined by: Patient Size Patient condition Hemodynamic stability Fluid Safety Guard Setting Excess Patient Fluid Limit CRRT SetDefaultRange M60130 ml100-200ml over 3hr M100 HF1000 HF1400 330 ml100-400ml over 3hr

16. Expected Variance in Fluid Removal Alarm condition that stops fluid pumps Treatment is stopped, then resumed Change bag interruption A small amount of variance from set patient fluid removal rate is normal due to interruptions in treatment.

17. Incorrect Weight Change Detected 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) Occurs when weight on one or more scales does not change according to set fluid flow rates.

18. 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

19. 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

20. Incorrect Weight Change: Patient Fluid GAIN If: Effluent flow is obstructed Then: Fluid may be infused to the patient from blood side of filter

21. Early Advisory Alarms Provides early notification of flow problems Prevents more serious alarm situation/s All fluid pumps are operational

22. 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

23. End Treatment What causes the End Treatment Alarm? The excess pt fluid loss or gain limit has been met or exceeded.

24. 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

25. References and Further Reading Prismaflex Operator Manual Prismaflex Tutorial Prismaflex Training Guide Software v3.20

26. QUESTIONS?

27. Prismaflex  System End Treatment

28. STOP Softkey

29. End Treatment: Three choices End treatment Change set Recirculation

30. Return Blood START RETURN activates blood pump only when pressed. When blood returned, press CONTINUE.

31. 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.

32. End treatment Procedure: Disconnect patient Unload and remove filter set Disconnect bags It is possible to end treatment with or without returning patient’s blood. End Treatment

36. Gambro is here to assist you 24 hours a day 7 days a week: 1-800-525-2623

37. References and Further Reading Prismaflex Operator Manual Prismaflex Tutorial