1. Training module 1 – Introduction and Preparation
Dialysis System SW
Training module 1 – Introduction and Preparation
Ref: Operator’s Manual SW
Chapter 1 – General Description
Chapter 3 – Machine Dressing and Priming
Chapter 4 – HD-DN Treatment

2. Introduction and Preparation
Introduction and Preparation
Important Notice:
This presentation does not relieve any user of the Artis Dialysis System from his or her duty to carefully read the full text of the Operator’s Manual before using the system.
Important:
Please note that the SW change to
of this presentation does not change the
training of the Artis Dialysis System for the
users.
Introduction and Preparation
Ref:
Operator’s Manual SW 8.08, Service code
Chapter 1 – General Description
Chapter 3 – Machine Dressing and Priming
Chapter 4 – HD-DN Treatment

3. Making life in the clinic easier for everyone
Making life in the clinic easier for everyone
Usability and design
Graphical User Interface
ArtiSet Blood Tubing System
Serviceability
Modular construction
Adapting therapies to every individual
Making life in the clinic easier for everyone
Artis is an advanced Hemodialysis System that makes everyone's life easier in the dialysis clinic.
Artis Dialysis System is built upon four cornerstones to meet the needs of :
The operator – usability and design - graphical user interface – blood cassette system
Bioprotective blood module – ArtiSet blood tubing system
The technician – serviceability of the ADS is an important criteria and has been an integral part of the design work.
The patient – bio-controlled therapies / bio-protective blood module
Ref:
Artis Concept Brochure HCEN53602© Gambro Lundia AB
Artis Product Brochure HCEN5346© Gambro Lundia AB

4.
Usability and design
The user interface is easy to read and displays step by step instructions in the operator message area
one flow setup – one touch priming
Usability and design
USERnomics is a Gambro trademark expression, describing Artis Dialysis System usability and design.

5. Appealing Design Clear, pure-line, ‘human touch’ Design for function
Appealing Design
Clear, pure-line, ‘human touch’
Pleasant – Convenient – Neat
Helps create an appealing and serene environment for patients and staff
Design for function
All components at your fingertips
Large and visible touch screen
Design for emotion
It has an appealing design
The technology is inside
Possible comment: The size of the machine  NOTE: Artis is still not the biggest machine on the market – 5008 is higher
Design for function – Ergonomics
Components accessible at the right height
Large and visible screen

6. Design for function The critical part needing surveillance
Design for function
The critical part needing surveillance
Status lights: decoupled from the screen – on the side, for high visibility
15’’ color touch screen
Hard Key Panel: for all key actions that can be required at any time: pump speed, alarm management and events
Blood pumps: highly visible and accessible, yet compact and protected
Sensor bar: all in one – used as a guide for patient lines with clamps
Trainers “don’t forget”: You do not have to show the slide, but should remember to demonstrate on the machine
Let’s start with the functional design review with the critical part requiring blood modules.
All components requiring surveillance gathered in the central part of the monitor; all others are elsewhere.
Several sensors inside the sensor bar – blood, air, Hemoscan, lines
All actions are done at same height, i.e. no work above shoulders level or below the knees.

7. Design for function Infusion pole Top Tray EvaClean
Design for function
Dialysis Fluid Module
All related components found in the same area
Top Tray
Removable, used as disposable holder
Bottom Tray
Plenty of space for concentrate canisters
Infusion pole
Easily adjustable
EvaClean
Waste handling device
Trainers “don’t forget”: You do not have to show the slide, but should remember to demonstrate on the machine

8. Design for function Move-ability Clean-ability
Design for function
Move-ability
Front and back handles for easy transportation
Clean-ability
Smooth surfaces
Cabinet validated for various cleaning agents
Trainers “don’t forget”: You do not have to show the slide, but should remember to demonstrate on the machine
A particular attention has been given to the clean-ability of the device:
Smooth surfaces have been given the priority and sharp edges have been avoided as much as possible.
The material used for the structure and the quality of the paintings have also made it possible to validate the use of various cleaning agents.
360°Swiveling wheels with front brakes

9. ArtiSet blood tubing system
ArtiSet blood tubing system
Compact design, optimized ergonomics
Non invasive pressure monitoring
Bio-materials and radio-sterilization
Bioprotective Blood Module - ArtiSetTM blood tubing system
Ref: Brochure HCEN54641© Gambro Lundia AB
ArtiSet blood tubing system is a cassette system with a compact design and reduced complexity minimizing the risk of errors, both at the level of manufacturing and clinical use (less components, less gluing points).
It facilitates a non invasive pressure monitoring and improved hemodynamics*.
The various ArtiSets comply with the latest European best Practice Guidelines:
Plastics, sterilization, user safety and connector blood contact (see below)
Phtalates-free plasticizer used in the PVC formulation (”Bioline” reducing migration into blood)
EtO free sterilization (Beta rays)
Injection site validated for safe needles (plastic)
Dialyzer connectors avoiding blood contact with tinted components
* = Flow dynamic softwares have been used to analyze and improve the ArtiSets hemodynamics. The velocity of blood is carefully controlled, avoiding dead zones with no flow as well as turbulences creating foaming. Also, the chambers bottom entry - bottom exit of blood helps reducing splashing effects. The specially shaped deflectors, ensuring laminar flow even at high blood flow rates, the venous filter (surface coated) with an asymmetrical window design (smaller at the bottom, bigger at the top) are ensuring a performant removal of micro-bubbles and particles. Combined, these features also contribute to improving the thrombogenicity of the system, which is investigated in a recent study using a reduced heparinization protocol. Both the TAT levels observed in the blood samples taken at regular intervals and the final residual blood volume were significantly reduced

10. ArtiSet blood tubing system
ArtiSet blood tubing system
Reduced extra-corporeal blood volumes compared to previous Gambro HD machines1
125 mL in DN / 145 mL in HDF / ~ 225 mL in SN
Reduced blood air-interface and contact surface
7 cm2 (50% less than standard lines - compared to previous Gambro bloodlines2)
Compact design, chambers in a single unit
Non-invasive pressure monitoring
No handling of transducer protectors
No risk of blood getting inside the machine
Non invasive and accurate pressure monitoring system
1-2: Refer to specific Operator Manuals for different bloodline volumes
Bio-protective blood module
Ref: ???
The total extra-corporeal blood volume is considerably reduced compared to conventional blood line sets and by that also the contact surface between blood and foreign materials.
The compact design of the arterial and venous chambers, which are cast in a single unit, the blood-air interface is down to 7cm2 (no expansion chamber and smaller chambers). This is approximately half the blood-air interface of conventional sets
The non-invasive pressure monitoring system is made out of a silicone diaphragm, enclosed in a mould POD. It is the position of the diaphragms inside the POD that gives the pressure signal to the monitor. The POD is impermeable, thus, the risk of blood leakage into the machine is eliminated

11. Adapting therapies to every individual
Adapting therapies to every individual
Easier approach to on-line HDF
Automatically achieve convective volumes >20 L3 with on-line HDF
Reduce the number of TMP alarms, manual checks and interventions
Automated profiling of UF rate and [NA+] level (Biofeedback system)
Manage fluid removal as per patient’s physiological response – vascular refill capacity
Recommended by the European Best Practice Guidelines (EBPG 3.1.2a)
Adapting Therapies to Every Individual - Bio-controlled therapies
Bio-controlled therapies
Bio-controlled therapies benefits:
Enable more patients to benefit from yet efficient and comfortable treatments
Treatments self-adapt to patient physiological status
Bio-controlled therapies reduce the need for repeated adjustment of the treatment settings
3 : Maduell et al, High Efficiency Post dilution Online Hemodiafiltration reduces All-Cause Mortality in Hemodialysis patients; JASN 24, p. 6, 2013

12. Artis in Practice Touch screen Intuitive user interface BiCart Select
Artis in Practice
Touch screen
Intuitive user interface
BiCart Select
Self-loading blood tubing systems
EvaClean
One touch priming
Alarm status and support
Artis in Practice
Our first hands-on session will include and deal with the above

13. Intuitive User Interface
Intuitive User Interface
The NavPad
Prescription
Before treatment
During treatment
Blood
Treatment overview
Fluid
Report
After treatment
Intuitive User Interface
Operator’s Manual, section 1.4.1
The Artis Treatment Overview screen with the navigation tool – The NavPad – in its lower right corner, which allows the operator to move between the 5 Main screens. The NavPad is available on all the Main screens in the lower right corner..
The slide is animated in 4 steps to explain the NavPad:
1. The 5 color coded NavPad buttons give access to the 5 Main screens: 2.
Prescription button - Light blue
Blood button - Red
Treatment overview button - Dark blue
Fluid button - Green
Report button - Yellow
3. Before and after treatment – specifically emphasize the use of the Prescription button to set treatment parameters before treatment start while the Report button gives access to all the treatment parameters automatically monitored by the system during the session but also after the treatment is ended
4. During treatment buttons - Blood, Treatment Overview and Fluid buttons are used for checking/adjusting detailed treatment parameters and activated functions
All five buttons may of course be used at all times during the dialysis process.

14. Sub screens 2017-11-27 Treatment Type Patient Card Distribution Volume
BP Monitoring
A/V Limits
Hemoscan
Heparin
Fluid Settings
Diascan
Isolated UF
Hemocontrol
Special Procedures
Disinfection
Treatment Type
Patient Card
Distribution Volume
Time Reminder
BlackBox
Screen Cleaning
System Data
Service
Sub screens
By pressing the different NavPad buttons the respective Main screen appears (Prescription, Blood, Overview, Fluid and Report) from which many related sub-screens can be reached. The slide shows some examples of sub-screens.

15.
Treatment Overview Screen
Operator’s Manual, section 1.4.3
Describe the Treatment Overview Screen in detail
Specifically explain:
The different values for set blood pump speed and arterial pressure compensated blood flow
The button bar next process button (the Center button) is ONLY displayed in the Treatment Overview Screen – it is recommended to always return to this screen
Click = Arrow down on computer key board
Click – finger appears on NavPad Prescription button
Click on Prescription button to move to next slide

16.
Prescription Screen
Operator’s Manual, section and
Describe the Prescription Screen in detail
Treatment time range is 10 minutes to 8 hours
UF Volume range in HD is 0 – 24L (UFR max. 3L/h)
This slide is animated as follows:
Click – finger appears on the select pad UF Volume button  the key pad opens
Click – finger moves to key pad confirm button  key pad disappears and exclamation mark on the UF Volume select pad button disappears
Click – finger appears on NavPad Prescription button
Click to move to next slide

17.
Prescription Screen
Operator’s Manual, section 1.4.4
Explain the Activated Function Select Pad
Click – finger appears on the select pad BPM button
Click to move to next slide
BPM settings screen is animated as follows:

18.
Prescription Screen
Operator’s Manual, section and 9.4
BPM settings screen is animated as follows:
Click – finger appears on the BPM activation button  activation bar turns green, heart + clock icon appears showing the function is activated
Click – finger appears on Close button  BPM sub screen disappears and the select pad activation bar on the prescription screen turns green
Click – finger appears on NavPad Blood Screen button
Click to move to next slide (Blood Screen Screen)

19.
Blood Screen
Operator’s Manual, section 1.4.5
Describe the Blood Screen in detail
Specifically explain the buttons in the button bar – they are all related to blood and there is no Center button
This slide is animated as follows:
Click – finger appears on NavPad Fluid button
Click to move to next slide (Fluid screen)

20.
Fluid Screen
Operator’s Manual, section 1.4.6
Describe the Fluid Screen in detail
Note that the UF Volume is already set via the Prescription Screen while the Treatment Time exclamation mark is still in place as this was not set earlier
Specifically explain:
Real treatment time, which is equal with elapsed diffusion time
Remaining treatment time is displayed on the Treatment Overview Screen
Non-diffusion time must be calculated by the Operator
This slide is animated as follows:
Click – finger appears on Fluid Settings button
Click to move to next slide

21. © YEAR, Legal owner 2017-11-27 Fluid Screen
Operator’s Manual, section and 3.3
Fluid Settings Sub-screen appears – explain the Fluid Settings Sub-screen
This slide is animated as follows:
Click – finger appears on Close button  Fluid Settings sub screen disappears
Click – finger appears on NavPad Report button
Click to move to next slide (Report screen)
© YEAR, Legal owner

22.
Report Screen
Operator’s Manual, section 1.4.7
Only describe very briefly as the Report Screen is presented in detail in Module 9
ADS continuously stores treatment data according to a set time interval
This slide is animated as follows:
Click – finger appears on NavPad Overview button
Click to move to next slide (Overview Screen)

23. Operator Message guidance
Operator Message guidance
Operator Message Guidance
Operator’s Manual, section 1.3.1
Emphasize the importance of reading and following the messages appearing in this area and in the specific windows appearing (e.g. Confirmation Required windows) on the screen

24. BiCart Select System Both concentrates are prepared on-line
BiCart Select System
Both concentrates are prepared on-line
during treatment from the:
BiCart (bicarbonate powder)
SelectCart (sodium chloride pearls)
SelectBag One (small electrolytes and glucose)
BiCart Select offers:
Closed System for Concentrates
Possible options for individualization
Simplified handling and storage
* Consult the respective product monographs of BiCart, SelectCart and SelectBag One for contraindications, warnings, precautions, adverse reactions, interactions, dosing and conditions of clinical use. Product monographs are also available by contacting us at
BiCart Select
Operator’s Manual, section 3.3
Sodium and bicarbonate settings do not influence the level of minor electrolytes (K+, Ca2+, Mg2+)
A range of ready-to-use SelectBag One compositions allows for easy tailoring of the prescription
On-line preparation in a closed system, eliminating contamination risks
The label clearly identifies both K+ and Ca2+ levels
80% weight reduction
Required storage space reduced by 80%
Improved flexibility: The clinic can keep the necessary variety

25. Concentrate Combinations
Concentrate Combinations
At concentrate connection
ensure the correct combination
is set (presetable)
BiCart Select
BiCart, SelectCart and SelectBag One
BiCart + A-concentrate
Canister
Central distribution
Concentrate Combinations
Operator’s Manual, section 3.3
To avoid alarms, the correct concentrate combination needs to be set before attaching the concentrates
The dialysis fluid preparation phase starts as soon as the concentrates are connected
By preset the dialysis fluid preparation phase can be delayed 15 minutes (no alarm appearing during this time)
Highlight
After the preparation phase is started, it is no longer possible to change
concentrate combination
Note: It is still possible to change acid alternative (e.g. C205 to C295)
After Preparation phase is started, it is no longer possible to change Concentrate Combination

26. Fluid circuit - treatment
Fluid circuit - treatment
Fluid circuit - Treatment
EvaClean – waste handling connects directly to drain (used priming fluid goes from EvaClean directly to the drain)
Single pass fluid system
Ultrafilters after water inlet and dialysis fluid mixing
A third Ultrafilter included in the ArtiSet Ultra for on line treatments
Clearance measurement after the dialyzer

27. ArtiSet Blood Tubing System
ArtiSet Blood Tubing System
ArtiSetTM Blood Tubing System
Operator’s Manual, section 3.5
“Link Slide”

28. ArtiSet HD-DN HC Venous Infusion line Dialyzer Arterial line
ArtiSet HD-DN HC
Venous Infusion line
Dialyzer Arterial line
Priming line
Arterial Infusion lines
Heparin line
Dialyzer Venous line
Back valve
Venous Injection port
Arterial Chamber
Venous Chamber
Hemoscan cuvette
Venous Infusion line
Artiset HD-DN HC
Operator’s Manual, section 3.5
Demonstrate the ArtiSet HD-DN HC with its different components
Arterial Injection port
Venous Patient line
Arterial Patient line

29. ArtiSet - Venous and Arterial pathways
ArtiSet - Venous and Arterial pathways
Post-pump
Pre-pump
Artiset - arterial and venous pathways
Operator’s Manual, section 3.5
Specifically emphasize what lines are pre and post the blood pump

30. Auto-loading Blood Tubing Sets
Auto-loading Blood Tubing Sets
Follow operator’s message for:
Auto-loading of the ArtiSet
Disposable set up / connections
Auto-loading Blood Tubing Sets
Operator’s Manual, section 3.5
When loading the ArtiSet specifically notice:
After the cassette is set on the hooks place the heparin line in its line guides.
Close the blood pump cover
Identify the Dialyzer A/V lines and place those in their respective line guides (above and below the venous pump)
Let the A/V Patient lines hang down with the paper strips still in place until they are set in the EvaClean; the weight of the lined bundle will help the lines to “fall” in place in the sensor bar slots
Place the A/V Patient lines in the automatic clamps with the paper strips still in place
Wait for the next Operator’s message to appear and continue
Highlight
All disposables connected in one single series of action
Dressing and preparing ADS takes only a few minutes
All disposables are connected in one single series of action

31. EvaClean Priming fluid draining device i.e. no waste bag is needed
EvaClean
Priming fluid draining device
i.e. no waste bag is needed
Design to draw fluid through the blood tubing system – where the A/V patient blood lines are connected
Anti-backflow safety system embedded
Automatically disinfected during the regular disinfection processes
EvaClean
Operator’s Manual, section and 3.5.1

32. Heparin syringe installation
Heparin syringe installation
Heparin Syringe Installation
Operator’s Manual, section 3.5.5
When loading the heparin syringe specifically notice:
That the syringe plunger base must have firm contact with the heparin syringe holder (see photo)
That the syringe plunger is placed in the two slots; one in the syringe holder (rear) and one as the white plunger lock (front)

33. Heparin administration
Heparin administration
The heparin line is automatically primed if the heparin administration function is activated before Auto-Prime starts
Artis performs a few “kicks” to open the one-way-valve and prime the line
If heparin administration function is not activated before Auto-Prime starts, the heparin line can be primed manually using the heparin ▲ position key
During heparin administration the light indicator on the pump panel is green lit
The Initial Dose is administered when blood enters the arterial dialyzer line (30 ml processed)
Heparin Administration
Operator’s Manual, section 3.7
The heparin volume needed to prime the heparin line is 0.6 ml. Neither this volume nor the volume needed for each “kick” (0.3 ml) are added to the Accumulated heparin volume displayed on the heparin settings sub-screen and the Reports screen.

34. Heparin Administration
Heparin Administration
30cc syringe (option)
Administration types available:
Linear: range 1.5 to 10 mL/h
Intermittent: dose range mL
Manual: range 0.5 to 12mL
10 cc syringe kit (standard)
Administration type available:
Linear: range 0.5 to 4 mL/h
Intermittent: dose range 0.5-4mL
Manual: range 0.5 to 4 mL/h
Heparin Administration
Operator’s Manual, section 3.7
Highlight
Extra Bolus button becomes available after Start Treatment
Administered upon Operator’s Confirmation – Displayed in the Report Screen Event list
Options available:
Initial Dose
Automatic bolus is administered upon the Operator’s confirmation (Extra Bolus)
Extra Bolus button becomes available
after Start Treatment

35. Auto-Prime Preparation
Auto-Prime Preparation
Follow operator’s message for auto-prime preparations
Close the lower venous infusion line and the two arterial pre-pump infusion lines
Check that the venous infusion line and the saline line clamps are open
Auto-Prime Preparation
Operator’s Manual, section 3.6
Highlight
Saline should be connected to the Venous Infusion line
Contradictory to other systems where saline is connected to the arterial line - During Auto-Prime the ADS blood pump runs clockwise (in opposite direction)
Saline line is connected to the Venous Infusion line

36. Auto-Prime - One touch priming
Auto-Prime - One touch priming
Press the Auto-Prime button for “booking” automatic start of the priming process - the button indicator bar turns yellow
When the function check is completed, the automatic priming process starts - the button indicator bar turns green
The dialyzer is primed and deairated from bottom to top - no need of rotating the dialyzer during the Auto-Prime process
Dialysis fluid sampling should be performed before Auto-Prime; do not book Auto-Prime when sampling is planned
Auto-Prime - One Touch Priming
Operator’s Manual, section 3.6.1
Specifically notice that if dialysis fluid sampling should be performed, Auto-Prime should not be booked. The Sampling button will not be displayed if Auto-Prime is booked/running/completed.
Highlight
True auto-priming; simply dress, press and leave
Even the dialysis fluid tubes are connected from the beginning (before the dialysis fluid is prepared)
True auto-priming; simply dress, press and leave

37.
Auto-Prime Settings
Auto-Prime Settings
Operator’s Manual., section
Specifically notice that after Auto-Prime is completed, Auto-Prime can be reset in this Autopriming Settings sub-screen (repetition of the full Auto-Prime process)
Also an Extra Prime process can be performed by pressing the Extra Prime button available in the Treatment Overview screen button bar when Auto-Prime is completed.
If using an Evodial 2.2 dialyzer, the following Priming Volume should be set:
• High Volume: 2000 mL of Priming Volume
• Low Volume: 1750 mL of Priming Volume
Priming volumes are calculated and presetable in accordance with the respective dialyzer instruction for use + a minimum of 250 ml

38. Auto-Prime – 4 phases process
Auto-Prime – 4 phases process
The venous line and chamber
The EvaClean applies a negative pressure and sucks saline into the venous chamber and line.
The arterial line and chamber and dialyzer blood side
The arterial blood pump starts at a rate of 50 ml/min filling up the arterial line and chamber from the bottom-up, running pump clockwise
The dialyzer fluid side
Continues until Artis no longer sense air in the dialysis fluid compartment
Removal of air from the extracorporeal circuit
The arterial blood pump restarts running at a rate of 250 ml/min. Intermittently the blood pump speeds up in order to purge air.
Auto-Prime – 4 phases Process
Priming of venous blood line. Saline line and venous infusion line clamps open. EvaClean applies a negative pressure to the venous blood line i.e. the EvaClean sucks saline into the venous chamber and line (from the saline infusion bag).
Priming of the dialyzer blood side, arterial chamber and blood line. Arterial blood pump starts, running in reverse, at 50 ml/min. This phase lasts 2.5 minutes, or until the system delivers 125 ml of saline, which is to the top of the dialyzer. Specifically notice that it is NOT possible to change the BP speed during this phase.
Priming of dialyzer dialysis fluid side. Automatically the Artis primes the dialysis fluid side, hydraulically. This is complete when the Artis no longer sees air in the dialysis fluid compartment.
Removal of air. Arterial blood pump restarts, running in reverse, at 250 ml/min, to complete the removal of air. Intermittently the blood pump will speed up in order to purge air. This continues until 1100 ml (default) of saline is delivered. Blood pump stops. Specifically notice that it is possible to change the BP speed (preset 10 to 350mL/min) during this phase.
Highlight
During Auto-Prime the blood pump runs in clockwise direction facilitating an improved deairation as the dialyzer is primed from bottom-up
No need to turn or tap the dialyzer during the Auto-Prime process
Operator’s Manual:
At the end of the priming procedure internal functional checks will be performed. If one of these checks fail, perform an Extra Prime procedure.
During Auto-Prime, the blood pump runs in clockwise direction facilitating an improved deaeration as the dialyzer is primed from the bottom-up

39. Alarm status and support
Alarm status and support
3 alarm priorities:
= sound
= lamp flashing
2 info messages:
Alarm messages appearance
Alarm Status and Support
Operator’s Manual, section 16.2
Only describe this slide very briefly as the Alarm handling is presented in detail in Module 5

40.
Nice to Know !
T1 Test - whenever Artis is switched on, a serial of function checks are performed. If any of these checks fails a resetable alarm is generated. In case a General Safe State alarm appears the protective system has identified an error prohibiting the use of the machine – try to switch Artis OFF and then ON again.
Dialysis fluid sampling - should be performed before priming; do not book Auto-Prime when sampling is planned
Automatic priming of the heparin line – Artis performs a serial of kicks to open the back valve and prime the line. The volume used is not added to the accumulated heparin volume displayed on the heparin settings screen
The Evodial dialyzer - special attention is needed in regards to the Auto-Prime procedure and priming volumes, see Op. Man. Section and 3.6.2
Nice to Know

41. Hands on Module 1 Attach concentrates Attach dialyzer
Hands on Module 1
Attach concentrates
Attach dialyzer
Load the Artiset and connect lines
Attach heparin syringe
Set heparin prescription
Linear 1.0mL/h, Initial Dose 2.0mL, Stop Time15 min)
Connect saline
Clamp status
Ready for priming?
Book Auto-prime
Demonstration & Hands on
The Trainer’s Check List should be used and ticked off during the hands-on training
By following the different hands-on prescriptions all function will have been practiced at the end of the course
Highlight
Ready for priming?
The Trainer should check that the clamp status is correct and that Auto-Prime is booked.

42. References
Maduell et al, High Efficiency Post dilution Online Hemodiafiltration reduces All-Cause
Mortality in Hemodialysis patients; JASN 24, p. 6, 2013

43. For safe and proper use of the devices referenced within, refer to Warnings, Precautions and the complete Instructions for Use or the appropriate manual available by contacting customer support.
ArtiSet, BiCart, SelectCart and SelectBag One are trademarks of
Gambro AB. Gambro is an indirect subsidiary of Baxter International.