1. Dialysis System SW
Training module 10 – Single Needle Double Pump
Ref: Operator’s Manual SW
- Chapter 6: HD-SN Treatment

2. HD-SN Double Pump Important Notice: Important:
HD-SN Double Pump
Single Needle Double Pump
Ref:
Operator’s Manual SW 8.08 Service code
- Chapter 6: HD-SN Treatment
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 user.

3.
SNDP Principle SN
cassette
Arterial phase; Arterial blood pump (Art_BP) is running until the automatically calculated post dialyzer pressure limit is met (SN pressure max) - venous line is clamped (VC)
Venous phase; Venous blood pump (Ven_BP) is running until the fixed low system pressure limit is met. (SN pressure min) - arterial line is clamped (AC)
SNDP Principle
SN maximum and minimum pressures are measured in the post dialyzer chamber
The extracorporeal flow:
Arterial clamp  pre pump chamber with arterial pressure measurement  arterial blood pump  pre dialyzer chamber  dialyzer  post dialyzer chamber with SN pressure measurement  venous pump  venous chamber with venous pressure measurement  Venous clamp

4. Programming HD-SN DP on Artis
Programming HD-SN DP on Artis
1. Select treatment type
2. Confirm parameters
Single Needle Double Pump – SNDP
Operator’s Manual, section and 3.4.2
SN must be preset in service level 2 to be available in the Treatment type list
Treatment Type must be confirmed before loading the SNDP ArtiSet
The Stroke Volume
Is a mandatory parameter – must be Confirmed before treatment start
Can be set within the range of ml - default value is 30 ml
Changeable before and during the treatment (via the Prescription screen Parameter list or on the Blood screen)
Highlight
Always set the HD-SN Treatment before starting the HD-SN DP cassette loading procedure
If not, ADS will expect a standard ArtiSet and guide the Operator to open only the Arterial pump cover …
Always set the HD-SN Treatment
before starting the HD-SN cassette loading procedure

5. Priming performed in SN
HD-SN DP
HD SN HC
Priming performed in SN
Patient Connection
SN or DN
Special Procedures
SN  DN
DN  SN
HD SN (Double Pump)
Ref: Operator’s Manual: Section Machine dressing and priming and Special Procedures 8:20 and 8:21
Install ArtiSet HD SN HC
Preparation and priming is performed in SN mode
Patient Connection may be performed in SN or DN mode
From Patient Connection until Stop Treatment it is possible to switch from DN to SN (or SN to DN) as many times as needed, keeping the SN cassette installed.
New SKU’s and IFU’s because of the new Intended Use (DNDP) and performances in DNDP – regulatory purposes
Needle mode switch is available, from Connect Patient until Stop Treatment keeping the SN cassette installed

6. Switching from SN to DN (DP) …
Switching from SN to DN (DP) …
Switching from SN to DN (DP) …
Ref: Operator’s Manual: Special Procedures 8:20
Note: It is not possible to switch from SN to DN when Isolated UF is still activated.
Performing this switch means the treatment continues in DN DP mode. The Arterial and Venous pumps are then running with the same rate, which is controlled by the Operator using the Arterial Blood Pump hard keys. The Venous Blood Pump is further controlled by a fixed system pressure of 100 mmHg (displayed in the Blood screen)..
Diascan and Hemoscan functions will remain available if they were activated from start.
Control loop on Venous pump with system pressure fixed at 100mmHg
when in Double needle Double pump mode

7. Needle mode switch is possible as many times as needed
… and from DN to SN (DP)
... and from DN to SN (DP)
Ref: Operator’s Manual: Special Procedures 8:21
Note: It is not possible to switch from DN to SN when Isolated UF is still activated.
To Confirm the switch to SN DP mode, the Stroke Volume first has to be set/Confirmed (mandatory parameter).
The Mean Blood Flow and Stroke Volume are displayed in the treatment overview screen.
The Blood Setting Sub-screen becomes available.
Diascan and Hemoscan functions will remain available if they were activated from start.
If activated, the Hemocontrol function deactivation Confirm Window appears; Check the UF and dialysis fluid Sodium parameters before Confirmation. (The UF volume/rate and dialysis fluid sodium parameters may be adjusted via the prescription screen select pad if needed.)
Needle mode switch is possible as many times as needed

8.
SNDP ArtiSet
Dialyzer Art. line
Post dialyzer
Expansion Chamber
Pre dialyzer
Dialyzer Ven. line
SN Service lines
Integrated blood circuit including 2 expansion chambers and a venous pump segment
Automatic loading of the complete blood circuit
Automatic priming and chamber level adjustment
SNDP ArtiSet
Operator’s Manual, section and section 16.8 concerning alarm 594 description
Demonstrate the SN ArtiSet and specifically point out the additional components
Double cassette; standard blood cassette + 2 expansion chambers (pre-dialyzer and post-dialyzer) and a pump segment
Autopriming - standard preparation
All chamber fluid levels - blood cassette and expansion chambers - are automatically adjusted
Blood circuit and pump management are designed to provide continuous and almost constant flow in the dialyzer - expansion chamber before and after the dialyzer is patented by Gambro
Highlight:
The fluid level in the post dialyzer chamber is normally quite low
It really looks too low but once the treatment is running it will be OK
SNDP alarm “594 SN Service Line(s) on SN cassette open” during priming. NOTE: If the clamps are closed, open the venous blood pump cover and check that the pump segment is correctly loaded. If not, it is possible to load it manually and then reset the alarm (once or twice)
The fluid level in the post dialyzer chamber is normally quite low

9. Blood Levels in the Chambers
Blood Levels in the Chambers
Blood level adjustment during SNDP treatment
1. Arterial chamber
During the arterial phase when the arterial automatic clamp is open
2. Venous chamber
During the venous phase when the venous automatic clamp is open
3. Expansion chambers (if blood levels in the two expansion chambers become
greatly different; e.g. after an alarm situation):
Decrease the “Stroke Volume” to 20 ml and the “Mean Blood Flow” to 50 ml/min and wait at least one cycle (arterial + venous phase) before stopping the blood pumps
Attach a sterile luer-lock syringe (at least 20cc) to the Service Line on the expansion chamber with the higher blood level and gently adjust by pushing or pulling the blood level in accordance with the other expansion chamber
Restart the blood pumps and adjust the Mean Blood Flow and “Stroke Volume”
Blood Levels in the Chambers
Operator’s Manual, section 8.28

10. SNDP Parameters Mean blood flow rate
SNDP Parameters
Mean blood flow rate
The effective blood flow rate during one cycle (20 to 270 mL/min, 10 mL/min step)
Stroke volume
The volume of blood passing through the dialyzer during a cycle (20 to 60 mL, 5 mL step)
SN pressure max
Automatically calculated in accordance with the set stroke volume
SN pressure
Actual pressure in the post dialyzer chamber
SN pressure min
Fixed at 40 mmHg
SNDP Parameters
Operator’s Manual, section 6.3.2

11. Treatment Overview Screen
Treatment Overview Screen
Mean Blood Flow
directly adjustable with BP hard keys
Stroke Volume value box
200
Treatment Overview Screen
Operator’s Manual, section 6.2 and 6.3
2 differences vs. DN treatment Overview screen
Mean blood flow – set and actual
Stroke volume – actual
The Mean Blood Flow can be adjusted either by:
Using the Blood Flow Increase/Decrease keys on the Hard Key Panel - In this case, the ratio Arterial Flow / Venous Flow is kept constant.
Using the “Arterial Flow” and “Venous Flow” buttons on the Blood Settings sub-screen during treatment. Each time the set Mean Blood Flow is changed in this way, the ratio Arterial Flow / Venous Flow is changed (see slide 13).
Highlight:
Adjustable mean blood flow
I.e. no need to set one flow for the arterial pump and one flow for the venous pump
Adjustable mean blood flow

12. Blood Settings Screen Adjustable Stroke Volume
Blood Settings Screen
Stroke volume set button (also available on Prescription screen)
Stroke Volume value box
Arterial and Venous pressure values and trend graph
Blood Settings button
200
Blood Screen
Operator’s Manual, section 6.3
The Blood screen contains additional information:
The set and actual stroke volume
An arterial and venous pressure graph that looks a bit different due to bigger changes in the arterial and venous pressures along with the blood pump shifts
A blood Settings button
Highlight:
Adjustable Stroke Volume
That is as most parameters reachable via the prescription screen or the blood screen
Adjustable Stroke Volume

13. Stroke Volume + = 40ml Arterial Phase Venous Phase Stroke Volume
Stroke Volume +
Stroke Volume
The stroke volume or the volume of blood passing through the dialyzer during one cycle can be visualized according to this slide
During the arterial phase, the levels are increasing in the two chamber pre and post dialyzer
During the venous phase, the levels are decreasing  the amount now pumped back to the patient is the stroke volume
Since one chamber is pre and the other is post, the flow through the dialyzer is more or less continuous
= 40ml
Arterial Phase
Venous Phase

14. Blood Settings sub-screen
Blood Settings sub-screen
Arterial flow set button
Venous flow set button
200
The Mean Blood Flow is automatically recalculated when Arterial or Venous Flow values are changed
Blood Setting sub-screen
Operator’s Manual, section 6.3
The blood flow for the arterial and venous pumps can be set individually
If another flow ratio than the preset 30% higher venous flow is needed, the arterial and venous flows can be adjusted using the two flow set buttons
This subs-screen also contains some additional information
Maximum SN pressure
Actual SN pressure
Minimum SN pressure
A graph displaying the actual SN pressure
Highlight:
Usually the venous pump runs about 30% faster than the arterial pump
Normally, it is possible to return the blood with a higher flow than it is removed from the patient i.e. decreasing the cycle time – this is the reason for the preset 30% higher venous flow (default)
SN Pressure Max, dependant of the stroke volume
SN Pressure, post dialyzer chamber pressure
SN Pressure Min, fixed at 40mmHg
Usually the venous pump runs about 30% faster than the arterial pump as it is easier to return blood faster - it also decreases cycle time

15. During Rinseback the A/V pumps run synchronously
SNDP Supervision
Operator control: Mean blood flow and Stroke Volume
Arterial and Venous flow adjustment (blood pump speed) for fine-tuning
System control: Post dialyzer pressure management; auto adjustment of pump speed and pressure threshold
Safety system: Pressure monitoring and Time-cycle
SNDP Supervision
Operator’s Manual, section
System Control;
SN Max pressure is automatically calculated by the machine according to the Stroke Volume set by the operator. When the “SN pressure” reaches this value, the phase is switched from Arterial to Venous.
Post-dialyzer Pressure:
-110 mmHg to +800 mmHg
Safety system;
There is a built in time limit that prevents the pumps from running for too long time
Highlight:
During Rinseback the A/V pumps run synchronously
This saves time since the blood is being return with a 100% continuous flow – normally in SN/DP the arterial pump is only running part of the time
During Rinseback the A/V pumps run synchronously

16.
Nice to Know !
Functions available with SNDP – Diascan*, Hemoscan, Isolated UF (*=accuracy not guaranteed for SN: blood pump does not run as fast as in double needle mode resulting in a decreased volume of blood cleared/processed)
The fluid level in the SN Venous Chamber is normally quite low
The Blood setting button becomes available at blood detection
When the Blood Setting sub-screen is open, the BP hard keys ▼ and ▲ are disabled
When a SN parameter is changed, 3-4 cycles are required for the change to become valid
Nice to know
Last bullet – be patient, it takes a while for the machine to adjust

17. Nice to Know – Switching Needle Mode
Nice to Know – Switching Needle Mode !
Isolated UF, Hemoscan and Diascan* are available when the treatment is started in HD DN (SP/DP) or SN DP mode. (*=accuracy not guaranteed for SN)
The Isolated UF function must be deactivated before switching Needle Mode (not available in the Select pad) and cannot be reactivated after the switch.
HemoControl is available when the treatment is started in DN. When switching to SN (DP or SP), HemoControl is deactivated upon the Operator’s confirmation of UF rate and dialysis fluid sodium concentration.
Nice to Know

18. Hands on Module 10 SNDP Switch between the needle modes
Hands on Module 10
SNDP
Switch between the needle modes
Hands on Module 10
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

19. Abbreviations for products
HD SN DP: Hemodialysis Single Needle Double Pump
HD DN HC: Hemodialysis Double Needle Hemocontrol
HD DN DP: Hemodialysis Double Needle Double Pump

20. For the safe and proper use of the devices referenced within, refer to Warnings, Precautions and the complete Instructions for Use or the appropriate manual avaialble by contacting customer support
ArtiSet, Diascan, Hemoscan and Hemocontrol are Trademarks of Gambro AB. Gambro is an indirect subsidiary of Baxter International Inc.