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Dialog+ SW 9.xx HDF Online. Technical Support International

1. Dialog+ SW 9.xx HDF Online

Technical Support International
B. Braun Avitum AG
Service Training Documentation – no update service. This document may not be copied, partly or whole, or made be
accessible to third parties without our permission and remains the property of B. Braun Avitum AG with all rights.

2. Folie 2

HDF Online
Upgrade to HDF Online not possible
Downgrade to standard machine not possible
All filters are always in use
B. Braun Avitum AG | DialogP SW9.xx_std_HDF Online_Rev. 1.02_2011-11-21 | Seite 2

3. What does HDF Online offer?

A safe procedure with a combination of HD and HF.
High efficiency with diffusion and convection.
Online production of substitution solution.
Replacing saline for priming and disconnecting the patient.
B. Braun Avitum AG | DialogP SW9.xx_std_HDF Online_Rev. 1.02_2011-11-21 | Seite 3

4. Folie 4

Hemodiafiltration
Combines two dialysis technics,
Hemodialysis and Hemofiltration
B
High clearance of small molecules
through diffusion
D
High clearance of middle molecules
through convection
mmHg
D
B
B. Braun Avitum AG | DialogP SW9.xx_std_HDF Online_Rev. 1.02_2011-11-21 | Seite 4
mmHg

5. Folie 5

Types of Therapies with HDF Online
B
D
F
B
Convection
D
mmHg
mmHg
D
B
mmHg
high-flux
low-flux
D
B
B
Diffusion
B. Braun Avitum AG | DialogP SW9.xx_std_HDF Online_Rev. 1.02_2011-11-21 | Seite 5
B
mmHg

6. Folie 6

HDF Online Concept
OSP
Postdilution
PV
Substitution port
SAD
Heparin
BLD
PBE
PA
BPA
Preadapter
Predilution
B. Braun Avitum AG | DialogP SW9.xx_std_HDF Online_Rev. 1.02_2011-11-21 | Seite 6

7. Folie 7

Microbiological Requirements
AAMI
Ph. Eur.
Bacteria
CFU/ml
200
Pyrogene
EU/ml
5
Dialysing Solution
2000
5
Sterile Solution
Ultrapure Dialysing solution
10-6
0
Bacteria
CFU/ml
100
1000
(DafKN)
0
0,1
0
0
Permeate
AAMI = American Association for the Advancement of Medical Instrumentation
Ph. Eur. = European Pharmakopoe
CFU
= Colony Forming Units
EU
= Endotoxin Units
B. Braun Avitum AG | DialogP SW9.xx_std_HDF Online_Rev. 1.02_2011-11-21 | Seite 7
Pyrogene
EU/ml
0,25
0,5 (DafKN)
0,25
<0,03

8. HDF Online Icon

B. Braun Avitum AG | DialogP SW9.xx_std_HDF Online_Rev. 1.02_2011-11-21 | Seite 8

9. Folie 9

HDF-Online Message: “Ratio gross UF rate/blood flow“
Start therapy in HD Mode
First reach correct blood flow
Change to HDF Mode
B. Braun Avitum AG | DialogP SW9.xx_std_HDF Online_Rev. 1.02_2011-11-21 | Seite 9
Supresses platelet activation
Lowers protein adsorption
Reduces hemolysis and clotting

10. Folie 10

Increase of TMP at start of HDF dialysis
A high TMP in the beginning of therapy causes
proteins to block the pores
The efficiency of the therapy is reduced
Blocking of the pores reduces the surface area
Even in UF Min the machine has a high
Ultrafiltration
hollow fibre
diffusive layer
TMP
time
B. Braun Avitum AG | DialogP SW9.xx_std_HDF Online_Rev. 1.02_2011-11-21 | Seite 10

11. Folie 11

HDF-Online Message: “Ratio gross UF rate/blood flow“
Example for a patient with 81 kg
In postdilution the ratio of total UF/blood flow can be max. 25-30%
In postdilution 30-40 L substitution volume
total substitution volume 1/3 of patient‘s body weight
In predilution 70-100 L substitution volume
Example for post-dilution:
body weight
81 kg
weight loss
3 kg
treatment time
5h
blood flow 300
350 ml/min
B. Braun Avitum AG | DialogP SW9.xx_std_HDF Online_Rev. 1.02_2011-11-21 | Seite 11
30% of 81 = 27 l
27 l + 3 l weight loss = 30 l
30 l : 5 h = 6 l/h
6 l/h : 60 min = 100 ml/min
Substituition volume
UF rate
nett UF
total UF
27 l/h
6 l/h (100 ml/min)
30 l
3l

12. Hardware Components

Substitution ports for infusing of the substitution
fluid pre- or postdilution
Automatic priming of the tubing set with
substitution fluid
2 DF filters to ensure clean substitution fluid
replaceable every 150 treatments or 900 hours
B. Braun Avitum AG | DialogP SW9.xx_std_HDF Online_Rev. 1.02_2011-11-21 | Seite 12

13. Folie 13

HDF Online – Blood Side Preparation
PV
PA
PBE
BPA
HP
SAD
RDV
SAKV
OSP (Online Substitution Pump)
Inlet
Outlet
B. Braun Avitum AG | DialogP SW9.xx_std_HDF Online_Rev. 1.02_2011-11-21 | Seite 13

14. Folie 14

HDF Online Therapy
PV
PA
PBE
BPA
HP
SAD
RDV
SAKV
OSP (Online Substitution Pump)
Inlet
Outlet
B. Braun Avitum AG | DialogP SW9.xx_std_HDF Online_Rev. 1.02_2011-11-21 | Seite 14

15. Folie 15

HDF Online Reinfusion
PV
PA
PBE
BPA
HP
SAD
RDV
SAKV
OSP (Online Substitution Pump)
Inlet
Outlet
B. Braun Avitum AG | DialogP SW9.xx_std_HDF Online_Rev. 1.02_2011-11-21 | Seite 15

16. Folie 16

Balance Chamber Principle Phase 1
Inlet Flow
Pump
DDE
FPE
Air Separator LA
BLD
Balance Chamber
RVDA
Outlet Flow
Pump FPA
PDA
Ultrafiltration Pump UFP
B. Braun Avitum AG | DialogP SW9.xx_std_HDF Online_Rev. 1.02_2011-11-21 | Seite 16

17. Folie 17

18. Folie 18

19. Folie 19

20. Folie 20

21. Folie 21

Balance Chamber Principle Phase 2
Inlet Flow
Pump
DDE
FPE
Air Seperator LA
BLD
Balance Chamber
RVDA
Outlet Flow
Pump FPA
PDA
Ultrafiltration Pump UFP
B. Braun Avitum AG | DialogP SW9.xx_std_HDF Online_Rev. 1.02_2011-11-21 | Seite 21

22. Folie 22

Balance Chamber Principle Phase 2
Inlet Flow
Pump
DDE
FPE
Air Separator LA
BLD
Balance Chamber
RVDA
Outlet Flow
Pump FPA
PDA
Ultrafiltration Pump UFP
B. Braun Avitum AG | DialogP SW9.xx_std_HDF Online_Rev. 1.02_2011-11-21 | Seite 22

23. Folie 23

24. Folie 24

25. Folie 25

Producing Substitution Fluid
Postdilution
HDF Filter
Balancing
DF-Filter
OSP
FPE
FPA
UFP
B. Braun Avitum AG | DialogP SW9.xx_std_HDF Online_Rev. 1.02_2011-11-21 | Seite 25
Predilution

26. Folie 26

HDF Online Balancing Chamber
Postdilution
600ml/min
Balancing
600ml/min
DF-Filter
80ml/min
520ml/min
HDF Filter
OSP
80ml/min
80ml/min
+ Patient UFP
FPE
FPA
600ml/min
+ Patient UFP
600ml/min
+ Patient UFP
B. Braun Avitum AG | DialogP SW9.xx_std_HDF Online_Rev. 1.02_2011-11-21 | Seite 26
Predilution

27. Folie 27

HDF Online – Dialysate Distribution in the Filter
DF Filter
HDF Filter
QD 600 ml/min
QD 520 ml/min
QS 80 ml/min
QB 290 ml/min
QUF 90 ml/min
QD 610 ml/min
B. Braun Avitum AG | DialogP SW9.xx_std_HDF Online_Rev. 1.02_2011-11-21 | Seite 27
QB 300 ml/min

28. Folie 28

Infusion Bolus – Patient Connection and Disconnection
Postdilution
For infusion the balancing chamber and
UF pump are stopped
HDF Filter
Free Flow Mode
DF Filter
OSP
FPE
FPA
Predilution
B. Braun Avitum AG | DialogP SW9.xx_std_HDF Online_Rev. 1.02_2011-11-21 | Seite 28

29. Folie 29

HDF Online – Hydraulics
Postdilution
HFB
HDF Filter
DDE
VDE
VBE
RVFPE
DF Filter
OSP
VSB
VDFF
FPE
VLA
FPA
VSAE
VSAA
VBP
VDA
RVDA
UFP
RVFPA
B. Braun Avitum AG | DialogP SW9.xx_std_HDF Online_Rev. 1.02_2011-11-21 | Seite 29
Predilution

30. Folie 30

HDF Online – Hydraulics
1 Hydrophobe filter with
adapter
2 Valve 3/2 way
B. Braun Avitum AG | DialogP SW9.xx_std_HDF Online_Rev. 1.02_2011-11-21 | Seite 30

31. Folie 31

HDF Online – Rinsing after a DF Problem
~ 1 Minute
HDF Filter
Rinsing
DF Filter
B. Braun Avitum AG | DialogP SW9.xx_std_HDF Online_Rev. 1.02_2011-11-21 | Seite 31
OSP

32. Folie 32

HDF Online – Electronics
Connection for online
valves and sensors
Tests in TSM
B. Braun Avitum AG | DialogP SW9.xx_std_HDF Online_Rev. 1.02_2011-11-21 | Seite 32

33. Folie 33

HDF Online – Filter Testing
DF, HDF Filter Tests
HFB
Manometer
HDF Filter
VBE
650 - 750 mbar
DDE
VDE
500 mbar
400 mbar
RVFPE
DF Filter
VSB
VSAE
VBP
VDFF
FBK1
FPE
1000 rpm
VLA
FVD
VSAA
FSU
FBK2
FPA
VDA
H2O
RVDA
500 rpm
500 mbar
UFP
Free Flow Mode
RVFPA
PDA
The hydraulic circuit is tested with
VDFF, VSB, VSAE + VSAA
B. Braun Avitum AG | DialogP SW9.xx_std_HDF Online_Rev. 1.02_2011-11-21 | Seite 33

34. Folie 34

HDF Online – Filter Test
Air is flushed from the DF-Filter
HFB
Manometer
HDF Filter
VBE
150 - 250 mbar
DDE
VDE
RVFPE
DF Filter
VSB
VSAE
VBP
VDFF
FBK1
FPE
1000 rpm
VLA
FVD
VSAA
FSU
FBK2
FPA
VDA
RVDA
H2O
500 rpm
500 mbar
UFP
Free Flow Mode
RVFPA
PDA
The hydraulic circuit is tested with
VDFF, VSB, VSAE + VSAA
B. Braun Avitum AG | DialogP SW9.xx_std_HDF Online_Rev. 1.02_2011-11-21 | Seite 34

35. Folie 35

HDF Online – Filter Tests
DF, HDF Filter and Port Tests
HFB
Manometer
HDF Filter
VBE
350 - 450 mbar
DDE
VDE
RVFPE
DF Filter
VSB
VSAE
VBP
VDFF
FBK1
FPE
1000 rpm
VLA
FVD
VSAA
FSU
FBK2
FPA
VDA
RVDA
H2O
500 rpm
PDA
500 mbar
UFP
Free Flow Mode
RVFPA
The hydraulic circuit is tested with
VDFF, VSB, VSAE + VSAA
B. Braun Avitum AG | DialogP SW9.xx_std_HDF Online_Rev. 1.02_2011-11-21 | Seite 35

36. Folie 36

HDF Online – Filter Test
DF, HDF Filter and Port Tests
HFB
Manometer
HDF Filter
VBE
DDE
VDE
500 mbar
400 mbar
RVFPE
DF Filter
VSB
VSAE
VBP
VDFF
FBK1
FPE
0 rpm
VLA
FVD
VSAA
FSU
FPA
FBK2
VDA
H2O
RVDA
500 rpm
500 mbar
RVFPA
UFP
B. Braun Avitum AG | DialogP SW9.xx_std_HDF Online_Rev. 1.02_2011-11-21 | Seite 36
PDA -100 mbar

37. Folie 37

Calibration RVDA and RVFPE
Measuring point for both calibrations:
flow 500ml/min and temperature 37 °C
1.
2.
without clamp for RVDA adjustment
with clamp the tube next to the FBK2
for RVFPE adjustment
RVDA 500 mbar
B. Braun Avitum AG | DialogP SW9.xx_std_HDF Online_Rev. 1.02_2011-11-21 | Seite 37
RVFPE 1.3 bar

38. Folie 38

Calibration of RVFPA
During the calibration pay attention to the following:
1.
2.
3.
4.
Both dialyser couplings should be in a water filled container
The DF filters must be decalcified and free of air
Low level test 1.20 Settings: flow 500ml/min, temperature 37 °C
Clamp the tube next to the FBK2
RVFPA 1.3 bar
B. Braun Avitum AG | DialogP SW9.xx_std_HDF Online_Rev. 1.02_2011-11-21 | Seite 38

39. Folie 39

Calibration of DDE
During the calibration pay attention to the following:
1.
2.
3.
Both dialyser couplings should be in a water filled container
The DF filters must be decalcified and free of air
Low level test 1.20 Settings: flow 500ml/min, temperature 37 °C
DDE 400 mbar
B. Braun Avitum AG | DialogP SW9.xx_std_HDF Online_Rev. 1.02_2011-11-21 | Seite 39

40. Folie 40

Change after 150 Treatments or 900 Hours
Follow the correct procedure
1. Chemical disinfection with Tiutol® KF with the old filter
2. Empty the filter
3. Test for residual disinfectant
4. Change the filter
5. Reset the counter
6. Fill in the rinsing mode for 5 minutes
7. Citric heat disinfection
B. Braun Avitum AG | DialogP SW9.xx_std_HDF Online_Rev. 1.02_2011-11-21 | Seite 40

41. Folie 41

Maintenance Kit
B. Braun Avitum AG | DialogP SW9.xx_std_HDF Online_Rev. 1.02_2011-11-21 | Seite 41

42. Folie 42

Thank you very much for your attention.
In case of any further questions,
please do not hesitate to ask me.
It is a pleasure for me to answer you!
B. Braun Avitum AG | DialogP SW9.xx_std_HDF Online_Rev. 1.02_2011-11-21 | Seite 42

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