lynda and “abyle” products. blood pump moves blood in all the therapies. in crrt the blood flow...
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Lynda and “Abyle” products
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Blood pump
Moves blood in all the therapies.
• In CRRT the blood flow is between 0.30 and 450 ml/min.
• In CPFA and PEX the blood flow ranges from 0.30 to 250 ml/min.
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Ultrafiltration Pump
Moves the ultrafiltration fluid, ranging from 0.5 to 12 lt/h.
Variable- Wanted weight loss
Reached weight loss
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Plasma Pump
It moves Pre-dilution infusion, range 0 -9.6 Lt/h, in CVVH/ IHF and Post-dilution infusion, range 0 - 4 Lt/h, in CVVHD/CVVHDF/IHD/IHDF.
In CPFA the plasma flows in a range from 0.5 to 25 % of blood’s flow
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Infusion Pump
In CVVH/ IHF/ CPFA - moves post-dilution infusion.In CVVHD/ CVVHDF/ IHD/ IHDF - moves dialysate.In PEX - moves substitution fluid.
Flow ranges from 0-12 Lt/h
Allows control over the precent of pre to post dilution infusion (green to blue pump flow).
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Citrate pump
This pump delivers citrate into the blood line.
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7 Pressure Transducers
7 pressure transducers checkdifferent pressures:• arterial - from - 300 to +30 mmHg• venous - from -30 to +300 mmHg• prefilter - from 0 to +400 mmHg• transmembrane (TMP) - from -300 to +400 mmHg• plasma output• cartridge output• cartridge input
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Blood Leak Detector
Optic detector with 2 sensors, can show a blood leak on the filtrate line.
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Air detector and clamp
An ultrasonic sensor reports the presence of air bubbles if bigger than 50 µl. This sensor is connected with a clamp to stop the venous blood flow in case of alarm.
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Syringe PumpA pump for administration of continuous (0-10 ml/h) or bolus (0-20 ml) of anticoagulant or Ca2+.
The pump can accept syringes of all types with a variable volume between 20 to 60 ml.
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HCT and SO2 Meter
The Hematocrit (with blood volume calculation) and the Saturation are measured continuously through a high-precision instrument from the arterial line. There is also the possibility of checking the hemo-concentration through the direct measure of HCT.
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Infusion Scale
It controls the infusion-dialysate fluid.
It can hold up to 40 liters exchange.
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Ultrafiltration Scale
It controls the ultrafiltrate fluid.
It can hold up to 40 liters exchange.
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Heater
It allows to heat the infusion fluidin pre or post dilution. The temperature canbe set between 30°
C and 40°
C with stepsof 0.1°
C.
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Display touch screen
A high-visibility display with user friendly and intuitive touch-screen interface. Allows clear, fast and direct dialogue with the machine. It shows colors and a clear graphic line with its 10.5 inches.
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Display
The screen is divided into 4 areas in which information appear.
Title area : name of active window and treatment.
Active window :displays information and
allows the user to set all data.
On line guide
Function keys : they are used toactivate different functions.
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Placement Kit disposable
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Treatment Options
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SCUF(SLOW CONTINUOUS ULTRAFILTRATION)
Uf
EMOFILTRO
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CVVH, IHF-HVHF(CONTINUOUS VENO-VENOUS HEMOFILTRATION/ INTERMITTENT HEMO FILTRATION – HIGH VOLUME HEMOFILTRATION)
Uf
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CVVHD/ IHD-SLED(CONTINUOUS VENO-VENOUS HEMODIALYSIS / INTERMITTENT HEMODIALYSIS SLOW EXTENDED DIALYSIS)
Uf
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CVVHDF/ IHDF(CONTINUOUS VENO-VENOUS HEMODIAFILTRATION / INTERMITTENT HEMODIAFILTRATION)
Uf
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PEX(PLASMA EXCHANGE)Liquido di
sostituzionePost diluizione
Plasma
PLASMAFILTRO
Thanks to a laminar flow, formed elements of blood are repelled by the electronegative membrane. Thus the activation and / or platelet dispersion is much more limited and erythrocytes survival is significantly unaffected.
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CPFA(COUPLED PLASMA FILTRATION ADSORPTION)
anticoagulante
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Extracorporeal CO2 Removal
(ECCO2R)
Veno-Venous-
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Oxygenation (↑O2) + Ventilation (↓CO2)
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Tissue Plasma
Red blood cell
Capillary w
all
CO2
O2 O2
HCO3-
Cl-
Na+
H2O
CO2 + H2O ca H2CO3
HCO3- H+
K+
H2O
O2
}Hb
}HHb
HbO2
CO2
O2
CO2
3-5%
85-90%
7-10%
CO2
Cl-
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Alveolar w
all
CO2
O2 O2
HCO3-
Cl-
Na+
H2O
CO2
CO2 + H2O ca H2CO3
HCO3- H+
K+
H2O
O2
}Hb
}HHb
HbO2
CO2
O2
Cl-
CO2
Lung Plasma
Red blood cell
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VILI – Ventilator Induced Lung Injury
VAP – Ventilator associated pneumonia
Barotrauma – Pneomothorax
Volutrauma - Overdistention induced permeability
edema
Atelectrauma - Shear injury induced by repeated
airway opening/closing
Biotrauma - Inflamatory reaction in the lung
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Dreyfuss et al. Am Rev Resp Dis 1985, 132: 880-884
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Dreyfuss et al. Am Rev Resp Dis 1985, 132: 880-884
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Tremblay et al. J Clin Invest 1997, 99:944-952.
MV- Moderate VolumeHV- High Volume
HP- High PEEPZP- Zero PEEP
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Oxygenation (↑O2) + Ventilation (↓CO2)
Tidal Volume (TV)
Frequency (F)
% O2 (FIO2)
Pressure (P)
A “protective” technique (low TV) for avoiding VILI causes exceeding CO2 levels that should be removed to avoid
Acidosis .
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(Veno-venous) ECCO2R(Venovenous Extracorporeal CO2 Removal)
CO2
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ECMO CPBDuration
Up to 4 days
ECMO Vs CPB
21 days Several hours
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FAQ1. Does ECCO2R oxygenate the blood?
Answer: Yes, but not enough to oxygenate the patient.
2. How long is the treatment?
Answer: A single kit can be used for up to 4 days, after 48 hours replacing the tubing (not the oxygenator) is needed!
3. Can we perform ECCO2R and CRRT at the same time?
Answer: Bellco is still working on it.
PO2 8mm/Hg PO2 650mm/Hg
ECCO2R:ECMO: 6000 ml/min
450 ml/min
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Main characteristics
Lilliput ECMO2 Oxygenator
Polymethylpentene membrane
Membrane surface 0,67 m2
Heater surface 0,02 m2
Filling volume 90 ml Connections 1/4”- 5/16” Maximum flow 450 ml/min 4 days duration ETO Sterilization
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Non thrombogenic surfaces: PHISIO COATING
COATINGCOATING
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Polypropylene “standard“ membrane
Polymethylpentene “plasma-tight“ membrane
gas comes into contact with blood
through microporous fibres.
gas transfer is obtained through direct contact.
gas comes into contact with blood
through microporous fibres.
gas transfer is obtained through direct contact.
The hollow fibres are protected by an
external thin membrane. Gas
transfer is obtained by diffusion.
The hollow fibres are protected by an
external thin membrane. Gas
transfer is obtained by diffusion.
Plasma-tight membrane: POLYMETHYLPENTENE
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Anticoagulation: Heparin or Citrate ???
To avoid Hypernatremia use Heparin – 10-15 Iu/kg/h
(Citrate)
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Continuous Treatments for Renal Failure
Intermittent Treatments for Renal Failure
Therapeutic Plasma Exchange Treatments
CPFA Treatment for patients with severe sepsis, septic shock or MOF
Treatment for CO2 Removal
LYNDA – A MULTIDISCIPLINARY APPROACH
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Thank you!
QUESTIONS?