PRISMAFLEX(TM)

Introduction

Differences

INTRODUCTION

The PRISMAFLEX(TM) is the newest generation of technology for CRRT (hemodialysis) offered by Gambro.

The following overview has been developed to provide a brief introduction to the PRISMAFLEX(TM) machine. This information is intended to introduce participants to the main differences between the current technology and the PRISMAFLEX.

PRISMAFLEX educational sessions will provide more detailed instruction regarding the technology.

How the Prismaflex(TM) is different from Prisma(TM) (major differences):

1. The Prismaflex(TM) has an additional pump that allows the delivery of fluid into the blood pre filter. This circuit is called the Pre Blood Pump (PBP). Fluid delivered into this circuit will be accounted for in the calculation of net fluid balance. In other words, if 200 ml is being delivered via the PBP and there is 100 ml of fluid removal, the machine will automatically remove the extra 200 ml.
   

   PreBlood Pump

   
   Examples of solutions that can be delivered via the PBP include anticoagulants (heparin or citrate).
   
   Prisma(TM) does not have a PBP. Infusions delivered prefilter are currently administered via an external infusion pump and are not accounted for in the net fluid removed as displayed by the machine. Currently, when infusions are administered (e.g. citrate), the fluid removal must be increased to match the infusion rate to provide a true net balance. Adjustments for the citrate infusion will no longer be required with the PRISMAFLEX(TM). When running citrate, the fluid balance will still need to be increased according to the systemic calcium chloride infusion.
   
2. The tubing for the Prismaflex(TM) is larger. This will lowers the resistance to flow and can reduce the amount of pull required to remove blood from the patient. This can cause access pressures to become less negative. Occassionally, access pressures may become low enough to trigger access disconnect alarms (access disconnect alarms occur when the access pressures are higher than <10).
   
   The solution to erroneous access disconnect alarms is to increase the blood flow rate until the access pressure again falls below <10 (it take more "pull" to move blood through the filter at a higher rate).
   
3. The Prismaflex(TM) has much higher maximum flow rate capabilities for blood flows, dialysate and replacement rates. The Prisma(TM) can only achieve blood flow rates of 150-180 ml/min (depending upon model). The current combined flow rate for dialysate PLUS replacement volumes is 4 L/hr. The Prismaflex(TM) can deliver up to 8 L/hr per hour (dialysate, replacement plus PBP). To achieve flow rates this high, a larger filter with higher blood flow capacity needs to be used. We will continue to use the same type of filter with similar flow rates to our current practice.
   
4. Currently, Prisma(TM) is initially set-up in CVVHDF mode. This provides the flexibility of being able to change the therapy to CVVH or SCUF, without changing the filter. If the Prisma(TM) is set-up as CVVH, dialysis can only be introduced by discontinuing the current treatment and setting up a new filter. While CVVHDF mode set-up provides the flexibility to adjust the treatment downward, it does limit the hemofiltration maximum flow rate to 2 L/hr. Higher hemofiltration rates can be run if the circuit is set-up initially as CVVH, however, dialysate cannot be added without starting a new filter. Prismaflex(TM) is a much more flexible system that allows any therapy change.
   
   The same Prismaflex(TM) filter can be run as predilution, postdilution, or a combination of both, when hemofiltration therapy is used. Currently, Prisma(TM) can only be run as predilution OR postdilution, depending upon the type of filter being selected. Currently, we only stock predilution sets for the Prisma(TM).We will continue using the predilution filters at this time.
   
5. An air elimination port similar to those found on intermittent hemodialysis circuits is incorporated into the Prismaflex(TM) circuit. This is not a component of the Prisma(TM). Assessment of the air-fluid level will be required hourly and prn. A filter to prevent blood from entering the machine is also used.
   
6. Technical differences exist among the filters used, methods for priming, heater and heater tubing and method for bag changes. This will be demonstrated in class.
   
7. Scales are still used to measure weight changes, however, the new Prismaflex™ is less susceptible to nuisance alarms. Scales are now located at waist level, with an improved ergonomic design for bag changes.
   
8. Data storage capabilities are available with the Prismaflex(TM).

   References:
   Gambro Training Manual 1 and 2
   Slides from Gambro Training package, reproduced with permission

Last UpdateMarch 30, 2010