09.00-10.00_ Clinical Update by TN

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Title, Subject, Author (c) Copyright 11/08/2015

Quality Assurance Tools Adekuasi DialysisClinical Update On Hemodialysis Practice

Triningsih, S.Kep; Jakarta; 12 Agustus 2015

Clinical Manager


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Fresenius Medical Care THE RENAL COMPANY Page 2

Agenda/ Objective

FEATURE & BENEFIT MESIN 4008 NG1

2

3

4

5

RINGKASAN

INPUT DATA PASIEN

PEMBACAAN & PENILAIAN OCM

PERAWATAN MESIN HD FMC 4008 NG


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Tujuan Pembelajaran

8. Peserta Mengerti dan Memahami Produk-Produk Fresenius, dan Mengaplikasikan

Di lapangan.

7. Peserta Memahami Trouble Shooting Mesin 4008 S NG

6. Peserta Mengetahui Perawatan Mesin 4008 S NG

5. Peserta Mengetahui Feature BPM dan Operasionalnya

4. Peserta Mengetahui Cara Kerja OCM BPM dan Manfaatnya Bagi Pasien

3. Peserta Bisa Memasukkan Data Pasien dan Pembacaan OCM

2. Peserta Mengetahui Kelebihan dan Keuntungan Mesin 4008 NG

1. Peserta Mengenal Komponen Mesin 4008 NG


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Pelayanan HD Mengacu Pada,.....

Melindungi pasien dalam penyelenggaraan pelayanan dialysis

yang dilakukan tenaga kesehatan. ( Peraturan MenKes RI No.

812/MENKES/PER/VII/2010 Tentang penyelenggaraan

pelayanan dialysis pada yankes)

Memberikan kepastian dan perlindungan hukum bagi

pengguna maupun penyelenggara pelayanan kesehatan.

(Konsensus Dialysis , 2003 hal 10 )

Tujuan umum pedoman pelayanan hemodialisis berorientasi

pada keselamatan dan keamanan pasien. (Pedoman

Pelayanan Hemodialisis , 2008 )


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FEATURE & BENEFIT MESIN 4008 NG


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MESIN HD Fresenius 4008 NG; Next Generation

Mesin HD 4008 NG

DIASAFE Bibag 5008


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1. User Interface (Monitor)the operator inputs treatment parameters and

receives information from the machine regarding

various aspects of the operating status

2. Extracorporeal Blood Circulation(Modules)

which pumps blood, anticoagulates blood and

monitors flows and pressures

3. Hydraulics System (Preparation ofDialysate)

the main function of which is the formationand

delivery of dialysate to the dialyzer

Feature & Benefit Mesin HD Fresenius 4008 NG



Tampak Belakang

MONITOR (REAR VIEW)

SAMPLING VALVE

BRACKET / DIALYZER CONNECTION

LINES

DIALYSATE OUTLET TUBE

DIALYSATE INLET

TUBE

DIASAFE PLUS

FILTER

DISINFECTION CONNECTOR

POWER SUPPLY UNIT

VENT TUBING (OVERFLOW)

CDS RED OPTION

WATER CONNECTOR (PERMEATE)DRAIN



Sistem Monitoring

Integrated Online Clearance Monitor (OCM) and BPM

Tool untuk memonitor kualitas dari dosis dialisis yang di berikan danmemastikan tingkat keamanan pasien

Plasma Na valueBPM



BPM; Blood Pressure Monitor

5008 BPM



Pemasangan Cuff HARUSBENAR& Searahdg

Arteri Brachialis

Size/ UkuranCuff disesuaikan

dg Pasien

Blood Pressure Module (BPM)



Fully automated and non-invasive, operating on the principles ofoscillometry

Programmable measurement interval of 5 - 15 - 30 60 minutes and

quick measurement

Measurement of Systolic and Diastolic blood pressure, Mean Arterial

Pressure (MAP) and Pulse rate

Blood Pressure Module (BPM)

BPM menu now part of the monitor



Bibag5008

Bibag 5008


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LANJUTAN,

Penyimpanan memerlukantempat yang luas

Transportasi/

pengangkutanperlu extratenaga


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PEMBACAAN & PENILAIAN OCM;

Online Clearance Monitor


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Quality Assurance Tool

OCM; Online Clearance Monitor


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OCM; Onlinne Clearance Monitor

Pilihan DiagramTampilan Monitor


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OCM; Onlinne Clearance Monitor

Pilihan DiagramTampilan Monitor


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Continuous Clearance Measurement(by Online Clearance Monitor)

Data input required

Watson formulaDry weight

Height

Age

Sex

Other parametersHematocrit (pre-set at

35%)

Measurement interval

(pre-set to 50 min.)

Set Target-Kt/V

OFFON


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Babb AL, Maurer CJ, Fry DL, Popovich RP, McKee RE :The determination of membrane permeabilities and solute diffusivitieswith applications to hemodialysisChem. Eng. Progr. Symp. Ser. 84,64 (1968) 59-68

The principle of OCM is based on the equivalence of the diffusive

characteristics of the sodium ion and the urea molecule through cells and

synthetic membranes.

The Equivalence Of Electrolyte AndUrea Clearance


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Parameters Desplayed by OCM


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Reduced Clearance And The Effect on Kt/V

130

An intradialyticreduction inclearance leads

to a visualiseddecrease indelivereddialysis doseKt/V which

would remainundetectedwithout OCM.


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Reduced Clearance And The Effect on Kt/V

130

An intradialytic

reduction inclearance leads to avisualised decreasein delivered dialysisdose Kt/V whichwould remain

undetected withoutOCM.

OCM allows

intradialyticcounteraction, i.e.an increase inblood flow wherepossible!


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4008 S

Effective

in-vivoclearance

Plasma Sodium

concentration(corrected to

flame

photometer)

Cumulating

Kt/V

Parameters displayed by OCM


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Blood samples(expensive) Kt/V >1.2 ...1.8

Dialysate; K and t,(no additional costs)

Monthly / quarterly Frequency In every session

Retrospective Quality Control Continuous, online

Staff, syringes, labtime cost and energy Effort None

Inconvenient Handling Automatic

The conventional

procedure today

Aspects With OCM option

Accuracy of K6-8% 5%

Impractical anduncommon

Quality assurance Standard!

Keuntungan Menggunakan OCM

Tidak ada tambahan atau biaya untuk

Pemantauan Kualitas yang tepat 100% untuk setiap sesi dialisis.


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INPUT DATA PASIEN


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GOOD RESULT


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Data-data pasien untuk Penghitungan V (urea)menggunakan Rumus Waltson


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Data Dialyser, QB, Waktu HD, UFG, dll

DIALYZER

HPS F.7

QB; 300Ml/Mnt


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Monitoring dari waktu ke waktu


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END OF DIALYSIS & RESULT OF Kt/V


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BAD RESULT

d i k hi ( )


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Data-data pasien untuk Penghitungan V (urea)menggunakan Rumus Waltson


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Data Dialyser, QB, Waktu HD, UFG, dll

DIALYZER

HPS F.7

QB; 300Ml/Mnt


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PERAWATAN MESIN HD FMC 4008 NG

Tampilan Menu Mesin 4008 S NG


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System parameters OTOMATIS PROGRAM DESINFECTAN

Tampilan Menu Mesin 4008 S NG


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Disinfection Program on 4008 S NG

Puristeril340/

Puristerilplus

Citrosteril/

Diasteril

Sporotal100

Sodium

Hypochlorite

3.5%

1

2

3

4

5

Disinfection

Program


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Hubungan Adekuasi Dengan Kecukupan Nutrisi

Kadar bunpredialisis

turun

Nafsumakanturun

Diet rendahprotein

Adekuasiturun

malnutrisi

hipoalbuminemia

edema

Tekananonkotik

turun

UF tinggi

Hipotensi

QB turunLama HD turun


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GAGAL GINJALKRONIS

Stem Cell

UremiaKekuranganMassa Ginjal

(Berbagai

Tahap)

KecenderunganBerdarah

InhibitorEritropoiesis

Colony-forming unitsErythroid (CFU-E)

Hemolisis

Hubungan Adekuasi Dengan Anemia

Eritropoietin

Osteodistrofi

Ginjal

Fibrosis

Sum-sum Tulang

Eritrosit

Malnutrisi

Keracunan Al

Def. B12

Def. Asam Folat

PTH

Fresenius Medical Care Indonesia


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Fresenius Medical Care Indonesia The only Integrated Renal Company

4008S Therapy System

Low-Flux HPS Dialyser

MX EcoSeries

On-line bibag


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THANK YOU FOR YOUR ATTENTION

09.00-10.00_ Clinical Update by TN

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