Chronic kidney disease is recognized as an urgent and growing global problem. According to the available data, it is estimated that there are millions of undiagnosed people, besides 4 million end-stage kidney disease patients in the world. Innovations and services to apply in order to get the best results for the increasing number of patients are gaining more importance every passing day.

For more than 60 years, Baxter has collaborated with the nephrology community to focus on pioneering care work in peritoneal dialysis (PD) and hemodialysis (HD). Thus, it continues to maintain its innovative vision with new treatments such as extended hemodialysis and remote patient management.

Within the framework of the service approach it has adopted, Baxter helps to expand access to care in different ways by providing different services and technologies that support care in different places such as home and centers and that also increase the application management efficiency.

Baxter’s commitment to quality care stems from its belief that while current care models are good, there is an opportunity to expand these care models with significant innovation. In addition, innovation simplifies the logistics of treatment, which will reduce the psychological and physical burden of care.

Baxter’s global product portfolio plays a critical role in making clinicians more efficient and effective in the treatment of inpatients and patients at intensive care units, operating rooms, dialysis clinics and at home. In addition, Baxter focuses on finding new and effective ways to improve patient outcomes, prevent potential complications before they become life-threatening, and increase access to care while reducing overall costs.

PRISMAFLEX System for Intensive Care

The PRISMAFLEX System, designed to support the recovery process of critically ill patients with acute kidney injury, stands out as a highly innovative system. The system, which draws attention with its flexibility, is able to successfully meet the demands of various treatments thanks to a versatile platform that can be adapted to specific patient needs.

Fluid algorithms help balance patient chemistry with fluid output for optimal treatment delivery. At any given time, it is possible to monitor how much treatment the patient has received within 7 ml of fluid accuracy. 

The PRISMAFLEX System also allows for individual patient care, as each patient is different. Unlike Intermittent Hemodialysis (IHD) or Slow Low Efficiency Dialysis (SLED), the PRISMAFLEX control unit is notable for being designed to provide Continuous Renal Replacement Therapy (CRRT) for 24 hours: metabolic control, acid/base control, fluid removal, electrolyte balance.

Fluid algorithms of the PRISMAFLEX System contribute to stabilizing the patient’s chemical state through fluid removal to provide optimum therapy. The PRISMAFLEX System’s EMR connectivity has the ability to streamline the clinician’s workflow by helping to reduce manual documentation. At the same time, the PRISMAFLEX System plays an important role in downloading treatment data, eliminating manual registration as well as easily integrating into many hospital EMR systems directly or through a third party. 

The PRISMAFLEX system should be restricted to patients with a body weight greater than 20 Kg. In addition, the PRISMAFLEX System is intended for continuous treatments such as CVVHDF, CVVHD, CVVH, SCUF and plasma treatments such as TPE. The PRISMAFLEX System stands out with its outstanding and integrated safety features designed to minimize risk, as well as its improved treatment accuracy.

Prismaflex System M100 – Prismaflex System M150

The Baxter product range consists of a wide variety of products. M100-M150 (PRISMAFLEX System-Hemofilter Sets) are the most important of them. M100-M150 should be restricted to patients with a body weight greater than 30 kg. With the AN 69 Dialyzer Membrane, set configurations are created and can be used to perform all CRRT treatments (SCUF, CVVH, CVVHD, and CVVHDF). The PRISMAFLEX Set is indicated for use only with the PRISMAFLEX Control Unit to provide continuous fluid management and renal replacement therapies. The system is designed for patients with acute renal failure, fluid overload, or both. This set is intended for use in the following vein-venous treatments: SCUF, CVVH, CVVHD, CVVHDF. All treatments administered through the PRISMAFLEX Set must be prescribed by a doctor. The patient’s size, weight, uremia status, cardiac status, and general physical condition should be carefully evaluated by the prescribing doctor prior to each treatment. The PRISMAFLEX M100 and M150 Sets should be restricted to patients with a body weight greater than 30 kg. 

ULTRAFILTER U9000

The U9000 ultrafilter is indicated for the purification of the incoming water for the dialysis fluid and for the purification of the dialysis fluid to obtain microbiologically high-quality dialysis fluid. The U9000 ultrafilter is intended for use with a water purification system. For AK98 V2, V3, and Artis dialysis systems: The U9000 ultrafilter should be replaced after 3 months of use or 150 disinfection cycles, whichever happens first. For AK 96 and AK 98 V1 dialysis systems: The U9000 ultrafilter should be replaced after 2 months of use or 100 disinfection cycles, whichever happens first. During the lifetime of the U9000, it is possible to have a maximum of 12 disinfections with sodium hypochlorite and a maximum of 8 disinfections with sodium carbonate. The U9000 ultrafilter is disinfected by the dialysis machine. It is also compatible with heat disinfection.

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Baxter disposable dialysis AK 96 can be defined as a dialysis machine that has been designed for use in one single patient for the application of hemodialysis treatment as prescribed by the doctor in patients who have renal failure or fluid overload issues. Teaching of patient consultancy and treatment techniques directly under the inspection and discretion of the doctor. The AK 96 dialysis machine has been designed to be used in a selfcare environment such as home, provided that it is applied by a competent and specialized person as prescribed by the doctor in a dialysis center environment.

The User Panel of the AK 96 dialysis machine contains a time indicator on the top of the panel, a Flow Chart below that, function buttons, a keypad (setting buttons) and Information Screen. The purpose of these parts can be listed as informing the user of the machine status and parameter values and guiding the user in various procedures.

The time indicator which shows whether the function check is ongoing also shows the remaining duration for the ongoing procedures. One of the basic components of the user panel is the flow chart. The flow chart shows the status of the dialysate as well as its direction of flow. This procedure is performed by changing the colors of the fluid path by means of lighting. In cases where blood is detected in the venous bloodline, the blood path in the flow chart lights up red.

The function buttons assumes the role of allowing access to certain functions and parameters. Some function buttons allow access to only one function. This applies when a function needs to be accessed directly. The other buttons allow access to various functions which can be accessed by using the setting buttons simultaneously with the text directives on the Information Screen. The Information Screen is located at the bottom of the User Panel. This panel constantly shows information about the ongoing procedures, alarms and activities. The keypad is located on the right of the Information Screen.

Intervention Philosophy

The communication between the user and the machine is basically buttoned and is realized via the Information Screen. The user chooses the options and gives the machines instructions by pressing the buttons. The machine shows information on the Information Screen, in text format or via the buttons, depending on whether it lights or not.

The machine shows the status of the ongoing procedures by lighting up the flow paths in the User Panel. There are two flow paths in the Flow Chart including the fluid path and the blood path. The fluid path shows the status of the dialysate with lamps of different colors and the blood path lights up red when the machine detects blood in the venous bloodline. 

The Flow Chart plays an important role in the interventions done in the machine as it constitutes the general framework of the “flow chart logic”. This means that the function buttons are placed according to the location that they belong to in the Flow Chart. Because the function buttons are essentially placed as per the rule when all user actions are realized as per the answer to the question, “Is this action about blood or dialysate?”, the function or parameter that needs to be accessed can be found easily on the user panel.

Baxter – Dialysis Disposable Use Details

Hold the On/Off button for 3 seconds to turn the machine on or off. When the machine turns on, the button lights up and a welcome screen is displayed on the Information Screen for several seconds. You can display information about the version of the program that is installed on the machine at this point. The On/Off button will continue to light as long as the machine is on. The machine should not be turned off using the On/Off button during the treatment if blood is detected.

The priming button lights up automatically when the machine is turned on during function check. This shows that the machine is ready for the bloodline to be inserted and the dialyzer blood section to be prepared. In addition, the priming button continues to light to show that the priming mode is active, until blood is detected. The priming main menu opens on the Information Screen in cases where the lit up Priming button is pressed.

The stop button should be used to start the rinse-back procedure at the end of the treatment. The menus for hooking off the patient and stopping the machine after the treatment for maintenance are also found here.

Rinse/Disinfection button is used to activate the rinse and disinfection programs. The Venous Pressure button should be pressed to open the venous pressure menu. In this menu, the venous pressure values are displayed with a bar graph about the current values and the current alarm limit settings.

The time menu is displayed when the time button is pressed. The Arterial Pressure button should be pressed to open the arterial pressure menu. In this menu, the arterial pressure values are displayed with a bar graph about the current values and the current alarm limit settings. When the Arterial Pressure button is pressed (when there is no alarm), the upward cursors are placed on the lower and upper arterial pressure alarm limits.

The Blood Path button should be pressed to open the Blood Path main menu. The BLOOD FLOW can be read/adjusted/edited in this menu. The HEPARIN pump settings and activation can be done. In addition, SINGLE NEEDLE function settings and activation can also be done. The HEPARIN item should be selected using the Keypad to access the submenu from the Blood Path main menu.