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Creating dimensions in treatment qualityThe Dialog Dialysis SystemHaemodialysis
Communication on all treatment levelsThe Dialog system forms the central means of the dialysis process,a means which is designed for the global requirements of patients,physicians, and nursing staff. A challenging medical technologyof superb quality is combined with intelligent components, withone consistent common denominator: optimal treatment qualityfor the patients.2
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The Dialog treatment system –certainly the right option for the futureThe Dialog treatment system –a product based on B. Braun’s expertiseThe knowledge that high treatment quality is notjust dependent on one component gives us a decisivecompetitive edge.We are one of the leading companies on the healthcare market and know the factors which aredecisive for an integrated high treatment quality.Our expertise results from more than 170 yearsof tradition and is based on our trend-settinginnovative strength in the diverse areas of thehealth care market. B. Braun’s portfolio comprises30,000 products which are sold in 50 countriesacross all of the five continents. More than 38,000employees worldwide work on B. Braun’s success.In 2008, they achieved an annual turnover of morethan 3.7 billion Euros.B. Braun is one of the biggest system providers inthe field of extracorporeal blood treatment andoffers a holistic range of treatments for thepatient’s benefit.Through its operating reliability and treatment safety,the Dialog system meets the requirements for ahigh treatment quality. Our powerful dialyzers ensurehighest treatment quality, which can also be measuredby means of the optional Adimea system.The bioLogic RR Comfort biofeedback system andthe Nexadia data management system contributeto optimising the procedures and quality of dialysis.Based on their perfect interaction, new dimensions ofquality can be achieved for dialysis treatments.4
Our commitment to treatment qualityThe comprehensive Dialog dialysis system is intended toaccompany and support the treatment procedure in thebest way possible.Meeting requirements through operating reliability andtreatment safetyOptimising the operating reliability and treatment safety for bothuser and patient creates the prerequisites for advanced technologies.Dialog is based on the practical workflows and requirements of thedialysis treatment and relieves the user of numerous steps throughthe interaction of its excellent hardware and intelligent softwarecomponents. Thanks to its perfectly harmonised system, its high-qualityoriginal accessories, excellent services and reliable worldwide logistics,the Dialog treatment system is an intelligent and proactive investment.Providing reliable and measurable treatment qualityxevonta is a new dialyzer generation which is characterised by highlyefficient clearance data and an optimal selectivity. A high percentageof middle-molecular uraemic toxins, such as b2-microglobulin, can beremoved with simultaneous extremely low albumin loss. xevonta isideally suited for the right dialysis dose – and Adimea can be used tomeasure it. Adimea measures dialysis efficiency (Kt/V) by determiningthe reduction in molar concentration of urinary excreted substancesin the dialysate drain. As a result, Adimea allows continuousmonitoring of dialysis efficiency throughout the treatment procedure.Optimising treatment quality and proceduresThe bioLogic RR Comfort biofeedback system and the Nexadia data management system contribute to optimising the proceduresand quality of dialysis. Through intelligent regulation of theultrafiltration rate, bioLogic RR Comfort helps to monitor andstabilise the blood pressure of a specific patient while the treatmentis still in progress. Nexadia is a data management system whichdocuments the entire treatment procedure with a new dimensionof safety and efficiency. The intelligent software optimises andfacilitates the management of patient data in a perfect workflowand reliably collects all treatment parameters.5
Meeting requirements through operatingreliability and treatment safetyReliabilityWith our more than fifty years of experience in the field ofextracorporeal blood treatment, we can ensure that the excellentquality of all our products remains on a reliably high level.With its HD 105, B. Braun placed the first haemodialysis systemfeaturing ultrafiltration measurement on the market, thusincreasing treatment safety. It was followed by the Dialog, whichwas the first system to be equipped with a user-friendly touchscreen. These two novelties formed the basis of new standardsin extracorporeal blood treatment.As a result of continuous further development, the currentDialog dialysis system convinces with its sophisticated productdesign and concept. The well-engineered technology ensuresreliable functionality. But ergonomic and aesthetic aspects alsoplay an important role in the configuration of the systems.The Dialog system can be completed by manifold options andaccessories, and can thus be individually configured accordingto the customer’s wishes.Our requirement for high treatment quality is also reflectedby our commitment to high safety standards. The system notonly provides maximum safety but can at the same time beindividually adapted to the conditions of a specific country oruser as well as to special treatment requirements.6Intuitive user guideThe neatly arranged touch screen allows easy and fast operation.Even users with less experience benefit from the self-explanatoryicons and the clear user guide. Online help functions andmessages in plaintext support the user in all operating phases.As a result, medical staff can quickly and reliably take theappropriate measures. Reminder functions – e. g. for drugadministration, blood pressure measurements and heparinadministration – assist the user, thus assure optimised treatmentprocedures even in phases of frenzied activity. The intuitiveoperation of the system is also ensured in stress situations sothat the user can always rely on the system’s safety.A list comprising up to six storable languages facilitates languagechanges while the treatment is in progress, meeting therequirements of multilingual dialysis staff.Numerous automatic functions, such as the weekly disinfectionprogram and the bidirectional connection to the Nexadia system, noticeably reduce the staff’s expenditure of time andamount of work – an essential feature for the efficiency of theDialog system.
An intelligent investmentIntelligent investmentThanks to its perfectly harmonised system consisting of anintelligent hardware and software, high-quality originalaccessories, excellent services and reliable worldwide logistics,the Dialog is a powerful and proactive investment. The balancedprice-performance ratio is convincing over the entire systemruntime and proves to be economically efficient even in dailyoperation.The standby mode combines economical and ecological aspects.Activated on the user’s request, the standby mode savesoperating costs by turning off the dialysate flow after a presetrinse time has elapsed. The consumption of water, concentrateand electric current can be reduced.By purposely refraining being bound to a particular product, wecan consider global economic aspects and have considerableflexibility with the use of consumables. Our objective is to convincewith the quality of our products, without limiting user’s individualfreedom of choice.In addition, the auto-priming function saves saline solution inonline systems, and this not only during HDF/HF online treatmentsbut also during standard haemodialysis procedures without theuse of additional or special consumables.7
Ensuring treatment qualityOutstanding performance profile:superior dialysis doseOptimal selectivity: maximal b2m-elimination withsimultaneous minimal albumin lossHighly efficient phosphate clearanceExcellent biocompatibilityComplete product range:6 high flux and 6 low flux variantsxevonta – a new dimension ofefficiency and effectivenessUsing trendsetting high-tech production, B. Braunhas developed xevonta, a new high-performancegeneration that meets the most sophisticated dialyserrequirements.The fibre development for dialysis is characterised byhigh and unique demands in order to ensure excellentconditions for optimised treatment.With the amembris membrane various complexdemands clearly have been realised. Innovative fibretechnology, combined with state-of-the-art housingdesign and continuous and diligent quality controlsin production, have created xevonta.8
Excellent preconditions foroptimal patient outcomeDialysis adequacy, assessed by urea kinetics, is animportant clinical performance indicator 1. xevontawith its outstanding clearance data offers bestpossible preconditions for an optimal dialysis doseand patient outcome.xevonta ensures an optimum clearance spectrum inparticular exceptionally high phosphate clearancevalues and thus may contribute to increasedphosphate removal.With its outstanding selectivity, xevonta allows foran efficient elimination of middle molecules andconcurrently shows an impressively good retentionfor albumin. amembris ensures the best conditionsfor a highly efficient treatment and for achievingthe recommended target ranges of serum albumin 2.Especially elderly, malnourished or multimorbidESRD patients may benefit from these performancecharacteristics.QD 500 ml/min, QF 0 ml/min1Couchoud C et al.: Assessment of urea removal in haemodialysis and the impact of the EuropeanBest Practice Guidelines, NDT 24: 1267-1274 (2009)2European Best Practice Guidelines for Haemodialysis (Part 2): EBPG guideline on nutrition, NDT 22: ii45-ii87 (2007)Data from manufacturers‘ published specification sheets9
Making treatment quality measurableFocus on the patient:One of B. Braun’s aims is to provide doctors andnursing teams with the best possible support forgiving patients the optimum dialysis dose. The basisfor this is continuous precise measurement anddisplay of the dialysis effectiveness during treatment.To achieve this, B. Braun has developed the Adimeareal-time monitoring method. Adimea measuresdialysis efficiency by determining the reduction inmolar concentration of urinary excreted substancesin the spent dialysate.Adimea is an innovative measurement method forreliable and continuous dialysis dose control (Kt/V)throughout the entire treatment. Medical and nursingstaff can selectively adjust the treatment parametersas early as during the treatment, which is of greatbenefit to the patient. In other words, the equipmentprovides an optimum means for reaching the settreatment goals.10Precise, innovative real-time measurement methodPrecise, innovative determination of the reduction of urinaryexcreted substances in the spent dialysate using UV technologyReal-time monitoring during the entire treatment periodvia continuous effectiveness measurementEasy and flexible operationOnly one input parameter:„patient weight pre-dialysis“Configurable and clear display of URR, spKt/V, eKt/Vas well as result prognosisChanges to treatment parameters possible at any time
Advanced dialysis technologyThe innovative Adimea system utilizes the principles ofspectroscopy for determining the reduction in molarconcentration of urinary excreted substances in the dialysatedrain. A light source 1 transmits ultraviolet (UV) light 2through the dialysate. The particles contained in the dialysate,which were removed from the plasma during dialysis, absorbthe light. This absorption is measured by a sensor 3 .The pioneering technology enables measurement in the spentdialysate. Adimea continuously analyses the changes in molarconcentration and is therefore in direct contact with thepatient. On the basis of this characteristic, Adimea is a highlyreliable and accurate instrument for an online determinationof the current Kt/V value during treatment.Adimea is impressive, not only in terms of its technology,but also with regard to its simple and clear operation:The application merely requires the input of a single patientspecific parameter – the patient’s weight before dialysis.231This means that time can be saved because the urea distributionvolume (V) no longer need to be determined and entered.Various treatment indices, from the simple urea reductionratio through spKt/V, or alternatively, eKt/V, are available forcontinuous real-time control.Clinical trials 1 reveal a very close correlation between thelaboratory-determined blood-spKt/V and the spKt/V determinedby Adimea.Correlation coefficient r 0.93; n 64During a total of 64 treatments, blood was serially takenevery twenty minutes for urea testing so as to determine thespKt/V from the blood as exactly as possible. The spKt/V valuedetermined by Adimea was recorded at the same time.The comparison of the data results in r 0.93 which is anexcellent correlation between the blood Kt/V and the AdimeaKt/V and hence a high degree of accuracy for the method. Themeasurement error recorded in these studies for the overalldetermination of the Kt/V is merely 7 %.Fig.: Scatter diagram: correlation between blood spKt/V and Adimea spKt/VAdimea – the technical innovation in Kt/V monitoring.1Werner, Günthner et al: data on file (B. Braun Avitum AG, Melsungen), 2009.11
Optimising treatment qualityReduction of treatments with hypotensive episodes(HE) by 52 %Reduction of treatments with at least oneHE symptom by 82 %Reduction of treatments with at least one HE-inducedtherapeutic measure by 64 %Intelligent blood pressure stabilisationThe patients’ well-being is one of the most important treatmentparameters in dialysis and is therefore a focal point of theDialog system technology. The innovative bioLogic RR Comfort biofeedback system of B. Braun monitors and stabilisesthe patients’ blood pressure drop through its intelligentregulation of the ultrafiltration rate (UF rate) during the treatment.Control algorithm of bioLogic RR ComfortThe bioLogic RR Comfort significanctly reduces hypotensiveepisodes and the associated symptoms while dialysis is in progress.It has been particularly designed for the long-term treatment ofchronically ill haemodialysis patients who often suffer from bloodpressure drops, as is well-known.bioLogic RR Comfort is the only biofeedback system which measuresthe blood pressure directly on the patient. In addition, it also utilisesstored blood pressure curves of previous treatments, owing to itsintelligent guideline technology. This results in an especially reliablesystem. Since it adjusts the ultrafiltration rate automatically andproactively, bioLogic RR Comfort is able to prevent an excessivelysharp drop in blood pressure during the treatment.The use of bioLogic RR Comfort is not limited to one singletreatment type alone – when combined with the Dialog ,the system is also compatible with other procedures, such ashaemodialysis (HD), haemofiltration (HF) and single-needle (SN).12123Retrospective period without bioLogic RR Comfort (7 weeks)Means over each periodRoeher o, Schmidt R, Korth S et al:bioLogic RR Comfort reduces hypotensive episodes in patients prone to intradialytichypertension, 38th Congress of the German Society of Nephrology, Munich, 2007
bioLogic RR Comfort – beneficial from any perspective. . . for the userbioLogic RR Comfort contributes not only to optimising thetreatment but also to improving many processes at the dialysiscentre.bioLogic RR Comfort also convinces with its economical aspects.Since the therapeutic measures required by hypotensive episodesare reduced, nursing staff is effectively relieved and the expensesfor blood-pressure-stabilising saline solutions can be cut down.What is more, additional costs for special consumables are notincurred either. . . for the patientbioLogic RR Comfort significantly reduces the frequency ofhypotensive episodes and the associated symptoms as well asany possibly required therapeutic measures.Since it is a learning system, bioLogic RR Comfort steadily increasesthe quality of the treatment. Usually, the system helps to keep thetreatment time and ensure increased dialysis efficiency.Since the number of blood pressure measurements is significantlyreduced as compared with the predecessor version, and theultrafiltration rate is subject to special control, the patient’swell-being is noticeably improved both during and after dialysis.The system is easily operated by just two key settings on its touchscreen, thus providing nursing staff with additional safety.Significant reduction of hypotensive episodesOwing to its fast and easy handling, bioLogic RR Comfort savestime and allows enhanced individual patient care.Continously improved treatment qualityEase to operate13
Significantly improving treatment proceduresAs has been proven by the study, Nexadia considerablyreduces the time required for the various workflows –time which nursing staff can instead devote to the patient.1Nexadia and Dialog in combinationUsed in combination, the Nexadia system and the Dialog haemodialysis machine allow intelligent retrieval andmanagement of data.The Dialog has outstanding network capabilities and cantherefore optimally support and relieve users in their daily duties.The basic requirements for a data management system areflexibility and ease of operation. That is why the Nexadia systemis adapted to the function – not vice versa.The Nexadia data management system enables the automationof labour- and time-intensive tasks, which ultimately allowsdoctors and nursing staff more time to dedicate to theindividual treatment of patients.1Moreover, the system provides consistent documentation foran optimal quality management as well as valuable help in theevaluation of the data collected. From treatment to archive,Nexadia contributes to continuously optimising the quality ofdialysis treatments.14In its modular structure, the Nexadia data management systemtakes not only data retrieval into account, but also allows for theprocessing, transmitting and archiving of any treatment- andpatient-related data incurred in a dialysis practice.More time for what is essential means moretime for the patientNexadia Monitor is intended for automatic retrieval,documentation and monitoring of data as well as for treatmentvisualisation.The easy-to-use graphical user interface can be freely configuredaccording to individual requirements. The data generated isdisplayed with self-explanatory icons.The manifold automation processes of Nexadia Monitornoticeably reduce the amount of work for the user while thedialysis treatment is in progress so that nursing staff can focuson what is essential – the patient.
Reliable qualityPatient scale and analysersExternal management systemsNexadia MonitorNexadia ExpertNexadia Monitor: automatic retrieval,documentation and monitoring of dataas well as treatment visualisationNexadia Expert: treatmentand quality managementExcellent treatment and quality managementNexadia Expert is the database for treatment managementat the dialysis centre. Nexadia Expert is precisely attuned toNexadia Monitor.Nexadia Expert offers the complete range of a digital patientfile. You can keep diagnoses and findings as well as medicationsand parameters from external laboratories, hospitals or medicalspecialists. Nexadia Expert allows accurate scheduling of futuredialysis treatment, including exact dates, durations, UF rates, aswell as prescriptions and medications.Nexadia Expert provides all of the important features requiredfor optimum quality management. Nexadia Monitor collectsmuch of the relevant data during the treatment and thereforesignificantly improves the treatment procedures.Easy operation meeting practical requirementsLess administrative activities and more time for the patientConsistent documentation for optimum quality assuranceSystematic optimisation of processesIncreased cost efficiency1 Osterkorn D.: “Networking for success in dialysis centers: A prospectivecomparative analysis“. Gesundheitsökonomie und Qualitätsmanagement2006; 11: 112-116.15
Dialog dialysis system:detailed perfectionSynergy provided by the integrated systemB. Braun’s innovative solutions focus on an excellent dialysis andan economical treatment routine. To achieve this, we offer anintegrated system which is composed of perfectly harmonisedcomponents.Our services include technical service, process advice, businessmanagement, consulting, planning, development, installation,and training. Our customers profit from the comprehensive expertise of one of the leading companies on the medical market.Our service involves customer proximityOur performance focuses on how we can realise optimal medicalcare. To achieve this, we need a wide range of services, includinginstruction and training courses in various medical fields.At B. Braun Avitum, we offer individual and personal customersupport. It is our goal to meet requirements of our customers.As we know from our many years of experience, this goalcan only be reached if individual situations are consideredholistically, in a way that goes beyond the mere provision ofhigh-quality products.Our customers profit from the comprehensive expertise of one ofthe leading companies on the medical market through individualand personal services:16nIndividual and personal support, including investmentconsulting, trial equipment, instruction courses, refreshertraining, and ongoing support with questions or problemsnHigh-quality technical service and supportnComprehensive training courses: product and user courses,certified further education on medical subjectsnInformation and training material for patients, for examplepatient information on dialysis with appropriate nutritionalcounsellingnStatus-quo analyses at dialyse centres and proposal forprocess optimisation
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“Innovative technologieswith many great featuresprovide more time forthe essential: proximityto the patient.”18
“Our patients’ confidence isbased on an excellent andefficient treatment qualitywhich is ensured by thesuperior B. Braun technology.”19
B. Braun Avitum AG Schwarzenberger Weg 73-79 34212 Melsungen GermanyTel. 49 5661 71-2624 Fax 49 5661 75-2624 dialysis@bbraun.com www.bbraun-dialysis.comW. 003.05.09/1 Nr. 708 0155A Edition: 05/2009
health care market. B.Braun's portfolio comprises 30,000 products which are sold in 50 countries across all of the fi ve continents. More than 38,000 employees worldwide work on B.Braun's success. In 2008, they achieved an annual turnover of more than 3.7 billion Euros. B.Braun is one of the biggest system providers in
