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Flexible and efficient dialysis treatmentHemodialysis
Pioneeringdialysis technologyB. Braun Avitum: A trusted partnerB. Braun Avitum, a division of B. Braun Melsungen AG, has been one of the leading providers of dialysistechnology for over 30 years. In our role as a global full-spectrum provider for extracorporeal bloodtreatment, we provide dialysis facilities with products and services for all aspects of blood purificationprocesses. Our integrated approach to research, production, and therapy ensures outstanding dialysistreatment in line with the latest medical advances. This not only boosts the efficiency of the treatmentprocesses used in our global network of over 250 dialysis centers but also improves quality of life for ourmore than 19,000 chronic dialysis patients.Every new product has to face – and meet – these high standards. The Dialog dialysis system far exceeds the minimum requirements in terms of many of its technical features – and impresses users withits versatile configuration range, extensive selection of accessories, and intelligent options.2
For the highest standardsDialog dialysis system – a perfect balanceThe balancing act is getting trickier: nowadays, every dialysisclinic faces the challenge of providing patients with the mostindividualized level of care possible while at the same timeoperating cost effectively. Striking the right balance betweenmedical efficacy and cost-effective treatment is the key.This situation calls for innovative technologies to meet individual needs, so that dialysis services can continue to be providedwith coverage for costs and without compromising on patientcare. B. Braun Avitum is breaking new ground in this area.Innovative technologies such as the Dialog dialysis system helpnephrologists and physicians employ the best possible treatments for their patients.Dialog is part of a completely new generation of dialysissystems aimed at delivering optimum care with highestefficiency. Innovations such as Adimea to monitor and controldialysis dose, bioLogic RR to prevent hypotensive episodes, andthe data-management system Nexadia consistently meettoday’s economic and medical requirements. The result: balancebetween patients’ legitimate requirements and the need forcost optimization, between effective dialysis and efficienttreatment.Find the right balance – find your way to B. Braun.3
Innovative technology for the highest standardsAdimea – precision real-time measurementof dialysis doseThe Adimea feature is a precision measurement procedure forreliable and continuous dialysis dose control (Kt/V) throughoutthe entire treatment. This innovative system uses the principlesof spectroscopy to determine the reduction in the molarconcentration of urinary excreted substances in the dialysatedrain. This pioneering technology enables measurement in theused dialysate. In order to continuously analyze change in themolar concentration, Adimea is directly connected to thepatient. This offers the advantage that physicians and nursingstaff can adjust the treatment parameters for the patient’sbenefit even before treatment is complete. This allows the unitto provide valuable support for achieving treatment objectives.Clinical tests show a very close correlation between the bloodKt/V determined in a lab and that calculated by Adimea . User UserBenefitsBenefitswithwithAdimea :Adi Real-time Kt/V monitoring in every dialysis session Online adaptation of treatment parameters for betteroutcome No determination of V - only predialytic weight needed Applicable for all HD treatment modes in URR, spKt/V,and eKt/V modeUsable at no extra cost in all current modes of dialysistreatment (HD, HDF, SN-CO).High accuracy: Proven to be highly preciseHigh accuracy, scientifically proven: This sample display for the UV absorptionsignal’s treatment progress and the serum urea values at 20-minute measurement intervals reveals the strong correlation.You can also get detailed information from the separatebrochure on Adimea or on the website www.adimea-bbraun.com.4Source: Castellarnau A, Werner M, Günthner R, Jakob M: Real-time Kt/Vdetermination by ultraviolet absorbance in spent dialysate: Techniquevalidation. Kidney Int. 2010 Nov;78(9):920-5
Innovative technology for the highest standardsbioLogic RR Comfort – intelligent bloodpressure stabilizationThe bioLogic RR Comfort biofeedback system regulates theultrafiltration rate automatically and predictively, preventinghypotensive episodes successfully during treatment. It is theonly biofeedback system on the market that measures thepatient’s blood pressure directly.It also uses intelligent guideline technology, taking intoaccount blood pressure profiles stored from previous treatmentsessions. This makes the system highly safe and reliable.In addition, with only two main settings via touchscreen, it isvery easy to use. This not only gives healthcare staff addedpeace of mind but also frees up more time for the patient. User Benefits with bioLogic RR Comfort: Considerable reduction in hypotensive episodes Continuous improvement in treatment quality Easy to use, without follow-up costsProven in studies: Excellent results with bioLogic RR ComfortReduction of treatments with hypotensiveepisodes (HE) by 52 %Reduction of treatments with at least oneHE symptom by 82 %Reduction of treatments with at least oneHE-induced therapeutic measure by 64 %Retrospective period without bioLogic RR Comfort (seven weeks)Means over each periodYou can also get detailed information from the separate brochure.1)2)Source: Roeher O, Schmidt R, Korth S, et al.: bioLogic RR Comfort reduceshypotensive episodes in patients prone to intradialytic hypotension. 38thCongress of the German Society of Nephrology, Munich, 20075
Innovative technology for the highest standardsConvective treatment – a flexible choiceThe impact of convective therapies on patient’s outcome is stillunder debate, although recent studies show survival advantagesfor patients treated with high post-dilution substitutionvolumes.1,2Depending on the dialysis mode, substitution volumes, anddialyzers used, the right balance between middle-moleculeelimination and albumin retention can patient individually bechosen.3To choose the right therapy for your patient, the Dialog systemoffers all needed modalities: Online Hemodiafiltration (HDF) Online Hemofiltration (HF) High-Flux HemodialysisHDF treatmentsThe Dialog HDF online device offers all of the standard currentsubstitution methods: HDF pre- and post-dilution, as well aspure hemofiltration (HF).Our target-oriented system enables you to achieve highsubstitution volumes in HDF post-dilution based on efficientlymonitoring the correct blood flow in relation to the ultrafiltration rate. In combination with xevonta Hi23 substitutionvolumes 24 l can be realized under routine conditions,accompanied by a loss of albumin of only 1.2 g/session.3Additionally, the system monitors the formation of clottings orcloggings by measuring the inlet blood pressure at the dialyzer.HD high flux - the alternativeAchievement of high substitution volumes depends on highblood flow rates. Due to various vascular access limitations orother patient-dependent restrictions, an adequate blood flowcannot be realized for every dialysis patient. In consequence,high substitution volumes cannot be reached for such cases.High-flux HD treatment can offer an alternative. The use ofdialyzers with high permeability (e.g., xevonta Hi23; KUF124 ml/h/mmHg) is linked to an increased internal convection,resulting in an effective removal of middle molecules. Albuminis nearly untouched ( 150 mg albumin loss/session)4 using thistreatment option. User ines:Machines: Fluid prepared online for priming,reinfusion, and infusion bolusduring treatment session No extra disposable needed forpriming in HD standard therapy Lifetime of Diacap Ultra up to150 treatmentsSources:1)Maduell et al.: High-efficiency postdilution online hemodiafiltration reducesall-cause mortality in hemodialysis patients. JASN 2013 Feb; 24(3)2)Grooteman et al.: Effect of online hemodiafiltration on all-cause mortalityand cardiovascular outcomes. JASN 2012 June; 23(6)6Gayrard et al.: Influence of high convection volumes in removal performancesof online haemodiafiltration (HDF), NDT (2013) 28 (suppl 1): i30-i32; 50th ERAEDTA CONGRESS, 2013, Istanbul, Turkey4)Ficheux et al.: The use of SDS-PAGE scanning of spent dialysate to assessuraemic toxin removal by dialysis. NDT 2011 July; 26(7)3)
Innovative technology for the highest standardsSingle needle-cross over –aimed for optimal resultsThe term “single needle-cross over” (SN-CO) derives from itsunique control technology. During SN-CO therapy, both bloodpumps run continuously, with regularly alternating arterial andvenous phases. During an arterial phase, the blood fills thearterial expansion chamber until the venous control pressure Patient’s dle-crossNeedle-Crossover:Over:closes the arterial clamp. During a venous phase, the blood isreturned to the patient until low arterial underpressure closesthe arterial clamp. The blocking clamps are thus controlled via a“crossover” function.The single needle-cross over system High volumes of treated bloodthanks to a constant flow of bloodin the dialyzer Protection of the vascular accessdue to indirect blood transportationVenous blood pumpDialyzer Excellent Kt/V results monitoredby Adimea due to undisrupteddiffusion process in the dialyzer1Source: 1) Rawer et al., Clinical application of real-time Kt/V determination by ultraviolet absorbance (Adimea ) in Single-Needle-Cross-Over (SNCO) dialysis andhemodiafiltration modes (HDF-online). Poster Su441. XLVII ERA-EDTA Congress 2010. Munich June 25-28.7
Innovative technology for the highest standardsClotting management –preventive pressure monitoringMeasuring the blood inflow pressure in the dialyzer via PBE sensor serves as aneffective method of hemolysis prophylaxis, as possible kinks in the blood line aredetected early on and indicated via the alarm system. In addition, the development ofa secondary membrane in the dialyzer is monitored and displayed by the PBE, so theuser can keep an eye specifically on the dialyzer status at all times during treatment.The user can then use this valuable information to take action early to preventexcessive blood clotting in the dialyzer. This not only significantly reduces the timeand effort needed by the user but also eliminates the costs of unnecessary filterexchange. User ment:Management:Preventive pressure monitoringpressure [mmHg]average PBE 10 min. after startof therapy plus 150 mmHg Hemolysis prophylaxis throughearly detection of kinks in theblood tubedialyzer gets blockedalarm limit Clotting management throughmonitoring the secondarymembrane pressure in the dialyzertherapy startremedy action dialyzer saved10820304050PBE Prevention of replacement ofexcessively clotted filters, savingtime, effort, and expense
Innovative technology for the highest standardsTreatment profiles –individual therapy selectionEvery patient is unique. With this in mind, advanced dialysisequipment items feature optimum flexibility, which allows todeliver individualized care for every patient. The Dialog dialysissystem uses six different treatment profiles, so dialysis processes can be adjusted and optimized to accommodate importanttreatment settings – entirely in line with patients’ individualneeds.Ultrafiltration profile:Adjusts fluid removal in the patient individuallyand variablySodium profile:Stabilizes the patient‘s circulation and electrolytelevelsBicarbonate profile:Adjustment for acid-base balanceHeparin profile:Individually adjusted for the coagulationand bleeding situationDF flow profile:Reduces use of concentrate, water, and energywith undiminished dialysis qualityTemperature profile:Prevents hypotensive episodes by stabilizing bodytemperature User Benefits with treatment profiles: Flexible combination of treatment profiles for successful therapeutic outcome Individual adjustment to various therapy conditions Convenient patient management and time savings by simply downloading patient data from Nexadia or patient therapy card9
Intelligent solutions for optimized processesNexadia – intelligent data managementBidirectional machineconnectionTime consumed(min)30252015-21:00 min (-83%)1050prior to implementationof Nexadia Monitorsubsequent to implementationof Nexadia Monitor Download of treatment settingsTreatment example with a scientifically proven time saving of over21 minutes of nursing activities per treatment. Time which nursingstaff can instead devote to the patient.1With an eye to the medical quality of treatment and theefficiency of workflows within the dialysis facility, data thatarise must be collected, processed, and archived effectively.Our Nexadia data-management system with the NexadiaMonitor software and the Nexadia Expert database can helpyou do just that, automating routine processes and considerablysimplifying documentation for quality assurance (QA) purposes.Nexadia Monitor: Interactive softwareNexadia Monitor is a clearly structured and user-friendlysoftware which provides a transparent view and control of awide range of processes in dialysis treatment.The data generated in connected dialysis machines, analyzers(e.g., blood gas analysis), and patient scales are automaticallytransferred and saved to Nexadia Monitor, which enables clearvisualization and convenient editing of the data. Thanks to thebidirectional data transfer between Nexadia Monitor and theconnected dialysis machines, consistent and up-to-the-minutedata records can be called up at any time, even during treatment.10directly into the Dialog Real-time collection of allrelevant treatment dataNexadia Expert: Flexible databaseNexadia Expert is a powerful and user-friendly database fordialysis-center therapy management. Operation of NexadiaExpert is intuitive. Functions include the editing and archivingof all treatment- and patient-related data and preparation ofthe documentation required for quality assurance.Data from other medical information systems can also beimported and managed, e.g., patient master data, laboratoryresults, and findings and diagnoses from external physicians.Nexadia Expert is perfectly co-ordinated with the Nexadiamonitoring software and automatically initiates bidirectionaldata transfer to and from Nexadia Monitor and any otherequipment connected to the system.Together, Nexadia Monitor and Nexadia Expert provide a highlyefficient and easy to use system.
Patient scale and analyzersExternal management systemsNexadiaMonitorNexadiaExpert Treatment support Administration Therapy monitoring Treatment schedule Data collection Digital patient file Data evaluation and management FilingNexadia creates connectionsThe Nexadia system adapts to its mode of operation – not viceversa. The entire dialysis station is intelligently integrated, sothat all connected dialysis and analysis devices and patientscales can communicate via Nexadia with external informationsystems. The software interfaces of the system make possiblenumerous combinations and connections, for example withhospital information systems. By means of standardizedhardware interfaces, our Dialog dialysis devices, as well asperipheral devices such as patient scales, can be easily integrated into the network.The Nexadia system and the Dialog dialysis system intelligentlyintegrate data collection and data management. Dialog possesses an excellent networking capability. So, for example,the touchscreen is used as the input terminal for Nexadia.Nexadia and Dialog create the best prerequisites for highvalue dialysis with optimized processes. User UserBenefitsBenefitswithwithNexadia:HDF Online Machines: Easy operation through bidirectional connection Increased cost efficiency Automation of complex tasks Fewer administrative activities and more timefor the patient Consistent documentation for optimized qualityassurance Easy operation meeting practical requirements Automated saving and filing of relevant data1)Source: Osterkorn, D: Networking for success in dialysis centers: A prospectivecomparative analysis. Gesundheitsoekonomie & Qualitaetsmanagement 2006,11: 112-115.11
Intelligent solutions for optimized processesEcoprime - two become oneEcoprime is the innovative system for easy and safe implementation of pre/post processing for dialysis treatment. Instead of theusual two NaCl containers, only one container is now needed forthe complete dialysis session.1,000 ml of NaCl solution is sufficient for filling and rinsing theextracorporeal system, as well as returning the blood. Moreover,the user can decide which of the common filling and rinsingprocedures is best suited.12
The easy route to more efficient dialysis1,000ml500ml1,000mlConventional procedureEcoprime systemA combination of proven components eliminates the need fora second NaCl container. One of these components is theDiscofix C three-way stopcock. It enables the desired amountof NaCl solution to be measured out reliably and accuratelyfrom only one container – from filling through to infusion.And it does so without restricting patient safety or treatmentquality.In addition, the bloodline system is immediately ready and easyto operate. User Benefits with Ecoprime System: Cost-effective: only one 1,000 ml container of NaClsolution for the entire dialysis treatment Ecological: thanks to waste prevention and resourceconservation Qualified process for optimized patient safety andhygiene Easy-to-use: convenient and safe handling thanks topre-connected bloodline system Ergonomic: reduced workload thanks to the eliminationof a second NaCl container13
More than repair and maintenanceExcellent service – perfectly streamlinedWith the decision to use the Dialog dialysis machine, ourcustomers benefit also from our highly qualified and experienced support teams and the mutually adapted service modules.platforms, training center, Service Portal, and Service Wiki, weprovide comprehensive information round the clock for ourservice organizations around the world.Our seven service modules at a glanceTailored training coursesService partners can select among more than 30 trainingmodules – worldwide, in the corresponding languages. With ourmobile learning concept, we offer certified trainings that havebeen developed based on customer needs.Excellent technical supportQuick and precise fault diagnosis, certified maintenance andrepair, technical safety testing, and diagnostic tools – ourtechnical support personnel increase the total lifespan andoperating time of your devices.Local presenceCertified technicians of B. Braun work in more than 100 countries worldwide. Supported by very-well-trained experts on allcontinents, they not only ensure the smooth operation of yourmachines but are always close to you.Modern communicationOur intelligent communication and diagnostic tools, comprehensive knowledge of dialysis, and close contact with ourcustomers are important success factors. With the digitalInnovative diagnosis toolsOur Trend-Viewer program automatically stores device data fora long period of time. In this way, temperatures, pressures,valve functions, and other parameters can be analyzed by oursupport teams worldwide. Thus, the service performance can besignificantly enhanced.Original spare partsAll Dialog machines worldwide are maintained with ourcertified original spare parts in order to ensure the quality thatyou expect: highest operating safety and reliability. In addition,we guarantee delivery of our original spare parts for at least10 years.Comprehensive service contractsA tailored service contract helps to increase machine reliabilityand simplify budget planning.14
More than repair and maintenanceDialog – pioneering technologyFit to your needsReliableMTBF up to two years1Recognized in many specialized online forumsService-friendlyEasy to maintainSpare parts are available at any timePreventive maintenance programSimplified fault searchModular design, simple and easy access to the hydraulic andelectronic facilitiesEnvironmentally-friendlyOptimized use of resourcesQuick savings results in the consumption of water, energy,saline, and concentrate1)Achieved under best practice service conditions15
FlexibilityIndividual configuration – from one source152634798Available in three basic configurations:Single pumpDouble pumpHDF online16
Dialog is distinguished by a high level of flexibility. Thisgives our clients maximum configuration possibilities forequipping their dialysis machines. Each dialysis device canbe configured individually from three modules with manyoptions and accessories.5Universal Front Tray1Multifunctional Tray6DF Filter Holder2Card Reader orNexadia BSL7BIC Cartridge Holder3ABPM:Automaticblood pressuremeasurement8Central ConcentrateSupply4bioLogic RR Comfort9Adimea 17
Therapy systemAll fits togetherThese diverse options, accessories, and consumables from a singlesource offer a perfectly adapted therapy system. At B. BraunAvitum, all fits together. Our modular dialysis systems offer youall the components for a successful therapy from just one supplysource – perfectly adapted to each other in their details.The Dialog system forms the center of the dialysis process.With various configuration possibilities, a wide scope ofaccessories, and intelligent options, you receive the solutionthat corresponds to your demand for optimized medical careand cost-effectiveness.ea uxtaxevonlHigh fbioLogic RR Comf o rtnt quality aneatmed prrtdoceevossersteofcf ectivpvelelseImnhessgiHbility and safetyasUmiAdxevontaLowFlux18iaNe x a d
Important information at a glanceGeneral dataDialysis fluid systemNominal voltage:Nominal frequency:Nominal current (max.):230 V (option: 120/240 V)50 Hz / 60 Hzmax. 11 A for 230 V or 16 A for 120 VDimensions (W x D x H):Weight (empty):approx. 510 x 637 x 1678 mmapprox. 85 kg in the basic designWater intakePressure range:Temperature range:Measurement tolerance:Flow:Tolerance:Blood leak detector:Alarm limit value:0.5 to 6 bar 10 to 30 CConcentrate supply:Pressure range:Standards:Canister/central supply/bicarbonate cartridge0 to 1 barEN 60601–1: (IEC 601–1)EN 60601–2–16: (IEC 601–2–16)EN 60601–1–2: (IEC 601–1–2)Produced in conformity with directive 93/42/EEC 0.2 mS/cm300 to 800 ml/min 5%optical, color-specific 0.50 ml/min (HCT 45%) 0.35 ml/min (HCT 25%)Ultrafiltration:- volume regulated through the balance chamber,ultrafiltration through ultrafiltration pump- sequential ultrafiltration (Bergström)Working range:0 to 4000 ml/hMeasurement tolerance:0.2 ml per chamber cycle, UF-pump tolerance 1%Degassing device:mechanical, through regulated degassing lowpressureDisinfectionExtracorporeal circulationBlood pump:2-roller pumpTransportation rate:50 to 600 ml/minTransportation tolerance: 10% with pressure up to -150 mmHgHeparin pump:injection pump for 10-, 20-, and 30-ml syringesTransportation rate:0.1 to 10 ml/hTransportation tolerance: 10%Safety air detector:ultrasound measurement in the tubeProtection system: ultrasound detector, automatic cyclical testingduring the entire operating phasePressure measurement at thearterial feed into the dialyzer(PBE) working area:0 to 700 mmHg 10 mmHgMeasurement tolerance:Arterial input pressure measurement(PA) working area:-400 to 400 mmHg 10 mmHgMeasurement tolerance:Venous backflow pressure measurement(PV) working area:20 to 390 mmHg 10 mmHgMeasurement tolerance:1)Temperature working range:selectable between 33 and 40 CConductivity processing:conductivity regulated- conductivity of bicarbonate 2 to 4 mS/cmWorking range:or 4 to 7 mS/cm- total conductivity 12.5 to 16 mS/cmMachineDialog (Single pump)Dialog (Double pump)Dialog HDF onlineItem number1710200571020137102072OptionAdimea bioLogic RR ComfortABPMBatteryItem number7102233710532471022267102244Chemical disinfection/cleaning: automatic running of program with minimalfree rinse time; various disinfection means maybe installedThermal disinfection/cleaning:automatic running of program at approx. 85 CCentral thermal/chemicalfor cleaning/rinsing the feed connectioncleaning/rinsing: for the device with simultaneous chemical orthermal disinfection of the ring connectionOptionDialog computer interfaceNexadia BSLCard reader (includes 5 cards)Patient therapy card (5 pieces)Bicarbonate cartridge holderCentral concentrate supplyDialysate flow filterStaff callBlood pump roller 7x10Item 0210271023157102340AccessoriesUniversal front trayMultifunctional trayBox comfortMonitor mini-shelfRecord holderCombi shelf holderUniversal storage trayItem 05500More configurations possible under different item numbers.19
B. Braun Avitum AG Schwarzenberger Weg 73-79 34212 Melsungen GermanyTel. 49 5661 71-0 dialysis@bbraun.com www.bbraun-dialysis.comNo. 7081009A Edition: 05/2014
B. Braun Avitum: A trusted partner B. Braun Avitum, a division of B. Braun Melsungen AG, has been one of the leading providers of dialysis technology for over 30 years. In our role as a global full-spectrum provider for extracorporeal blood treatment, we provide dialysis facilities with products and services for all aspects of blood purification
