Bloodlines set for upgrade with double membrane technology Gambro continues to put patient safety at the forefront of our priorities with the introduction of double membrane technology, 2M-PROTECT TP®, to our bloodlines. The new double membrane bloodlines will: • Increase patient safety by avoiding potential leakage and cross contamination. • Improve handling with easy grip of the new square shaped membrane casing. • Prevent disconnection or cracking by shortening and softening the extension line. Sam Ford, Marketing Manager, explains what lies behind this development: “The pressure transducer protector is a vital connection point to the haemodialysis machine and its pressure measuring devices. It’s really the last line of defence to prevent blood contamination. “There is concern in the dialysis community about reported cases of blood contamination through single membrane pressure transducer protectors. Although there is no evidence that this is an issue with Gambro’s bloodlines, we are constantly striving to innovate and improve patient safety and therapy experience. That’s why we are introducing the double membrane across our range over the coming months.” Contact Samantha Ford 01480 440006 samantha.ford@gambro.com Prismaflex provides a safer way to deliver citrate anticoagulation How citrate works Citrate anticoagulants work by chelating (binding) calcium in the patient’s plasma, reducing ionised calcium levels in the blood whilst it is in the circuit. This disrupts the clotting cascade in several places. Then, as the blood returns to the patient (via the return line), it mixes with the systemic blood flow to restore the Ionized calcium levels reactivating the clotting process. This results in only the blood in the circuit being anticoagulated - and not the patient. There are numerous benefits involved in using citrate. It can increase the circuit life considerably (1, 2), reducing nursing work load and increasing the time the patient is filtered and potentially reducing cost. Citrate anticoagulation has also been shown to reduce the risk of patients bleeding, and subsequent transfusion requirements (2). This can give the opportunity to anticoagulate patients who are at high risk of bleeding or HIT-positive patients. Citrate and patient safety Patient safety has always been an issue when delivering citrate. Many studies have reported potentially dangerous side effects such as metabolic alkalosis and hypernatremia (3, 4). These side effects have mostly been associated with the use of concentrated (hypertonic) citrate solution. These hypertonic forms of citrate have forced the users to use non-physiological replacement and/or dialysate fluid which can significantly increase the risk to the patient. Gambro has reduced the risks of these side effects by developing both a citrate and a dialysate/replacement fluid that are isotonic. Both the Prismocitrate 10/2 and the Prism0cal contain physiological levels of buffers and sodium. Consequently, the risks of potentially dangerous side effects are greatly reduced. Adding a second membrane to Gambro’s bloodlines will make a positive contribution to patient safety 4 Intensive care units in Europe and the US have long been using citrate to anticoagulate the circuits during continuous renal replacement therapy (CRRT). In this article, Lloyd Buck, Gambro’s Acute Care Product Manager, looks at the most important issues around citrate anticoagulation - and at the contribution Prismaflex makes to its safe application.

Take care when buying used Prisma machines Recently we have been advised of Prisma units being sold by third parties. While on the face of it these can seem a good buy, they may be missing the vital upgrades that are essential for optimum performance. The machines in question have typically been used in NHS Trusts and are now available for sale through a leasing company. These machines are unlikely to have had the latest software upgrade that we recently carried out on machines supplied directly by us. Our message is clear: any Prisma machine that has not had the software upgrade is not fit for purpose. If you have purchased one of these machines, or if you are thinking of doing so, please contact our Technical Services department. They can advise you accordingly, including in terms of the cost of the suitable upgrade. Gambro does offer pre-owned, fully upgraded Prisma machines with 12-month warranties. Alternatively you may wish to consider our Prismaflex machine, the latest generation of CRRT equipment. Contact Technical Service department 01480 444000, option number 3 Gambro’s citrate capability through Prismaflex The flexibility of the five pump design of the Prismaflex means that citrate can easily and safely be used to deliver anticoagulation during CRRT. High volume haemofiltration during citrate delivery is possible, as well as CVVHDF if required for improved small molecule clearances. The Prismaflex is capable of citrate delivery as standard, so there’s no need for expensive upgrades to the machine. All Prismaflex filter sets are also capable of delivering citrate, which eliminates the need to stock dedicated citrate sets. Using the Prismocitrate 10/2 on the predilution scale the Prismaflex infuses the citrate in to the circuit as the blood is removed from the patient. Additional replacement and dialysate may be used to achieve the required exchange rates/clearances. A calcium infusion may also be required dependent on the patient blood calcium levels. Gambro are able to provide guidelines on all relevant flow rates and monitoring to deliver citrate anticoagulation successfully. Contact Lloyd Buck 01480 444049 lloyd.buck@gambro.com 1 Monchi M, et al Citrate vs. heparin for anticoagulation in continuous venovenous heamofiltration; a prospective randomized study. Intensive Care Med 2004; 30: 260-5. 2 Kutsogiannis DJ, et al Regional citrate versus systemic heparin anticoagulation for continuous renal replacement in critically ill patients. Kidney Int 2005; 67:2361-7. 3. Meier-Kriescher HU, et al. Unexpected sever hypocalcaemia during continuous venovenous haemodialysis with regional anticoagulation. Am J Kidney Dis 1999;33:1-4. 4. Morgera S. et al. Metabolic complications during regional citrate anticoagulation in continuous venovenous haemodialysis: single centre experience. Nephron Clin Pract 2004;97:c131-c136. Isotonic fluids reduce the risk of side effects such as metabolic alkalosis and hypernatremia Call Customer Service for free! You can now contact Gambro’s Customer Service team for free by phone or fax, for everything from accessing product information to placing orders. Elaine Thompson, Sales Administration & Service Manager, says: “Last year we centralised our Europe-wide Customer Service team to Brussels, which has helped to make extensive product knowledge and experience available to UK customers. Now the addition of the free phone and fax numbers makes the service even better for UK customers.” This free service applies to all UK mainland customers, including Northern Ireland. Customers in the Republic of Ireland need to check with their network provider as we are unable to guarantee that their calls will be free. For all other services, you can still contact our UK Head Office at Huntingdon on 01480 444000. The new numbers are as follows: Telephone 0800 652 1380 Fax 0800 652 1390 Contact Elaine Thompson 01480 444034 elaine.thompson@gambro.com