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User-friendly and cost efficient dialysis monitor providing safe and adequate hemodialysis.

DBB-EXA has been developed for the value-oriented dialysis  providers who are committed to high quality and safety standards, looking for a monitor to deliver standard HD treatments and  advanced therapies as well.

With the D-FAS system DBB-EXA can simplify and automate user operations.

New Features and Benefits

  • Dialysis-Fully Automated System [D-FAS]
  • Connectivity with Venous Needle Dislodgement System
  • Dialysis Dose Monitor [DDM]
  • Dialysate Flow adaption according to the BP-speed
  • Optimised substitution volume by advanced Filtration Fraction
  • Haemo-Master
  • Patient card reader & Viewer
  • Unidirectional communication

The breakthrough in usability

Dialysis Fully-Automated System

Healthcare professionals in the dialysis facility have many tasks to complete such as lining, priming, entering prescribed treatment data, blood filling and wash back besides the primary role of patient care. Dialysis Fully-Automated System (D-FAS) can simplify and automate user operations. As a result, it may be possible that operator errors and / or the risk of contamination can be significantly reduced.

 

Advantages

  • Reducing standard operational tasks between treatments such as preparation, connecting and disconnecting patients.
  • Minimising the number of times the operator has to interact with DBB-EXA.
  • Simplifying and automating the tasks to reduce operator errors and risks of contamination.
  • Dialysis facility can select automatic priming, wash back and emergency bolus utilising dialysis fluid or saline (based on the facilities policy).
  • Automatic wash back solution can be switched from dialysis fluid to saline. The operator can keep the standard wash back procedure even if the power supply is interrupted.
  • D-FAS blood filling removes the priming solution automatically through the dialyser. Patient UF removal can be minimised.

D-FAS priming

The operator installs the bloodline set and dialyser, and then starts D-FAS priming. D-FAS automatically primes the extracorporeal circuit without operator intervention.

D-FAS blood filling

The operator simply connects the arterial and venous patient access and starts D-FAS blood filling. D-FAS blood filling can remove the priming solution automatically through the dialyser, therefore the patients UF removal can be minimised.

D-FAS wash back

After the completion of the treatment, D-FAS wash back returns the blood in the extracorporeal circuit automatically through the arterial and venous patient access without any operator intervention. All the operator needs to do is simply disconnect the patient.

D-FAS emergency bolus

The operator can start the emergency bolus without handling the bloodline set. D-FAS emergency bolus can deliver automatically a defined volume of substitution fluid to the patient.

Connectivity with Venous Needle Dislodgement System

To minimise the risk for the patient DBB-EXA triggers an alarm and stops the Blood Pump according to the signal from an external device.

e.g. Venous Needle Dislodgement System

Note

DBB-EXA is the first device which is designed according to the Public Available Standard [IEC PAS 63023]

Dialysis Dose Monitor

Positive long-term prognosis & higher quality of life for your patients!

Several studies have proven that a positive longterm prognosis and improved quality of life (QOL) of patients depends on the actual delivery of dialysis dose. Adequate dialysis dose may improve QOL [7-9].

Insufficient clearance performance can have various reasons:

  • No counter flow of blood and dialysis fluid due to incorrect connection
  • Shunt recirculation
  • Dialyser clotting
  • Frequent alarms of dialysis machine which shortens effective treatment time
  • Reduced effective blood flow etc.

Advantages of the Dialysis Dose Monitor

  • Real-time monitoring
  • Recognise treatment inconsistencies
  • Easy handling
  • No additional costs for disposables

Measurement principle of the DDM

A sensor located directly in the spent dialysis fluid measures the absorbance at a wavelength which directly correlates with patient blood urea nitrogen (BUN) concentration.

The continuously measured values are inserted in the formulas for single pool Kt/V (spKt/V) and urea reduction ratio (URR) and the results are immediately displayed.

K, Kt, Kt/V, eKt/V, URR can be displayed.

Reaching treatment goals

Reaching the individual treatment goals for your patients can only be achieved by always knowing the actual status. At the same time, necessary adaption of treatment parameters must be considered.

By using the Dialysis Dose Monitor, measured Kt/V is displayed in graphic form with a projection line.

You can see deviations from the treatment goal at an early stage, and react accordingly.

Dialysate Flow adaption

When the dialysate flow rate equals the blood flow rate, almost 90% of the maximum small solute clearance is achieved.

By using Flow adaption, the dialysate flow rate increases automatically with an increasing blood flow rate thereby ensuring an equal treatment efficiency for all conditions.

This could lead to reduced dialysis fluid consumption and costs in terms of energy, water etc without compromising Kt/V.

Method

Dialysate flow rate (Duplex pump speed) is controlled by below formula.

*Setting: multiplying factor (Range 1 to 2)

Optimised Substitution Volume

High volume Haemodiafiltration has been shown to have survival benefits for a patient, therefore physicians prefer to set increased substitution volumes where possible.

However, it is difficult to define because higher volumes may also lead to excessive hemoconcentration and subsequent high transmembrane pressures or other related alarms

With the DBB-EXA, optimised substitution rate is automatically calculated when the nurse enters the Ultrafiltrate removal value (Quf).

When blood Flow, Haematocrit and Total Protein are downloaded from the Patient Card, DBB-EXA calculates an optimised Substitution volume (Qs) by using the Filtration Fraction of plasma water.  If the TMP rises during treatment, the substitution rate is automatically reduced by the TMP Substitution Flow control.

TMP Sub control avoids alarms = less alarms leading to more trouble-free treatments, less workload for nurses, no need for further operator intervention during treatment and convenience for patients

This ultimately means an effective High Volume Haemodiafiltration treatment can be performed.

Blood Volume Monitor (BVM) and Plasma Refilling Rate (PRR)

BVM module transmits near-infrared light through the bloodline and measures the reflected light. A wavelength of near-infrared light is adsorbed and reflected by the red blood cells. Patient blood volume and blood cell concentration in the arterial bloodline are correlated. Haemo-Master observes the change of reflected light during the treatment and a change of patient blood volume (dBV) can be monitored continuously. Blood volume measurement is considered as a useful tool to help improve tolerance and the hemodynamic response [3]. Estimated patient PRR is calculated from UF rate and dBV trend. Nephrologists can refer to the PRR to help estimate adequate UF rate to stabilise the dBV. The monitored dBV and PRR are displayed in graphical form and clinicians can observe the patient fluid status visually.

BV-UFC and BV-COC

For each patient an individual curve for the ideal blood volume change is established. DBB-EXA continuously measures dBV during the dialysis treatment. This is the basis for automatic regulation of the UF rate (BV-UFC) and dialysis fluid conductivity (BV-COC) so that patient dBV follows the ideal curve. Some studies show that automatic regulation of the UF rate and dialysis fluid conductivity reduces incidents of hypotensive episodes and the frequency of symptoms during the treatment [4-6].

Patient Card Reader & Viewer

Unidirectional communication

Head Office

NIKKISO Europe GmbH
Head Office
Desbrocksriede 1
D-30855 Langenhagen

International HQ

NIKKISO Europe GmbH
Sales Department
Kapstadtring 7
D-22297 Hamburg

Subsidiary Office

Nikkiso Belgium bvba
Industriepark 6
B-3300 Tienen
Belgium

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