hp relay function introduction - ccnapi

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V3.4

HP Relay Function IntroductionCharlie Tang

International Marketing Dept.

© Medcaptain 2020 All rights reserved.

Content

Clinical requirement of relay

Single drug relay

Multi drug relay

Relay group


What is Relay?

Relay Race Relay Infusion


Relay Control

• Information exchange between pumps

• Status detection and Pump control

• Infusion Workstation is required


Different Relay

Single Drug Relay Multi-Drug Relay


Content

• Single Drug Relay

• Multi-Drug Relay

Single Drug Relay

Part 1


• The max. size of syringe is 50/60 ml, when using a syringe pump, end-users are frequently facing the “Changeover” issue.

• Hemodynamic instability following the Changeover of Vasoactive Infusion Pump (CVIP) is a common problem in the intensive care unit [1][2].

• Serious issue occurs when failure of the cardiovascular system compromises tissue perfusion, like shock. It may threaten patients’life [3][4].

• The usual practice of CVIP may cause a related incidents at the frequency of 17.8% [1]

1. Argaud L, Cour M, Martin O, et al. Changeover of vasoactive drug infusion pumps: impact of a quality improvement program. Crit Care 2007; 11:R1332. Malanie Arino, Jane P. Barrington, Anne L. Morrison, Donna Gillies Management of the changeover of inotrope infusions in children Intensive and Critical Care Nursing (2004) 20,275-2803. Hollenberg SM. Vasoactive drugs in circulatory shock. Am J Respir Crit Care Med 2011; 183:847-554. Holmes CL. Vasoactive drugs in the intensive care unit. Curr Opin Crit Care 2005; 11:413-7

Clinical Trouble


The application of drugs with low half-life times (e. g. catecholamines) require a quick and safe change of an empty syringe into a new one.

Swaying of the blood pressure cannot be avoided by changing the syringe manually.

Syringe 1

time

Syringe 2

Rate

Quick Change (QC) of the syringe

MAP changes sharply

Importance of continuous infusion

Presenter

Presentation Notes

MAP: mean arterial pressure


Syringe ①finished

Nurse change

the syringe

Syringe ②Starts

• Nurse uses one pump. The first syringe empty, then change a new syringe.

• The gap between two syringes' replacement will cause a trouble on hemodynamics.

Single Pump

The usual practice of CVIP

Presenter

Presentation Notes

CVIP: Changeover of Vasoactive Infusion Pump

Channel ①finished

Nurse change

the syringe

Channel ②Starts

• The upgraded practice need 2 pumps.

• When channel ① is near empty, nurse starts to prepare the channel ②

• When channel ① is finished, nurse starts channel ② as fast as she/he can.

• This practice may shorten the gap time.

• While the gap is still there if there is still an “operator” to control the starting time of channel ②.

Channel

Channel

①

②

The upgraded practice of CVIP


Channel ①finished

Controller

Channel ②Starts

• A better way is to use a multi-channel infusion workstation.

• At the beginning, both channels will be prepared with drugs.

• The controller will check the status of channel ①, when channel ① finished, the controller

will start channel ② automatically.

• Nurse no longer need to stay at the bed side waiting when channel ① is about to finished.

• Controller is much faster than the manual operation. So the gap will be much shorter.

Channel

Channel

①

②

Auto-Changeover Method


Auto-changeover method is good for clinical practice, while there is still a risk.

Syringe pump is a mechanical equipment. A mechanical equipment is always with mechanical clearance. The

mechanical clearance may still cause a gap time between two syringes, normally it is called “rising time”.

Like what is shown on the fig above, during the rising time, the channel ② will not meeting the setting rate, which may

cause a “lack of drugs”.

Time

Rate Auto-changeover method

Rising time

Channel ① Channel ②

Syringe pump’s gap

Most of the infusion systems stop here.They cannot erase the mechanical clearance.

But this is not the answer that clinical staffs need.


1. Medcaptain worked with the best hospital of China, Peking Union Medical College Hospital, for two years, and

developed a new technology to solve this issue.

2. With the help of this technology, the average rising time can be less than 10 seconds

3. This technology is named “Quick to Steady-State (QSS) infusion method”.

4. We’ve applied the invention type patent together with PUMCH

5. Patent SN：201610838250.1

The unique solution of Medcaptain


This is the startup graph with 20ml syringe on the setting rate of 5ml/h. We can see the difference between two

methods.

The red line is the syringe pump with QSS model, the blue one is the same syringe pump that is working without

QSS model.

Without QSS

With QSS

QSS technology VS Normal infusion

Presenter

Presentation Notes

图为使用20ml注射器在5ml/h输注时，无稳态注射技术时的不升曲线（蓝色）和有稳态注射技术时的不升曲线（红色）对比。没有使用稳态注射技术的注射泵达到稳态需要的时间约为8分钟。有稳态技术的注射泵不升时间为六秒。（图中横坐标每个刻度对应3秒时间）


Testing Method: Using same syringe pump (with QSS and without QSS) to infuse the same hyperensort to a dog, under the dose rate of 1.25mcg/kg/min, recording the ABPs, ABPd and MAP. When MAP reaches140mmHg, stop the infusion, and record the starting time and stopping time.

Start QSS-stop Without QSS-stop

When working with QSS module, we could see MAP increased in 3min. And MAP reached 140mmHg in 6min.

When working without QSS module, MAP didn’t change at the first 6min, and reached 140mmHg at about 12min.

QSS technology VS Normal infusionAnimal Testing

Fig Resource: PUMCH animal testing

Presenter

Presentation Notes

使用同一台注射泵以“注射泵速1.25ug/kg/min”给大狗输注同一管升压药，实时记录大狗的收缩压、舒张压、平均动脉压。当平均动脉压达到140mmHg左右时停止药物输注。加装了稳态输注模块时，启动输注3分钟后血压值即开始快速不升，6分钟时平均动脉压即达到目标的140mmHg。未加稳态输注模块时，启动输注后6分钟内血压没有不升趋势，6-9分钟之间，血压开始不升，9分钟之后血压开始快速不升，到12分钟左右时才达到目标血压值。


• Blue line, MAP under the usual practice of VIP, drops when changing the syringe

• Red line, MAP under the relay function with QSS, cannot see the gap

MAPRelay function with QSS

MAPUsual practice of CVIP

Fig resource：PUMCH animal test

QSS module relay VS Usual practice of CVIP Animal Test


Relay functionContinuous infusion!

Channel 1 Start from very beginning

Channel 2 When channel 1 ‘FINISHES”, start automatically without “STOP”

Key Words One by One Automatically Without stop

Can be active at anytimeQuick to steady-stateInfusion data synchronized

Channel 1

Channel 2

time

time

Rate

Rate

Medcaptain Relay Function


Parameter Synchronization

Norepinephrine0.1mcg/kg/min

Norepinephrine0.1mcg/kg/min

When single drug relay is activated, the dose information will be synchronized automatically


1. This Syringe Pump is using 50ml syringe, running rate: 5ml/h, syringe is almost empty.

2. How to replace syringe without stop giving drug?

Question-1


Single Drug Relay

Relay


Single Drug Relay


So easy a caveman can do it


I want to set these two pumps to be run circularly

Question-2


Relay Cycle


Dual Relay Notice 1

Relay

Running

• Relay can be activated at any time

• In order to active “Dual relay” , the right position in the slot need to be chosen


• Dual Relay ONLY available for same type of pump

Dual Relay Notice 2


• In order to active “Dual relay”, same type of consumables need to be used for two pumps

Dual Relay Notice 3


• ONLY available for same drug name

• If the drug name is different, the second pump will be alerted and required to switch to the same drug as the first pump.

Dual Relay Notice 4


Is it possible to set the relay sequence as above?

Question-3

①

②

③


Relay Entrance


Relay Setting


Modify relay during infusion-Relay set button

Infusing pump

Waiting pump

• “Relay Set” button only on the waiting pumps

• Quick access to modification during the relay

infusion

Multi-Drug Relay

Part 2


Clinical Trouble

• Drug Interaction

• Eg. Albumin therapy follow by Antibiotics

Albumin Administration in Patients With Cirrhosis and Infections Unrelated to Spontaneous Bacterial Peritonitis (Infecir), ClinicalTrials.gov Identifier: NCT00124228

Albumin Cephalosporin

Albumin Sodium Chloride Cephalosporin

Presenter

Presentation Notes

Spontaneous bacterial peritonitis (SBP) present in cirrhotic patients induces severe circulatory dysfunction, which results in renal failure in up to 30% of the patients. Renal failure is an important prognostic marker, representing the major predictive factor of in-hospital mortality. Recent studies have shown that plasma volume expansion with albumin associated with cefotaxime in patients with SBP is more efficient to prevent renal failure than cefotaxime treatment alone. The in-hospital and three-month mortality rates, furthermore, were significantly lower in the group treated with albumin.


Albumin

Nurse manual flush with

Sodium Chloride

Cephalosporin

Normal Operation

Channel ①

Channel ②

• When the Albumin is finished, the nurse has to be at the bed and flush with the sodium

chloride.

• The Cephalosporin in the second channel has to start manually.


Albumin

Sodium Chloride

Cephalospori

n

Channel ①

Channel ②

Auto-Changeover Method

Channel ③

• If a multi-channel infusion workstation is used, the auto changeover method can be

applied.

• When Albumin is finished, the specific volume of Sodium Chloride will be flushed

automatically.

• After flushing, the Cephalosporin in the third channel will be start automatically.

• The workload of the nurse will be reduced


Relay functionContinuous infusion!

Channel 1 Start from very beginning

Channel 2 Wait till Channel 1 ‘FINISHES”, then start automatically without “STOP”

Channel ….. Continuous with next channelOr go back to Channel 1

Key Words One by One AutomaticallyWithout stopCan be active at anytime

Channel 1

Channel 2

time

time

Rate

Rate

Medcaptain Relay Function


I want to do a multi drug relay from channel 1 to channel 3.How can I set it up?

Question-5


For the first time-Relay Setting

1234

Select Multi-Drug Relay

Default: Single Drug Relay


Relay Entrance


Two type of relay compare

Single Drug Relay Multi-Drug Relay

No Data SynchronizationNo Relay Cycle


Rule of Multi-Drug Relay?


Relay Setting


Multi-Drug Relay Sequence


Relay UI

Slot Number

Relay Index

Relay Running

Relay Waiting

Circular Relay


How many sets of pumps can be added into a relay sequence?

Question-4

？


Max. Sequence

Pumps

For the clinical application, only 2 pumps are required for a relay.3 is more than enough.


If I want to have more than 3 pumps to be pre-programmed, what can I do?

Question-5

？

Relay group

Part 3


New Function

Relay GroupGroup BGroup A


1. Channel 1 and channel 2 get a relay.2. Channel 3 and channel 4 get another relay.

Question-4


Relay Group


Relay Group

Relay Group B

Relay Group C

Relay Group D

Relay Index

Relay Group A


OPEN QUESTION 1

• Channel 1 and channel 3 are running.

• If I activate the dual relay on channel 2, what will happen?

10ml/h

20ml/h

?

Presenter

Presentation Notes

Upwards synchronize first


Which modes does the new relay function support?

OPEN QUESTION 2

Rate Time Weight Sequence Trapezia

TCIPCATIVALoadingDoseMicro

Intermittent


Questions

Thank you!

International Nursing Convention

Management of circulation —Story behind the target

Wenzhao. Chai

ICU department

Peking Union Medical College Hospital

Between clinical and academic: Execution force

Target of haemodynamics: a reflection of academic level

Execution force: Story behind the target

Understanding of pathophysiology: the level of execution force

Solution for exact problem: the ability of execution

Management of capacity: An story of puerpera

Female, 26 yrs, Placenta previa with

implantation

Massive hemorrhage after cesarean

section

Hysterectomy

Infused 28U concentrated red blood cell

Post-operative variation of hemodynam

• Blood pressure: 100/60 mmHg

• Pumped in large dose of norepineph

• CVP: 14mmHg and rising

Presenter

Presentation Notes

Example, please feel free to use a practical example you are familiar with

Presenter

Presentation Notes


Condition of the heart

Principle of hemodynamic treatment: Dehydration

Contractility of left heart drop obviously

Diameter of postcava : 2.2cmH2O

MAP 70MMHg, CO3.0

Tissue perfusion in good condition

But Progressive elevation of CVP

increase

Heart rate 150 times/minutes

Presenter

Presentation Notes


How to dehydrationSpeed is

everything 1. Furosemidum 10mg intravenous infusion:800 ml/h

Blood pressure drop, hypoperfusion occur

2. Furosemidum 5mg intravenous infusion: 400ml/h

CVP does not drop

3. Furosemidum 5mg intravenous infusion: 400ml/h, change

the infusion interval to 2 hours

Result: negative balance reach 6000ml in 20 hours, CVP was

kept between 8-10

Presenter

Presentation Notes


Management of capacity: what we should know

1. Current patient condition: rapid recovery, adjusting period,

steady period, dehydration period

2. Different period of hemodynamic treatment, requirement of

capacity

3. Relationship of the cause and result of the reasons for

changing of hemodynamic parameters

4. Plasma return time

Target blood pressure: usually an empty shell

Neurocrit Care Published online 21: April 2015

Management of blood pressure：a story of 8 minuts

Neurocrit Care Published online 21: April 2015

Fluctuate of blood pressure: countless reasons

Maintaining a stable target blood pressure is

the foundation of hemodynamic treatment

Turn over, cough,

outside influence

Anesthesia,

analgesia

Breathing

condition support

Infusion of

vasoactive agent

cause blood

pressure variation

One small target at a time

2009 British Association of Critical Care Nurses, Nursing in Critical Care 2009 • Vol 14 No 4

Why changing pumps will impact the blood pressure?

Intensive and Critical Care Nursing (2004) 20, 275—280

Greau et al. Ann. Intensive Care (2015) 5:40

Two pumps combo: substantial improvement


1. Medcaptain worked with the best hospital of China, Peking Union Medical College Hospital, for two years, and

developed a new technology to solve this issue.

2. With the help of this technology, the average rising time can be less than 10 seconds

3. This technology is named “Quick to Steady-State (QSS) infusion method”.

4. We’ve applied the invention type patent together with PUMCH

5. Patent SN：201610838250.1

The unique solution of Medcaptain


This is the startup graph with 20ml syringe on the setting rate of 5ml/h. We can see the difference between two

methods.

The red line is the syringe pump with QSS model, the blue one is the same syringe pump that is working without

QSS model.

Without QSS

With QSS

QSS technology VS Normal infusion

Presenter

Presentation Notes

图为使用20ml注射器在5ml/h输注时，无稳态注射技术时的不升曲线（蓝色）和有稳态注射技术时的不升曲线（红色）对比。没有使用稳态注射技术的注射泵达到稳态需要的时间约为8分钟。有稳态技术的注射泵不升时间为六秒。（图中横坐标每个刻度对应3秒时间）


Testing Method: Using same syringe pump (with QSS and without QSS) to infuse the same hyperensort to a dog, under the dose rate of 1.25mcg/kg/min, recording the ABPs, ABPd and MAP. When MAP reaches140mmHg, stop the infusion, and record the starting time and

stopping time.

Start QSS-stop Without QSS-stop

When working with QSS module, we could see MAP increased in 3min. And MAP reached 140mmHg in 6min.

When working without QSS module, MAP didn’t change at the first 6min, and reached 140mmHg at about 12min.

QSS technology VS Normal infusionAnimal Testing

Fig Resource: PUMCH animal testin

Presenter

Presentation Notes

使用同一台注射泵以“注射泵速1.25ug/kg/min”给大狗输注同一管升压药，实时记录大狗的收缩压、舒张压、平均动脉压。当平均动脉压达到140mmHg左右时停止药物输注。加装了稳态输注模块时，启动输注3分钟后血压值即开始快速不升，6分钟时平均动脉压即达到目标的140mmHg。未加稳态输注模块时，启动输注后6分钟内血压没有不升趋势，6-9分钟之间，血压开始不升，9分钟之后血压开始快速不升，到12分钟左右时才达到目标血压值。


• Blue line, MAP under the usual practice of VIP, drops when changing the syringe

• Red line, MAP under the relay function with QSS, cannot see the gap

Fig resource：PUMCH animal test

QSS module relay VS Usual practice of CVIP Animal Test

MAPUsual practice of CVIP

MAPRelay function with QSS


Single Drug Relay operation

Easy operation for fast relay set up

Thank you

hp relay function introduction - ccnapi

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