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The

Blood Volume Monitor

The Blood Volume Monitor

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time [min]0 15 30 45 60 75 90 105 120 135 150 165 180 195 210 225 240

UFR

[ml/h

r]

0

1000

2000

3000

4000

RB

V [%

]

86

88

90

92

94

96

98

100

102

104

CHAMNEY P, 1997

3,5% RBV- Decrease

BVM- Individual Measurement results

Fluid overloaded patient

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Time [min]0 15 30 4545 6060 7575 9090 105105 120120 135135 150150 165165 180180 195195 210210 225225 240240

UFR

[ml/h

r]

00

10001000

2000

3000

4000

RB

V [%

]

82

84

86

88

90

92

94

96

98

100

102

104

CHAMNEY P, 1997

11% RBV-Decrease

„Dry“ patient

BVM- Individual Measurement Results

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Blood Volume Monitor

The principle of the BVM measurement

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How does the BVM control ultrafiltration?

Green Zone

Uncritical area: No BVM Control. In the beginning of the treatment the patient is fluid overloaded. The initial UFR is high but it will be constantly reduced over the treatment time.

Yellow Zone

UF Control required: The BVM avoids a decrease of the RBV into the critical RBV area. The closer the RBV gets to the critical RBV area, the more the UFR will be reduced. If the RBV increases, the UFR will also be increased.

Red Zone

Critical area: High likelihood of a blood volume induced hypotensive episode. The UFR may be reduced to a minimum rate or if „UF Control continue“ was activated (first volume half) it can be reduced to 0 ml by the BVM.

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Example: cRBV of 84%

4000 ml 4 h 1000 ml/hwith UF control to begin 2 x 1000 ml/u = 2000 ml/hAfter one minute: UF removed: 33 ml3967 ml 3 h 59 min 995 ml/hwith UF control 2 x 995 ml/h = 1990 ml/h

100 % to 92 %

2 X

4000 ml 4 h 1000 ml/h

After 1 hour: UF removed: 1560 ml

2440 ml 3 h 813 ml/h

When RBV is 92 % 2 x 813 ml/u = 1626 ml/u

When RBV is 88 % 1 x 813 ml/u = 813 ml/u

92 % to 84 %

Between 2 and 0

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BVM status

The actual status of the BVM is displayed by icons in the BVM menu

A calibration of the cuvette is needed to perform a BVM measurement / UF control, the calibration will be performed automatically during preparation.

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BVM Menu

Icon Status BVM

Actual BVM Rate and UF Volume

Display UF Goal and permitted deviations from UF goal

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BVM Menu

Max. BVM Rate, may be limited by the user

Function: crit. RBV adaption

In measuring mode for the coarse adjustment of the crit. RBV for new and not known patients during the first volume half of the treatment

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Saves cRBV after the treatment• Lowest measured RBV, or

cRBV

„Target-RBV“adjustment range

Time (h)0 1 2 3 4 5

86889092949698100102104

RB

V(%

)

RBV

Adaptation mode - measuring

Active only during the first half of the treatment (1st volume half)

cRBV„target-RBV“

adjustment range

Time (h)0 1 2 3 4 5

86889092949698100102104

RB

V(%

)

RBV

• Highest RBV with blood pressure alarm

set BPM windows!

1. BVM „only“ measuring

• „Coarse adjustment“

• Unknown patients

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BVM Menu

cRBV fine tuning in BVM UF Control mode

The critical RBV may be reduced several times by 1% during the first volume half of the treatment depending on the actual RBV

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The cRBV may be reduced several times during the first volume half of the treatment by 1% if the actual reached RBV

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• UF-rate will be higher after reducing cRBV with 1%.

Lowering crit RBV

Higher UF-rate

Adaption during the First Volume Half

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Permitted UF Goal Deviations

• Permitted UF Goal deviations– More flexibility of UF Goal– Allows adaption to patient conditions

Initial deviations from the UF Goal may be defined in the operator setup

Maximum permitted deviations are set in the service setup

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Tolerated volume deviation

Limitation in technician‘s setup (+1000 ml/-1000 ml)

Default values in user setup

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Tolerated volume deviation

Goal:

1. Adaptation of the UF-volume to actual refilling / gentle treatment

2. Possibility to extract more volume in case of excessive fluid overload or unknown dry weight

3. Avoidance of messages

Method:• Tolerance of an upper and lower UF-volume deviation

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Setting/Changing of UF Goal Deviations

Setting or changing of the permitted UF Goal deviations may be set in the BVM menu via the UF prognosis tool

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Tolerated volume deviation - Input -

• Tolerance of upper and lower volume deviation

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Messages during the First Volume Half

If a serious drop in RBV should occur during the first volume half (i.e. due to food intake) or a misbalance between BPR / UFR a minimum rate may be set to compensate the decrease of RBV or to prevent haemoconcentration.

The minimum rate set during the first volume half will be automatically reset when the second volume half starts

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Messages during the First Volume HalfMessages during the First Volume Half

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Messages during the First Volume HalfMessages during the First Volume Half3300

-1512

= 1788

1788/

2u50

= 631 ml/h

631

631

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Minimum Rate Second Volume Half

If a serious decrease of RBV should occur in the second volume half a minimum rate may be set to achieve the minimum UF goal

The minimum goal may be reduced by 100 ml if the achieving of the minimum UF goal is uncertain and the limits set in the service setup allow the reduction

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Minimum Rate - Second Volume Half

A warning will be displayed if the RBV should drop under the critical value when a minimum rate was set

The warning will be repeated at intervals of 1% if the RBV continues to drop

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If a reprogramming of the cRBV or the UF goal is required at this point of the treatment, please set the minimum UF Rate

Reprogramming is now possible in the BVM menu or the treatment screen. The minimum rate will be reset after the reprogramming of the desired values.

Minimum Rate Second Volume Half

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BVM graphic display

UF Rate

RBV Course uncritical UF area

Control area

Critical area

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BVM graphic display

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Thank you very much for your

Attention!

Diapositive numéro 1BVM- Individual Measurement resultsBVM- Individual Measurement ResultsBlood Volume MonitorHow does the BVM control ultrafiltration?Example: cRBV of 84%BVM statusBVM MenuBVM MenuDiapositive numéro 31BVM Menu Adaption during the First Volume HalfPermitted UF Goal DeviationsTolerated volume deviationTolerated volume deviationSetting/Changing of UF Goal DeviationsTolerated volume deviation - Input -Messages during the First Volume HalfMessages during the First Volume HalfMessages during the First Volume HalfMinimum Rate Second Volume HalfMinimum Rate - Second Volume HalfMinimum Rate Second Volume HalfBVM graphic displayBVM graphic displayDiapositive numéro 51