PRISMAFLEX CRRT SYSTEM

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Joanna Carson
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1 THE PRISMAFLEX CRRT SYSTEM Recover.

2 patients benefit There s a simple reason why the Prismaflex system is used more than any other Continuous Renal Replacement Therapy (CRRT) It s a complete system with the technology needed to help critically ill patients recover from Acute Kidney Injury (AKI). When considering patient outcomes, safety and ease of use, the reasons to implement CRRT with the Prismaflex system add up. device in the world. Confidence Starts With the Right CRRT System Successful improvement of impaired renal function demands a system that provides: Efficacy through therapy that most closely mimics the native kidney in small to large molecular clearance Accuracy of prescription delivery that is defined as optimal by the physician Versatility That Meets Diverse Patient Needs No two AKI patients are the same. The diversity of critically ill patients requires individualized care. Unlike Intermittent Hemodialysis (IHD) or Slow Low Efficiency Dialysis (SLED), the Prismaflex system delivers slow, continuous 24-hour treatment for: // Metabolic control // Fluid removal // Acid/base control // Electrolyte balance Physiologic Approach Continuous renal replacement avoids potential harmful effects associated with inconsistent treatment. Combining diffusion and convection provides optimal solute clearance. Indexed toxin clearance 1 Safety through automation of fluid measurement and The Prismaflex system is the only device that delivers removal to prevent risk of injury and minimize alarms all modes of CRRT without additional equipment. and down-time CVVHDF // continuous veno-venous hemodiafiltration Efficiency through real-time presentation of data and storage of treatment history to ensure patient CVVHD // continuous veno-venous hemodialysis safety, clear understanding of patient status, and treatment parameters Physiologic therapy accurately and gently balances fluid removal for hemodynamically unstable patients. CVVH // continuous veno-venous hemofiltration SCUF // slow continuous ultrafiltration TPE // therapeutic plasma exchange Urea (small molecule) ß 2-m (middle molecule) Myoglobin (large molecule) Diffusion // Convection // Native Kidney Albumin (large molecule)

3 Integrated Anticoagulation uniquely safe Gambro has led the industry in advancing CRRT without sacrificing safety. The Prismaflex system is designed for the critically ill patient. Its intelligent algorithms balance patient chemistry with fluid removal for optimal therapy delivery. Clinicians can be confident in knowing how much therapy the patient is receiving. Minimizes clinician involvement through automatic integration of anticoagulation with all modes of therapy // Provides automated and integrated anticoagulation options through the 5th fluid pump and syringe pump // Eliminates need for ancillary pumps and any patient risk of mismatched fluid flows between machines CRRT requires carefully balanced anticoagulation to ensure patient safety. PROVEN Hemofilter Sets // Offers proven performance; Gambro AN 69 hemofilters were used exclusively in the RENAL Study 4 // Demonstrates middle/large molecule clearance // Uniquely absorbs ß2-microglobulins, cytokines, anaphylatoxins, complement factor D, vascoactive substances, and coagulation factors with exclusive AN 69 membrane // Accommodates use of low to high flow filter sets to meet your patients needs Eliminates requirement for periodic filter flushings Accurate Fluid Management // Uses a highly-accurate, scale-based fluid management system (+/- 300ml/24 hrs) that is benchmarked by Acute Dialysis Quality Initiative (ADQI) recommendations 2 Offers extremely high levels of fluid removal accuracy through intelligent algorithms and self-calibrating fluid scales // Reduces risks of patient injury due to unmonitored, accumulated fluid By managing fluid overload or excess fluid removal, it is possible to reduce poor outcomes in critically-ill AKI patients, hypotension and other negative consequences. 3 By providing a full range of molecular clearances, Gambro hemofilter sets are designed to maximize therapy delivery, minimize complications for critically-ill patients, and reduce complexity for caregivers. Innovative Sterile Solutions // Improves prescription flexibility and corrects acidosis 5,6 using a complete range of bicarbonate buffered solutions with various ionic formulations // Reduces pharmacy labor, waste, and potential error associated with mixed products 7,8 All fluids are packaged in two-compartment bags to ensure solution stability with quick and safe preparation = Time saving features With market-leading sterile dialysate (PrismaSATE) and uniquely regulatory approved replacement fluids (PrismaSOL), Gambro is your source for sterile solutions designed for optimal therapy, flexibility, and reduced risk of infection.

Minimizes clinician involvement through automatic integration of anticoagulation with all modes of therapy // Provides automated and integrated anticoagulation options through the 5th fluid pump and

4 Simply Managed A nurse s time is precious. Manually monitoring multiple system conditions on an hourly basis makes patient care a challenge. The Prismaflex system saves time by providing automatic adjustment and immediate visual feedback of the system s condition. Spend time serving, observing and caring for patients, not managing machines. Patented Air Removal Chamber Eliminates the need to break open the circuit during therapy and use manual air removal via a syringe Removes air continuously to prevent time lost troubleshooting Minimizes clotting through automatic air removal without the need for manual intervention. Automated Simplified Pressure Monitoring EMR Connectivity and Calibration Integrates conveniently with // Provides automatic, realtime tracking of all relevant pressures including filter pressure and transmembrane pressure (TMP) Self-checks every two hours to eliminate manual monitoring and calibration of pressure sensors Detects system leaks automatically, eliminating the need for visual inspection Through simplified system checks, nurse involvement is reduced. most hospital EMR systems, either directly or through a third party // Simplifies evaluation of CRRT treatment reports and results Eliminates manual recording and transfer of CRRT treatment data to reduce risk of error // Enables CRRT treatment data download for research purposes By eliminating the need for tedious paper documentation, clinicians save time. Confidence From Start to Finish All sets automatically load and self-prime Tubing on hemofilter sets are preconnected and color coded for easy setup // System disposables and effluent never need to touch the floor // Unique back-up battery enables uninterrupted therapy delivery // Intuitive on-screen troubleshooting visuals are easily accessible during setup and therapy delivery Does not require confirmation that therapy bags are draining equally Eliminates requirement to weigh the patient regularly to confirm fluid balance = Time saving features

Spend time serving, observing and caring for patients, not managing machines.

5 Use the complete CRRT system that delivers what patients and healthcare providers need. Integrated CVVHDF // The only device that delivers all modes of CRRT without additional equipment and TPE Accurate fluid management // Scale-based system with +/- 300mL/24hrs Patented air removal // Removes air continuously and automatically to prevent lost time Simplified EMR connectivity // Integrates conveniently with most hospital EMR systems, either directly or through a third party Ease in bedside preparation and operation // Clinician involvement is lessened because of integrated automation and monitoring References: 1 Hypothetical representation by Gambro of clearance levels. 2 Bunchman, T., Palevsky, P., Tetta, C. ADQI 1 Conference: CRRT. Retrieved October 16, 2009 from adqi/adqi01.html. 3 Bourchard, J, et al: Fluid accumulation, survival and recovery of kidney function in critically ill patients with acute kidney injury. International Society of Nephrology, 2009; KI, , 13 May RENAL: Randomized Evaluation of Normal versus Augmented Level of Renal Replacement. Bellomo et al, Intensity of Continuous Renal Replacement Therapy in Critically Ill Patients. N Engl J Med 2009; 361; Macias, W.L., Choice of replacement fluid/dialysate anion in continuous renal replacement therapy. American Journal of Kidney Diseases, 1996; Vol. 28, No 5, Suppl. 3 (October), pp. S15-S20. 6 Druml, W. Metabolic aspects of continuous renal replacement therapies. Kidney International, 1989, Vol Culley, C.M. et al., Implementing a standardized safety procedure for continuous renal replacement therapy solutions. American Journal of Health System Pharmacy, 2006; 63: Barletta, J.F., Resource Utilization and Total Cost of Commercially Available versus Manually Compounded Solutions Used for Dialysate in Continuous Renal Replacement Therapy. Hospital Pharmacy, 2008; 43: _ Gambro Lundia AB To learn more about the Prismaflex system, please visit gambro.com/prismaflex or call Denver West Parkway, Suite 400 Lakewood, Colorado Visit us at Gambro, AN 69, PrismaSate, PrismaSol and Prismaflex are trademarks belonging to the Gambro Group.

Removes air continuously and automatically to prevent lost time Simplified EMR connectivity // Integrates conveniently with most hospital EMR systems, either directly or through a third party Ease in

THE PRISMAFLEX SYSTEM

THE PRISMAFLEX SYSTEM The Prismaflex Control Unit is intended for: Continuous Renal Replacement Therapy (CRRT) for patients weighing 20 kilograms or more with acute renal failure and/or fluid overload.