Glossary

 

The following glossary provides excellent background reference about SMARRT™ therapy for hemodialysis.

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• Access
  • The means by which the patient’s bloodstream is reached for hemodialysis. In hemodialysis, fistulas, grafts, and catheters are used for vascular access.
• Access disconnect
  • A broken connection to the patient’s bloodstream caused by a disconnection at either the blood-in or blood-out access points
• Access mode
  • The means by which the bloodstream is accessed for hemodialysis to take place
• Acute renal failure
  • A condition in which the kidneys suddenly stop working. In many cases, patients are able to recover kidney function with temporary support provided by hemodialysis.
• Air detectors
  • Sensors that monitor the blood circuit for air. The Allient System’s air detectors can detect bubble(s) of air in the blood tubing, an empty heparin container, or empty saline bag. All bubble detectors initiate alarms that stop the movement of fluids.
• Air embolus
  • The closing of a blood vessel caused by an air bubble. The Allient System uses air detectors on both the arterial and venous blood tubing to prevent air embolis.
• Alarm
  • An indication of a major error condition on the Allient System. All alarms stop the operation of the fluid delivery systems. There are three levels of alarms on the system that are displayed in increasing order of severity.
• Alert
  • An indication of a minor error condition on the Allient System. Fluid delivery systems on the Allient System are not stopped by an alert.
• Ammonia detector
  • A disposable component on the Allient System’s dialysate tubing set that changes color when the ammonia level in the dialysate exceeds an acceptable level
• Anemia
  • A condition caused by the lack of sufficient red blood cells
• Angina
  • Severe chest pain caused by a deficiency of oxygen to the heart muscle
• Antibiotic
  • A substance used to destroy or inhibit the growth of microorganisms
• Anticoagulant
  • A substance that is given to prevent clotting of blood. Heparin is an anticoagulant.
• Antiseptic
  • An agent that prevents infection by inhibiting the growth of microorganisms
• Arrhythmia
  • Any disturbance in the rhythm of the heart
• Arterial
  • Relating to the muscular elastic tubes that carry blood away from the heart to the cells, tissues, and organs of the body - in hemodialysis, the tubing carrying blood from the patient to the dialyzer (“blood-in tubing”)
• Arterial tubing
  • The portion of the blood tubing carrying the blood from the patient to the dialyzer (“blood in”)
• Arteriovenous fistula
  • The surgical connection of an artery directly to a vein, usually in the forearm, created in patients who will need hemodialysis. The fistula causes the vein to grow thicker, allowing the repeated needle insertions necessary for hemodialysis.
• Arteriovenous graft
  • A portion of an artificial blood vessel that is connected to an artery at one end and a vein at the other end. In hemodialysis, a graft is used for vascular access.
• Aseptic
  • Free of disease-producing microorganisms
• Aseptic technique
  • Practices that help reduce the risk of exposure of patients and caregivers to potentially infectious blood and tissue
• Bacteria
  • Organisms too small to see with the naked eye that can produce disease or infection
• BFR
  • Blood flow rate. In hemodialysis, the amount of blood passing through the dialyzer each minute - determined by the speed at which the blood pump is set
• Bicarbonate
  • A buffer found in blood that neutralizes acids and is reabsorbed by healthy kidneys. Bicarbonate is added to the dialysate fluid to help restore bicarbonate levels in hemodialysis patients.
• Biocompatible
  • “Similar to the human body” and not causing an adverse reaction or triggering an immune response in the patient
• Bilirubin
  • The yellowish pigment in bile - derived from red blood cells that have completed their life span - normally present in the blood in small amounts but increases in certain pathological conditions
• Blood leak
  • In hemodialysis, a condition in which the dialyzer fibers or membrane develop a small break or tear that allows blood to leak into the dialysate
• Blood leak detector
  • A unit with a sensor that detects the presence of blood in the dialysate tubing. In hemodialysis using the Allient System, this condition triggers an alarm that causes hemodialysis treatment to stop.
• Blood pressure
  • The pressure of the blood flowing through the blood vessels - stated as a systolic number over a diastolic number
• Blood pump
  • In hemodialysis, a pump that moves the patient’s blood from the patient’s body through the blood tubing, through the dialyzer, and back to the patient’s body. Traditional hemodialysis systems use a roller pump: the Allient System uses the Pulsar™ blood pump, a single-use, disposable, dual chambered pneumatically operated blood pump.
• Blood tubing
  • Tubing that attaches to a needle or catheter, removes toxin-laden blood from the patient, passes it through a dialyzer, and returns the detoxified blood to the patient (also see extracorporeal circuit)
• Blood set
  • The Allient System’s blood set is made up of sterile blood tubing, heparin tubing, and the blood pump. The blood set is completely disposable and is designed for single-use only.
• Bloodborne
  • Carried by or present in human blood
• Bolus
  • In hemodialysis, a concentrated mass of medication given intravenously during treatment
• Bradycardia
  • A slow heartbeat characterized by a pulse rate of less than 60 beats per minute
• BUN
  • Blood urea nitrogen. A waste product, or toxin, that appears in the blood as protein from food digested. BUN levels are a measure of how well the kidneys are functioning as well as the adequacy of dialysis and nutritional status. A high BUN indicates that the kidneys are not removing enough waste.
• Calcium
  • An element necessary for nerve and muscle function. In hemodialysis using the Allient System, calcium is added to the infusate solution to replace the calcium removed from the dialysate solution by the sorbent cartridge.
• Cannulation
  • The process of inserting a needle into the graft or fistula
• Catheter
  • A plastic or rubber tube, inserted into a vein or cavity, through which fluids enter or leave the body
• Clamp
  • On the Allient System, an electrically controlled, pneumatically driven device on the tubing used to control fluid movement
• Component
  • A necessary “part” of a mechanical system. Each separate system making up the Allient System as a whole (the dialysis management system, for example) is made up of separate components (dialysis tubing, sorbent cartridge, infusate pump, ammonia sensor, etc.).
• Conductivity
  • The measure of ions in a solution. A conductivity meter is used to measure the chemical composition of dialysate and infusate by measuring the solution’s ability to conduct an electrical current.
• Contaminated
  • The presence of potentially infectious materials
• Convection
  • The transmission of heat in liquids or gases caused by the circulation of the heated particles
• Creatinine
  • A waste product released from the muscles of the body. Creatinine is normally removed from the blood by the kidneys. Creatinine is removed from the blood of persons with impaired kidney function during hemodialysis treatment.
• CRF
  • Chronic renal failure - a slow and progressive loss of kidney function over several years, often resulting in End Stage Renal Disease (ESRD)
• Declotting
  • In hemodialysis, removal of blood clots so fluid can flow freely through blood tubing
• Default
  • An option that is selected automatically
• Dextrose
  • A simple sugar that is used by body cells for metabolism. In hemodialysis using the Allient System, dextrose is one of the chemicals added to potable water to mix the dialysate solution.
• DFR
  • Dialysate flow rate - the average value of dialysate flow. This value is dependent on the type of dialyzer used.
• Dialysate
  • A mixture of water and carefully measured chemicals that is used to clean the patient’s blood during hemodialysis. In hemodialysis using the Allient System, precise amounts of sodium bicarbonate, sodium chloride, and dextrose are mixed into potable water in concentrations based on the patient’s prescription.
• Dialysate jug
  • In hemodialysis using the Allient System, a 6-liter container in which the dialysate is mixed and that holds the dialysate fluid before the fluid is drawn into the dialysate reservoir
• Dialysate pressure
  • The pressure created by the dialysis “in” and “out” pumps. In hemodialysis using the Allient System, a pressure sensor in the dialysate tubing monitors dialysate pressure to ensure that dialysate and side pressure are in the right range to keep a neutral pressure across the dialyzer.
• Dialysate set temperature
  • A value entered at setup of the Allient System. A sensor in the dialysate tubing of the Allient System constantly monitors temperature, and an alarm is presented if the temperature is out of range.
• Dialysate tubing
  • A disposable component of the Allient System - a single-use set of tubing that includes dialysate and infusate tubing components. The dialysate tubing carries the dialysate from the dialysate bag, through the sorbent cartridge, dialyzer, and back into the dialysate bag.
• Dialysis
  • The process of removing wastes and excess fluid from the blood. This is normally done by the kidneys. If the kidneys fail, the blood must be cleaned artificially using special equipment. The two major forms of dialysis are hemodialysis and peritoneal dialysis.
• Dialysis flow rate
  • The average rate of dialysate flow
• Dialysis technician
  • An individual who provides hemodialysis care under the supervision of a registered nurse or a physician - also referred to as a Patient Care Technician
• Dialyzer
  • An artificial kidney used in hemodialysis. The dialyzer is a canister containing microscopic fibers through which blood is passed. Dialysate solution is pumped around the fibers - wastes and extra fluid in the blood pass through the fibers in the dialyzer into the dialysate solution.
• Diastolic
  • The bottom blood pressure number (or second number) that measures the force of the heart muscle at rest, when it expands and fills with blood
• Diffusion
  • The process by which particles move through a semi permeable membrane from an area of high concentration to an area of lower concentration. Dialyzers use diffusion to “clean” the blood.
• Disposables
  • In hemodialysis using the Allient System, single-use components such as blood and dialysate tubing, dialyzer, and dialysate and infusate packets
• Dual-needle mode
  • One of the two access modes used for hemodialysis (the other is single-needle mode). In dual-needle mode, two needles are used for treatment - one arterial and one venous.
• Duration
  • In hemodialysis, the length of the treatment. In hemodialysis using the Allient System, duration is determined by the type of sorbent cartridge used.
• Electrolytes
  • Salts in the body fluids including sodium, potassium, magnesium, and chloride. The kidneys control the amount of these electrolytes in the body. When the kidneys fail, electrolytes get out of balance, causing potentially serious health problems.
• EMI
  • Electromagnetic interference. Interference caused by radiation from devices such as portable telephones or radio equipment
• ESRD
  • End-Stage Renal Disease - any irreversible kidney disease that requires hemodialysis therapy or kidney transplant. The term “endstage” means that the renal disease is permanent and irreversible, and not that the patient’s condition is terminal.
• Extracorporeal circuit
  • The path of blood circulating outside the patient’s body and through the blood tubing during hemodialysis.
• Fistula
  • See arteriovenous fistula Flush volume In hemodialysis, the amount of saline used to remove all impurities from the dialyzer prior to use.
• Flush volume is specific to the dialyzer used.
• Glucose
  • A type of sugar normally found in the body - also called blood sugar. Dextrose (a similar sugar) is added to the dialysate solution to replace any glucose removed from the blood by hemodialysis treatment.
• Goal weight
  • Post-dialysis weight at which all or most of the excess fluid has been removed from the patient- also referred to as “Target Weight” or “Dry Weight”
• Graft
  • See arteriovenous graft
• Hansen connector
  • Connector designed for leak-tight connection of tubular components
• Hematocrit
  • A measure that tells how many red blood cells are present in a blood sample. A low hematocrit suggests anemia or increased blood loss. The hematocrit of the patients’ blood is tested for anemia, which is a common condition in hemodialysis patients.
• Hemodialysis
  • The use of an artificial kidney (or “dialyzer” ) to clean wastes from the blood after the kidneys have failed. The patient’s blood is circulated through tubing to a dialyzer, which removes wastes and extra fluid from the blood. The cleaned blood then flows back into the patient’s body.
• Hemoglobin
  • The substance in red blood cells that carries oxygen through the body. A low hemoglobin count suggests anemia or blood loss.
• Hemolysis
  • A life-threatening condition caused by the destruction of red blood cells. During hemodialysis, hemolysis may be caused by low blood sodium, overheated dialysate, too dilute of a dialysate solution, certain chemicals in the dialysate water, low conductivity, excessive arterial pressure, or kinked blood tubing.
• Heparin
  • A substance that slows the natural clotting of blood. Heparin is added, based on the patient’s prescription, to the blood circuit during hemodialysis.
• Heparin bolus volume
  • A set amount of heparin that is delivered at the start of hemodialysis treatment
• Heparin end time
  • The amount of time before the end of hemodialysis treatment that heparin delivery is stopped
• Hepatitis
  • An inflammation of the liver usually caused by a virus. Hepatitis is infectious and can be transmitted by contact with the blood of a person with the actual illness or by a carrier of the virus.
• Hepato renal
  • Pertaining to the liver and kidneys
• Hyperammonemia
  • An abnormally high level of ammonia in the blood
• Hypercapnia
  • An excess of carbon dioxide in the blood
• Hyperglycemia
  • Too high a level of glucose (sugar) in the blood - a sign that diabetes is out of control
• Hyperkalemia
  • A high level of potassium in the blood - can cause irregular heartbeat and cardiac arrest if severe
• Hypertension
  • High blood pressure, which can be worsened by too much fluid in the blood vessels or by fluid overload
• Hypoglycemia
  • Low blood sugar
• Hypotension
  • Low blood pressure
• IFR
  • Infusate flow rate
• Infiltration
  • The leakage of a substance into body tissues. In hemodialysis patients, infiltration of blood into the tissues surrounding the access can occur if the needle punctures the back of the vessel wall or is partially dislodged from the access.
• Infusate
  • An electrolytic solution for use in hemodialysis to replace electrolytes lost during the treatment. Infusate for use with the Allient System is composed of a solution of potable water and potassium, calcium, and magnesium acetate (as per the patient’s prescription).
• I.V.
  • Intravenous - within a vein
• Kidney failure
  • The loss of kidney function (See also ESRD)
• Kidneys
  • The two bean-shaped organs located on either side of the spine, just above the waist. In persons with normal kidney function, the kidneys filter waste from the blood, excrete urea, and maintain water and electrolyte balance. A dialyzer functions as an “artificial kidney” for persons undergoing hemodialysis.
• Kt/V
  • A measurement of how much urea is being removed from the blood during dialysis. The measurement takes into account the efficiency of the dialyzer, the treatment time, and the total amount of urea in the body.
• KUF
  • Ultrafiltration coefficient
• LED
  • Light emitting diode
• Luer lock
  • Standard connector designed for leak-tight connection of tubular components
• Lumen mode
  • The means by which the bloodstream is accessed for hemodialysis - can be by either single-needle or dual-needle mode (“single-lumen” or “dual-lumen”) (same as “access mode”)
• Magnesium
  • A mineral found in the soft tissue, muscles, and bones. In hemodialysis using the Allient System, magnesium is added to infusate solution (as per the patient’s prescription) to replace calcium removed from the dialysate solution by the sorbent cartridge.
• Membrane
  • A thin, soft sheet or layer of tissue that lines a cavity, covers an organ, or separates parts of the body. A membrane can act as a filter, allowing some particles to pass from one part of the body to another while keeping others in place. The artificial membrane in a dialyzer filters waste products from the blood.
• Microorganism
  • A life form too small to be seen by the naked eye
• Mode
  • On the Allient System, a group of task-specific user interface screens associated with specific system and user actions. See “Treatment Mode”
• Negative pressure
  • In hemodialyis, the difference in the pressure in the blood and dialysate sides of the dialyzer, which allows ultrafiltration to take place
• Nephrologist
  • A medical doctor who specializes in treating patients with kidney disease
• Occlude
  • In hemodialysis, to obstruct or block flow in a blood vessel, graft, or catheter
• Osmosis
  • The tendency of a fluid to pass through a semi permeable membrane into a solvent concentration that is higher than that of the fluid, thus equalizing the concentrations on either side of the membrane
• Parameters
  • A variable that, by itself, cannot be precisely determined. In hemodialysis using the Allient System, parameters for prescription entry include treatment duration, dialyzer model, UFR rate, heparin volume, etc.
• Pathogen
  • Any disease-producing agent, especially a virus or bacterium or other microorganism
• Patient care technician
  • See dialysis technician
• Peritonial dialysis
  • A form of dialysis in which the lining of the abdominal cavity is used as the dialyzing membrane
• Phosphorus
  • A nonmetallic element present in many foods. Excess phosphorus is normally removed by the kidneys. The sorbent cartridge used by the Allient System removes phosphorus.
• Pneumatic
  • Operated by air pressure
• Pneumatic override switch
  • A switch located on the rear of the Allient System that opens the machine clamps to release tubing and allow the operator to manually return blood
• Potable water
  • Water that meets United States Environmental Protection Agency requirements for potable tap water
• Potassium
  • An electrolyte necessary for optimal body function. Potassium is added to the infusate solution when using the Allient System to replace potassium removed by the sorbent cartridge.
• Pre Weight
  • The weight of the patient before hemodialysis. This weight is compared to the patient’s last postdialysis weight and to their goal weight to gauge the effectiveness of the hemodialysis treatment.
• Prime
  • In hemodialysis treatment using the Allient System, “prime” refers to filling and rinsing the blood and dialysate tubing with a solution of saline (blood tubing) and dialysate (dialysate tubing). Dialysate is pumped through the dialysate circuit (and sorbent cartridge) to remove air and any impurities in the water used to mix the dialysate and infusate solutions. Saline is pumped through the blood circuit to remove air. The system is primed after all disposables have been installed and prior to the patient being connected for treatment.
• Pulsar™ Blood Pump
  • A dual-chamber, pneumatically operated blood pump used by the Allient System. The Pulsar™ blood pump is a component of the Allient System’s blood tubing set and is used for a single treatment only.
• Qb
  • Blood flow rate
• Qd
  • Dialysate flow rate
• Recirculation mode
  • An option on the Allient System that allows the patient to be temporarily disconnected (up to 20 minutes) during hemodialysis. The Allient System continues to circulate blood and dialysate while in Recirculation mode.
• Reverse ultrafiltration
  • A condition where fluid from the dialysate side crosses the membrane into the extracorporeal circuit
• RF
  • Radio frequency
• Rinseback
  • The process of using saline to flush the patient’s blood back into the body at the end of the hemodialysis treatment
• Rx
  • Prescription
• Saline
  • A solution containing sodium and chloride. During hemodialysis treatment using the Allient System, saline can be transferred into the arterial blood tubing at any time. The patient also receives saline at the start of the hemodialysis treatment (saline remaining in the blood tubing from the priming process) and at the end of the treatment with blood rinseback.
• Semi permeable membrane
  • A material through which only certain particles may pass, and through which other particles cannot pass. The membrane separating the two-chambers of the dialyzer is semi permeable.
• Sensor
  • A mechanical device that receives and responds to a signal. The Allient System uses sensors to measure dialysate pressure, temperature, blood flow, ammonia, etc.
• Sepsis
  • The spread of an infection from its initial site to the bloodstream
• Shunt
  • A tube inserted into the body used for vascular access for dialysis. Also referred to as a “cannula”
• Single-needle mode
  • One of the two access modes for hemodialysis. In the single-needle mode, only one needle is used to draw blood from the patient and send the blood through the dialyzer and back to the patient.
• Sodium
  • One of the chemical salts in the human body - found and taken into the body most commonly as table salt. When excess amounts of sodium cannot be excreted from the body by the kidneys, edema and high blood pressure may result. A sodium level that is too low can cause low blood pressure.
• Sodium bicarbonate
  • A chemical salt that is mixed, as per the patient’s prescription, in potable water as a component of the dialysate solution when using the Allient System
• Sodium chloride
  • A chemical salt that is mixed, as per the patient’s prescription, in potable water as part of the dialysate solution when using the Allient System
• Sonalert
  • The audio alarm mechanism on the rear of the Allient System machine
• Sorbent cartridge
  • Single-use cartridges that use sorbent technology to regenerate dialysate - the sorbent cartridge removes toxins from the spent dialysate (dialysate that has passed through the dialyzer). The dialysate can thus be recirculated throughout each treatment. The type of sorbent cartridge used for each patient (SORB+™ or HISORB+™) is based on the patient’s prescription.
• Sorbent hemodialysis
  • Hemodialysis using sorbent cartridges to remove toxins from the dialysate and allow the dialysate to be recirculated throughout the treatment. Sorbent hemodialysis uses an infusate solution to replace electrolytes removed from the patient’s blood by the sorbent cartridge.
• Systolic
  • The top blood pressure number that measures the force of contraction of the heart muscle as blood is pumped out of the heart chambers
• Thrombus
  • A clot formed in a blood vessel
• TMP
  • Transmembrane pressure
• Touchscreen
  • A pressure-sensitive user-interface screen. The touchscreen on the Allient System controls the system software, allows the user to enter treatment parameters, and constantly displays information on treatment and machine status.
• Toxin
  • A poisonous substance produced by living cells that is capable of causing disease. In hemodialysis, refers to waste products that accumulate in blood. Toxins are normally removed by healthy kidneys. During hemodialysis, the dialyzer removes these waste products from blood.
• Treatment mode
  • On the Allient System, a group of task-specific user interface screens associated with specific system and user actions. There are five treatment modes on the Allient System: Rx Entry, Treatment Setup, In Treatment, Transport, and Post Treatment. Each mode corresponds to the tasks necessary for a successful hemodialysis treatment.
• Troubleshooting
  • Responding to a warning, alert, or alarm on the Allient System
• UF
  • Ultrafiltration
• UF goal
  • Determined by the patient’s prescription. This value is entered at treatment setup and determines the amount of excess fluid to be removed from the patient during hemodialysis.
• UFR
  • Ultrafiltration rate. This is a calculation performed automatically by the Allient System based on the patient’s pre weight and goal weight.
• Ultrafiltration
  • The process of removing excess fluids from the blood. Ultrafiltration takes place in the artificial kidney, or dialyzer, by the movement of the fluid and solutes across the semi permeable membrane.
• Ultrasonic
  • Relating to acoustic frequencies above the range heard by the human ear. On the Allient System, ultrasonic signals directed through tubing are used to detect any air in the tubing.
• Universal Precautions
  • An approach to infection control that presumes that all human blood and body fluids are infectious. This approach uses barriers such as gloves, masks, and eye protection to protect from contact with blood or body fluids.
• Urea
  • A waste product found in the blood caused by the normal breakdown of protein in the body. Urea is normally removed from the blood by the kidneys and then excreted in the urine. Hemodialysis is used to remove urea from the blood of patients with kidney failure.
• Uremia or uremic syndrome
  • Changes in the body caused by the buildup of waste products in the blood when the kidneys fail to function
• URR
  • Urea Reduction Ratio. A blood test that compares the amount of blood urea nitrogen (BUN) before and after dialysis to measure the effectiveness of the dialysis treatment.
• User interface screen
  • A touchscreen display on the Allient System that controls the system software, allows the user to enter treatment parameters, and constantly displays information on treatment and machine status
• Vascular access
  • The means by which the blood is transferred from the patient into the blood circuit of the hemodialysis machine. In hemodialysis, fistulas, grafts, catheters, and vascular accesses are used for access.
• Venous tubing
  • The portion of the blood tubing carrying the blood back to the patient after the blood has passed through the dialyzer (“blood out”)
• Vital signs
  • Blood pressure, temperature, pulse, and respiratory rate