dialysis product & interface

Kidney Dialysis MonitorResearch Report

Gina MetssaluPiret Uustal

Ruth-Helene MelioranskiMartin Pärn

Sven Sõrmus

supervised by:

Biomeditsiinitehnika instituut

spring 2014

in cooperation with:

Tehnomeedikum /Tallinna Tehnikaülikool

Introduction

The researchers' team of Technomedicum have worked out and patented a new optical method to monitor uremic toxins in the blood and through that raise the quality of the dialysis process.

The task for our semester project is to design

- the physical body for the new device (incl. the functions, case, semantics etc)

- the communication between dialysis device and users (patient, nurse, doctor).

Backround

Approximately 2.2 million end stage renal disease (ESRD) patients are treated worldwide, 1.5 of them are haemodialysis (HD) patients and the growth of new patients is approximately 7% a year (1). Without the treatment the patients would die rather quickly (after ca 3-4 days) due to complications caused by excessive body water and uremic toxins in the body. A large part of patients’ life quality decrease and HD expenditures are related to hospitalisations and interventions due to the side effects causing high morbidity and mortality (2). Therefore, to improve well-being of the patients and cost effectiveness, the society is interested that adequate renal replacement therapy with high quality and minimum complications is offered.

What is a dialysis?

· Dialysis is the artificial replacement for lost kidney function. · Eliminating waste (diffusion) and unwanted water (ultrafiltration) from the blood· Well functioning kidneys filter all the blood in your body with 30 min.· 2 leading causes of kidney disease are high blood pressure and diabetes.· It is possible to live with only one kidney.

The functions of the kidney

Excretory functions- remove waste products- remove excess fluid- regulate acid-base balance- regulate electrolyte levels Secretory functions

- regulate blood pressure (renin)- regulate red blood cell production (EPO)- regulate calcium uptake (active vitamin D)

Treatment Modalities

Hemodialysis

In hemodialysis, your blood flows through a machine that has a filter which cleans the blood. This machine is called a dialyzer or artificial kidney. Hemodialysis is usually done three times a week, several hours each session. It can be done at a dialysis center or at home. To get your blood into the dialyzer, two needles are inserted into your vein during each dialysis treatment.- hemofiltration- hemodiafiltration

http://clinicindelhi.com/hemodialysis/

Treatment Modalities

Peritoneal dialysis

How does peritoneal dialysis work?

A soft tube, called a catheter, is placed in your belly. This is done by minor surgery. This catheter makes it possible for you to easily connect to a special tubing which allows two to three quarts of a cleansing fluid to flow into your belly. The cleansing fluid is called dialysate. It takes about 10 minutes for the dialysate to fill a belly. When the filling is done, the catheter is capped so that it doesn't leak. The lining of a belly (called the peritoneal membrane) acts as a natural filter. It lets the wastes and extra fluid in blood pass through it into the cleansing fluid. At the same time, the lining of a belly holds back the important things a body needs, like red blood cells and nutrients. To do its job, the dialysate must stay in a belly for two hours or more, depending on body size and how much waste has to be removed. This time is called dwell time. After dwell time, cleansing fluid must be drained from body into an empty bag. In-and-out process must be repeated a number of times during the day, using fresh dialysate. PD can be done at home, at work, or while traveling.

Two options:

- Continuous cycling peritoneal dialysis or automated dialysis (CCPD)With CCPD, a machine called a cycler does the exchanges automatically while you sleep. You may also need to do one exchange during the day if your kidney function decreases further.- Continuous ambulatory peritoneal dialysis (CAPD) With CAPD, you do the exchanges yourself three to four times a day.

http://sainternshipufs.blogspot.com/2012/06/4-5-june-2012-universitas-hospital.html

Treatment modalities

Kidney transplant

A kidney transplant is an operation that places a healthy kidney in your body. The transplanted kidney takes over the work of the two kidneys that failed, so you no longer need dialysis.

If you have a transplant, you must take drugs for the rest of your life, to keep your body from rejecting the new kidney.

Transplanted kidney usually works well 8-10 years, after that it needs to be replaced.

Currently (2014) 99 000 people are in a waiting list of kidney donor in USA. Fewer than 17 000 receive one each year.Every day 14 people die waiting for a new kidney.

Alternatives

UCSF researchers today unveiled a prototype model of the first implantable artificial kidney, in a development that one day could eliminate the need for dialysis.

3D printed Kidney - by Surgeon Anthony Atala. An early-stage experiment that could someday solve the organ-donor problem: a 3D printer that uses living cells to output a transplantable kidney

Revital Cohen - Dialysis Sheep (2008)http://designculturelab.org/2011/08/06/dialysis-sheep-sacrificial-lambs-black-sheep-and-speculative-designs-publics/

http://blog.sculpteo.com/2011/08/10/3d-printing-for-regenerative-medicine/

http://www.ucsf.edu/news/2010/09/4450/ucsf-unveils-model-implantable-artificial-kidney-replace-dialysis

http://www.medindia.net/healthnews/kidney-transplantation-news.asp

Research Methodology

GIGAmapping

Online research

On-site observation at the hospital

Interview with a patient and patient journey

Mapping out different aspects of dialysis and the problems related to it. Analysing their interconnections. Finding new connections between the parts of the process. (addendum A)

To map out the nature and need of dialysis, to learn the dialysis process in detail and to identify the problems that dialysis patients are experiencing.

To understand the interaction between the patient and the hemodialysis machine. To monitor the workload of nurses.To monitor the activities of the patients during the dialysis process.

To recieve a feedback from the patient about the dialysis process.To map the level of his understanding of the process and the need for it. To understand patient’s daily schedule due to dialysis and his attitude towards it.

The poll

To get statistics. To map the level of patients understanding of the process. To measure the scope of the problem. To find out patients needs and expectations.

Overview of the research

Reality in hemodialysis

· 2,2 million ESRD patients worldwide (about 1,5 million HD patients)· 7 % annual growth rate· time consuming: 4-5 hrs, 3-4 times/week· Life expectancy if a person starts dialyse in the age over 75 years: 25 % - 1 year 60 % - 5 years· Life expectancy if a person starts dialyse in twenties: 20 or in some cases even 30 years· complex medical and dietary regimen· expensive- ca 50 billion USD annually· complications

Patient needs a dialysis process 3-4 times in a week and it takes 3-5 hours.

Blood urea concentration over a time of period(several dilaysis)

Mon WedWed FriFri

Bloo

d ur

ea c

once

ntra

tion

mm

ol/l

5

10

15

20

25

-20

30

0


http://www2.nephrocare.com/global/en/products/5008.html

On-site observation at the hospital

- Majority of the patients are under the care of nurse* safer environment* fear of doing hemodialysis at home

- Younger and more fit patients interact with new machine themselves.

- During the dialysis the nurses are required to fill out patient records manually

- Newer hemodialysis machines have patient-friendly screens and operating principles and can be operated by the patients themselves.

Newest machines at the hospitals now. Patient friendlier. Self service.

Current machines at the hospotal.No patient-machine interaction takes place.

Older machines. Currently stocked aways and used only if really needed.

Addendum A

KIDNEY DIALYSISSTAKEHOLDERS

COMPETOTORS SELLING DIALYSIS

MACHINES

FAMILY EMPLOYER

SUPPLIERSHOSPITAL SYSTEM

PATIENT

Patient

SCHOOL WORK

QUALITY OF LIFEFEELINGS

VACATION

YOUNG WORKING PEOPLE

BABY CHILD TEENAGER STUDENT PARENT ELDERLY

2 leading causes of kidney desease are high blood pressure and diabetes.

It is possible to live with only one kidney.

Kidneys filter all the blood in your body with 30 min.

WHAT IS A DIALYSIS?Dialysis is the artificial replacement for lost kidney function. It is an artificial process of eliminating waste (diffusion) and unwanted water (ultrafiltration) from the blood. Kidneys do this naturally. If a kidney is failed or damaged and cannot carry out the function properly - a person may need dialysis.

fearuncertaintylack of motivationhelplessnessroutineno freedom being a burdenuselessnessno financesuncertain of futuredepressingwaitingallonewhat’s the pointtime lostwant to enjoy the last years of your life

HEMODIALYSIS AT THE HOSPITAL

3-4 x week 3-5 hours

stuck to the machinewasted timepainfulvein infection

For patients with other health problems and for elderly people

Hospital

MON TUE WED TH FRI SAT SUN MON

under medical careless infection“social club”get out of housemeet other people

HEMODIALYSIS AT HOME

PERITONEAL DIALYSIS

4 times in a day30 min

For patients with no other health problems

no needlesno painsuitable for kidsflexible scheduleless dietary restrictionsdoable at nighteasy to travel

risk of infection

3 x week3-4 hours

5-7 x week2 hours

6 x week6-8 hours

Every other night6-8 hours

8 % of all dialysises (in USA)

Due to longer/more frequent dialysis: feel betterless/no nausealess/no “washed out” feelingless/no headacheless/no crampingfexible schedulemore toxins removed

risk of infectionneed long trainingneed “care partner” (family member)need to hire a “care partner”

Home

IDEAPOTENTIALgrowing number of patients - 6 % in a yearcurrently on dialysis - 3 million people currently on hemodialysis - 1.3 million peoplew

Instant data of Dialysis qualitySAVE TIMESAVE MONEYshorter tiem of dialysisnew use of old machines (eg. in poor countries)

See the futureBe like others

Feel usefulFinancial independenceDo what you love

FreedomMotivationEnjoy the life

patient diaryeasy data handlingdata sharing Doctor-Nurse-Patient-Family member

Business - new device



Revital Cohen - Dialysis Sheep (2008)



http://designculturelab.org/2011/08/06/dialysis-sheep-sacrificial-lambs-black-sheep-and-speculative-designs-publics/

Alternatives

HEMODIALYSIS MACHINE

ADDED SCREEN

ADDED SENSOR

HOSPITAL

FAMILY

patient diaryat home

..............................

..................

Doctor Nurse

Data of dialys

is effecti

veness

in 2 days

Preparin

g the m

achine

Sterily

zing fl

ites

Start

pump and timer

Measure

blood press

ure in

every

30 minutes

Removing t

he tubes f

rom th

e patient in

3-5 hours

Patient r

ecove

ry 10-15 m

inutes

Possible afte

reffects

PROCESS

Measure

:kg

temperatu

re

blood press

ure w

hen standing a

nd sitti

ngMeasure

:kg

temperatu

re

blood press

ure w

hen standing a

nd sitti

ng


FACTSbased on data of USA

1 out of 10 people (over 18 years old) have reduced kidney function

Currently (2014) 99 000 people are in a waiting list of kidney donor. Fiewer than 17 000 receive one each year.Every day 14 people die waiting for a new kidney.

Today’s dialysis machines are far from perfect. Their efficiency is only around 10% of that of a functioning kidney, and when used three times per week, they are incapable of controlling unhealthy fluctuations in the concentrations of metabolites such as urea in the blood.

90 000 people die of kidney desease (more than Breast and Prostate cancer combined)

Life expectancy if a person starts dialyse in the age over 75 years:25 % - 1 year60 % - 5 years

Life expectancy if a person starts dialyse in twenties: 20 or in some cases even 30 years.

SCHEDUAL

by Piret Uustal I Gina Metssalu I 2014supervised by Birger Sevaldson

HEMODIALYSIS


KIDNEY DIALYSISSTAKEHOLDERS

COMPETOTORS SELLING DIALYSIS

MACHINES

FAMILY EMPLOYER

SUPPLIERSHOSPITAL SYSTEM

PATIENT

Patient

SCHOOL WORK

QUALITY OF LIFEFEELINGS

VACATION

YOUNG WORKING PEOPLE

BABY CHILD TEENAGER STUDENT PARENT ELDERLY

2 leading causes of kidney desease are high blood pressure and diabetes.

It is possible to live with only one kidney.

Kidneys filter all the blood in your body with 30 min.

WHAT IS A DIALYSIS?Dialysis is the artificial replacement for lost kidney function. It is an artificial process of eliminating waste (diffusion) and unwanted water (ultrafiltration) from the blood. Kidneys do this naturally. If a kidney is failed or damaged and cannot carry out the function properly - a person may need dialysis.

fearuncertaintylack of motivationhelplessnessroutineno freedom being a burdenuselessnessno financesuncertain of futuredepressingwaitingallonewhat’s the pointtime lostwant to enjoy the last years of your life

HEMODIALYSIS AT THE HOSPITAL

3-4 x week 3-5 hours

stuck to the machinewasted timepainfulvein infection

For patients with other health problems and for elderly people

Hospital

MON TUE WED TH FRI SAT SUN MON

under medical careless infection“social club”get out of housemeet other people

HEMODIALYSIS AT HOME

PERITONEAL DIALYSIS

4 times in a day30 min

For patients with no other health problems

no needlesno painsuitable for kidsflexible scheduleless dietary restrictionsdoable at nighteasy to travel

risk of infection

3 x week3-4 hours

5-7 x week2 hours

6 x week6-8 hours

Every other night6-8 hours

8 % of all dialysises (in USA)

Due to longer/more frequent dialysis: feel betterless/no nausealess/no “washed out” feelingless/no headacheless/no crampingfexible schedulemore toxins removed

risk of infectionneed long trainingneed “care partner” (family member)need to hire a “care partner”

Home

IDEAPOTENTIALgrowing number of patients - 6 % in a yearcurrently on dialysis - 3 million people currently on hemodialysis - 1.3 million peoplew

Instant data of Dialysis qualitySAVE TIMESAVE MONEYshorter tiem of dialysisnew use of old machines (eg. in poor countries)

See the futureBe like others

Feel usefulFinancial independenceDo what you love

FreedomMotivationEnjoy the life

patient diaryeasy data handlingdata sharing Doctor-Nurse-Patient-Family member

Business - new device



Revital Cohen - Dialysis Sheep (2008)



http://designculturelab.org/2011/08/06/dialysis-sheep-sacrificial-lambs-black-sheep-and-speculative-designs-publics/

Alternatives

HEMODIALYSIS MACHINE

ADDED SCREEN

ADDED SENSOR

HOSPITAL

FAMILY

patient diaryat home

..............................

..................

Doctor Nurse

Data of dialys

is effecti

veness

in 2 days

Preparin

g the m

achine

Sterily

zing fl

ites

Start

pump and timer

Measure

blood press

ure in

every

30 minutes

Removing t

he tubes f

rom th

e patient in

3-5 hours

Patient r

ecove

ry 10-15 m

inutes

Possible afte

reffects

PROCESS

Measure

:kg

temperatu

re

blood press

ure w

hen standing a

nd sitti

ngMeasure

:kg

temperatu

re

blood press

ure w

hen standing a

nd sitti

ng


FACTSbased on data of USA

1 out of 10 people (over 18 years old) have reduced kidney function

Currently (2014) 99 000 people are in a waiting list of kidney donor. Fiewer than 17 000 receive one each year.Every day 14 people die waiting for a new kidney.

Today’s dialysis machines are far from perfect. Their efficiency is only around 10% of that of a functioning kidney, and when used three times per week, they are incapable of controlling unhealthy fluctuations in the concentrations of metabolites such as urea in the blood.

90 000 people die of kidney desease (more than Breast and Prostate cancer combined)

Life expectancy if a person starts dialyse in the age over 75 years:25 % - 1 year60 % - 5 years

Life expectancy if a person starts dialyse in twenties: 20 or in some cases even 30 years.

SCHEDUAL


HEMODIALYSIS


Interview with a patient / patient journeyMale I 81 years old I dialysis patient over 2 years

- had kidney failure after heart surgery when he was given wrong medicine (overdose of Potassium) which injured his kidney functions.

-kidney dialysis every Mon, Wed, Friday, from 8-12

- patient himself is responsible monitoring his heart rate during the dialysis. If its too low or high the patient moves the position of the bed to raise his legs.

- the patient is not aware of the effectiveness of the dialysis in the end of the process. He is not monitoring the display of the machine (even if there is screen it is not visible nor understandable for the patinet).

- if the display would be visible and understandable to the patient he would be interested and positively influenced to see the effectiveness of the dialysis process.

- the patient follows the remaining time of the dialysis process from the sepparate wall clock. He does not see the timer from the machine.

- he feels fairly good after the dialysis. He walkes home 15-20 minutes and needs to sleep 2 hours to feel completely well.

- the patient claimed that when he was sometimes placed under an older model of hemodialysis machine he did not feel comfortable and did not trust the effect of the dialysis as much

- the inability to use restroom during the dialysis process is sometimes a problem

Older hemodialysis machine


Patients

Age

Working?

In order to get overview of patients habits and their awareness of hemodialyses process we conducted a research among the hemodialyses patients in estonia. There is about 200 regular HD patients and we got answers from 32. It makes ab 16 percent of all patients in Estonia.


Patient awareness of the dialyses process

44 % of the patients are not aware what is happening with their blood during the dialyses process

64 % NOT aware what does the data displayed on the machine (such as Kt/v) means.

79% NOT aware how clean is their blood after the dialysis.

48% believe that knowing the results of the dialysis process effectiveness would influence them positively.

80% following their blood pressure during the process.


Dialyses at home?

80% NOT willing to do dialysis at home

43% believes dialysis at home would affect their daily routine

Main reasons:

- no conditions- don’t dare- not sterile enough - live alone- fear of blood, needles and whole process

25% would be more encouraged to have dialysis at home if the doctor has overview of the process in real time.

Findings

Increase blood flow

Improvement in clearance

Positive effect on Kt/V

- The benefits of real-time measurement are obvious: if Kt/ V is only checked monthly or quarterly, it may be months before suboptimal dosing is discovered. By measuring online during every therapy, the new sensor is able to identify suboptimal dosing immediately, support timely adjustments in treatment parameters and also eliminate common process- related factors influencing the previous reference method (taking of blood samples).

In medicine, Kt/V is a number used to quantify hemodialysis and peritoneal dialysis treatment adequacy.

K - dialyzer clearance of urea t - dialysis time V - volume of distribution of urea, approximately equal to patient’s total body water

There are 4 ways of how the doctor, nurse or patient can influence the Kt/V during dialysis process thanks to the costant information of dialysis quality given by new sensor:

Hemodialysis machine and sensor

High concentartion of substances

Reduce blood flow Increase dialysate flow Longer dialysis time







Findings

- The patient is interested in knowing and following the effectiveness of dialysis during the process.

- The patient would be positively motivated if he was able to monitor the effect of the process.

- Newer dialysis machine and a machine that is understandable to the patient raises trust towards the process and makes the patiet interact with the machine (more independence to the patient, less work to the hospital stuff)

Patient

-The ability to receive constant feedback of the patients dialysis quality eliminates the “guess work” of the nurses and doctors in setting the machine parameters before an during the dialysis process. The optimal dialysis process for each patient can be figured out faster and is based on reliable data.

- The machine could ease the workload of nurses by automatically saving the information of the dialysis process (work that is now done manually).

- In case the patient recives dialysis in a different clininc (e.g. while traveling) the data of the patients dialysis parameters will be available to the nurses and doctors in a new clinic as well.

Doctors / Nurses

Findings

Nursing file what now is filled by hand for each patient

Findings

Market

- Older models of hemodialysis machines that have new sensor can be used in a more effective way.

- Hemodialysis machines can be made avaialable to more patients. Older machines that would be otherwsie disregarded can be taken more clinics and to rural areas so the patient would not have to travel long distances to receive dialysis.

- Less developed countries with older dialysis machines can offer better dialysis quality to their patients and make it avaialble to more people.

- Lower costs than purchasing brand-new hemodialysis machines.

Regulations

- There are several laws and regulations in Estonia for producing, maintaining and handling medical devices (3), but as far as we talking about adding the new sensor only as a affix to outlet hose, then we are not influenced by them directly.

Existing solutions

The first integrated dialysis dose monitor in the world, utilising the UV-technology, is the Adimea system (Option Adimea, BBraun Avitum AG) (B. Braun Avitum AG 2010). The heart of the Adimea system is the optical sensor DiaSens, integrated into the HD machine, delivering values of real-time Kt/V or URR for the dialysis team during a treatment

Findings

Goal

Increase patient motivation to take better care of their

health through raising awareness of the dialysis

process.

Focus

The existing analysers are built in the whole kidney dialysis apparatus. The aim is to develop a standalone analyser which suits with dialysers produced by different companies. Today the procedure takes place in the hospital under the control of the medical personnel. The new system is connected with internet and should be able to work also in the other environments out of hospital and patient should be able to manage with it alone. The disadvantages of the existing methods for uremic toxins determination are utilization of disposables or chemicals, rather complicated and expensive measurement procedure. To overcome those difficulties, a monitoring system would be preferable. Recently a good correlation between ultraviolet (UV)-absorbance and several small removed waste solutes (urea, Cr, UA) has been found, indicating that UV-absorbance may enable monitoring of several uremic toxins linked to the malnutrition–inflammation complex syndrome and the risk factors of CVD. The obtained results demonstrate the possibility to follow a single hemodialysis session continuously and to monitor deviations in the dialysator performance by using UV-absorbance. The UV-method does not need blood samples, any disposables or chemicals, is fast, and allows continuous measurements of the standard dialysis adequacy parameters (e.g. Kt/V, URR).

http://www.bbraun-avitum.ro/cps/rde/xchg/av-avitum-ro-ro/hs.xsl/7370.html

http://www.cb.ttu.ee/ee/edu/DBB0070/Biooptics_HD_public.pdf

Focus

External sensor

· Real- time measurement system· Photometric sensor that continuously measures light absorption in spent dialysate· Estimating the reduction of substances concentration, which is linearly related to their concentration in blood· Capable of delivering Kt/V in most treatment models, including HDF, HD and single needle treatment

Advantages

· continous, on-line monitoring. Other methods- once in every 25 min. New sensor every 6 sec ( Kt/V)· no blood sampling· without any disposables or chemicals· evaluates delivery of prescribed treatment dose (Kt/V)· can estimate TRU, PCR, URR· possibility to measure other solutes besides urea· estimation until the target is achieved· no interference with dialysis machine’s operation

Values for patient

- simple, understandable,always visible screen

- blood result instantly shows if patient has been taking care of his health (eg. correct diet)

- practice in the hospital, simplicity of the process and awareness encourages to do dialysis at home

- aware what is happening

- cares more of his/her health

- independence

Values How?

Values

Values for nurse

- patient data stored in the device and easily accessible when needed

- most data saved automaticaly to the new screen during the process

-machine setup based on exact blood data. Alarm if goal not achived.

- easy data handling and storing

- save time

- easier setup of dialysis machine

Values How?

Values

Market

Values

Currently, there is about 600 000 old hemodialysis machines in the world. Many of these machines are in good condition, but miss certain functions limiting the treatment modalities a clinic can perform.Those functionality could be raised significally by adding them percise sensor and extra screen.

CHOOSE MACHINE

OLD MACHINE MANUAL PROCESS

MACHINE TESTING AND SETUPca 15 min

INSTALL FILTER, TUBES,

DIALYSATES

CONNECT PATEINET TO

MEASURE BLOOD PRESSURE

(connect with machine)

CONNECT PATIENT WITH

MACHINE

CHOOSE PROGRAM-Hemodialysis

-Hemodiafiltration (HDF)- Ultrafiltration

MACHINE ADJUSTS AUTOMATICALLY ACCORDING TO

PATIENT

ALL SETUP MADE INSTANTLY

CHANGES CAN BE MADE

SENSOR ALARM-change something

HOW DOES PATIENT

FEEL

START(MACHINE)

FOOD DIARY SYNC

NURSE CHANGES PARAMETERS ON

MACHINE:

- BLOOD FLOW

-DIALYSATE FLOW

- UF PROFILE +/-

NURSE ENTERS CHANGES TO THE

SCREEN:

- BLOOD FLOW

-DIALYSATE FLOW

- UF PROFILE +/-

DIALYSIS TIME ADJUSTS ON THE SCREEN GRAPH

SAvEPROCESS

PRINTDATA

WHICH DATA NEEDS

PRINTING?

In the case of independent patient - who fills out the paper sheet for nurses

now? Is patient able to do this?Is all that data always needed?

Can blood pressure be measured at the

same time in 2 places (in dialysis machine

and on NEW SCREEN)2 connections.

So blood pressure could be followed from the screen.

what happens if blood pressure will be shown only on

NEW SCREEN. What changes in Dialysis machine? Does it affect anything?Is bloodpressure

data usually saved to magnetic card also? Is

it needed for that?

FEEL + UNFASTEN THE

PATIENT

FEEL -

low blood pressureT

clogged fistula(MACHINE)

arter/vein pressure

blood sugar(MACHINE)

cramps(MACHINE)

headache(MACHINE)

DISPLAYED :-previous dialysis data

-usual setup parameters (kg, dialysis time)

-medicaments-previous blood test results from lab

- patient food DIARY



MAGNETIC CARD

NEW MACHINE

WEIGH THE PATIENT

CAN CHANGE SETUP PARAMETERS

-kg-dialysis time

.

.

.

1

2 3

4 5 6

7 8

9 10

11 12

13 14 15

Weights herself and remembers it

Prebooks always new machine

Sets up the machine parameters- with

magnetic card

Nurse preparesmachine

Connects herself- needles, sensors etc

Patient chooses pro-gram

Starts machine

Takes the new Screen

Start of new screen- automatically, after fluid starts flowing- TIME AND BLOOD

PRESSURE as a screen saver

Inserts parameters to the New Screen

BLOOD PRESSURE as a screensaver

Home menu-PATIENT SELECTION

PATIENT PARAMETERS

PRECISE GRAPH

SCREEN

progress is going on as predicted

Usual time is up, but screen shows onlly

75% of result

75% of GOAL

Becouse of upcom-ing meeting chooses

to finish anyway

Suggestions to the next time

Prebooks for the next time longer session Disconnects herself

Just comes every mondey, wendsday

and friday at 8 oclock

Waches his blood pressure

Nurse waches and marks down the

weight


Nurse connects with machine

Nurse sets up the machine

Nurse choses program

NurseSTARTs

Machine

Calls nurse when not feeling good

Weights herself

Security code necessary?

Nurse gets info about PREvIOUS

SESSION PARAMETERS


PRESSUREin a patient page view

PRECISE GRAPH

SCREEN

lack of GOAL

Nursechanges parameters

AUTOMATICALLY SAvES ALL

WIRELESS CONNECTION?CAN IT START

AUTOMATICALLY AFTER FLUID

STARTS RUNNING?

GOALgets better

GOALis achieved

Nursedisconnects

nurse inserts weight

SAvEPROCESS

PRINTDATA

Nursetakes blood sample

nurse inserts BLOOD TEST RESULTS

PORTABLE SCREEN for INSERTING WEIGHT

INSTANTLY already in “weighting Cabinet”

JAAK, 62Pensioner. Doesn’t work, lives alone

in Mustamäe.

PIIA, 32Works as a project manager, studies

administrative management in TTU-s master program. Mother of two chil-

dren. Travels a lot

HOME MENU- PATIENT SELECTION-INSERTING WEIGHT

MACHINE NEEDS TO BE SET UP

BLOOD PRESSURE starts screening in a

patient page view


weight

inserts weight

Piias actings Jaaks actings Nurses actings NEW SCREEN Ns- Piias acting Ns- nurse acting Ns- Jaak acting

Concept in usePatient journey

CHOOSE MACHINE

OLD MACHINE MANUAL PROCESS

MACHINE TESTING AND SETUPca 15 min

INSTALL FILTER, TUBES,

DIALYSATES

CONNECT PATEINET TO

MEASURE BLOOD PRESSURE

(connect with machine)

CONNECT PATIENT WITH

MACHINE



MACHINE ADJUSTS AUTOMATICALLY ACCORDING TO

PATIENT

ALL SETUP MADE INSTANTLY

CHANGES CAN BE MADE

SENSOR ALARM-change something

HOW DOES PATIENT

FEEL

START(MACHINE)

FOOD DIARY SYNC

NURSE CHANGES PARAMETERS ON

MACHINE:

- BLOOD FLOW

-DIALYSATE FLOW

- UF PROFILE +/-

NURSE ENTERS CHANGES TO THE

SCREEN:

- BLOOD FLOW

-DIALYSATE FLOW

- UF PROFILE +/-

DIALYSIS TIME ADJUSTS ON THE SCREEN GRAPH

SAvEPROCESS

PRINTDATA

WHICH DATA NEEDS

PRINTING?

In the case of independent patient - who fills out the paper sheet for nurses

now? Is patient able to do this?Is all that data always needed?

Can blood pressure be measured at the

same time in 2 places (in dialysis machine

and on NEW SCREEN)2 connections.

So blood pressure could be followed from the screen.

what happens if blood pressure will be shown only on

NEW SCREEN. What changes in Dialysis machine? Does it affect anything?Is bloodpressure

data usually saved to magnetic card also? Is

it needed for that?

FEEL + UNFASTEN THE

PATIENT

FEEL -

low blood pressureT

clogged fistula(MACHINE)

arter/vein pressure

blood sugar(MACHINE)

cramps(MACHINE)

headache(MACHINE)

DISPLAYED :-previous dialysis data

-usual setup parameters (kg, dialysis time)

-medicaments-previous blood test results from lab

- patient food DIARY



MAGNETIC CARD

NEW MACHINE

WEIGH THE PATIENT

CAN CHANGE SETUP PARAMETERS

-kg-dialysis time

.

.

.

1

2 3

4 5 6

7 8

9 10

11 12

13 14 15

Weights herself and remembers it

Prebooks always new machine

Sets up the machine parameters- with

magnetic card


Connects herself- needles, sensors etc

Patient chooses pro-gram

Starts machine

Takes the new Screen


PRESSURE as a screen saver

Inserts parameters to the New Screen

BLOOD PRESSURE as a screensaver

Home menu-PATIENT SELECTION

PATIENT PARAMETERS

PRECISE GRAPH

SCREEN

progress is going on as predicted

Usual time is up, but screen shows onlly

75% of result

75% of GOAL

Becouse of upcom-ing meeting chooses

to finish anyway

Suggestions to the next time

Prebooks for the next time longer session Disconnects herself

Just comes every mondey, wendsday

and friday at 8 oclock

Waches his blood pressure


weight


Nurse connects with machine

Nurse sets up the machine

Nurse choses program

NurseSTARTs

Machine

Calls nurse when not feeling good

Weights herself

Security code necessary?

Nurse gets info about PREvIOUS

SESSION PARAMETERS


PRESSUREin a patient page view

PRECISE GRAPH

SCREEN

lack of GOAL

Nursechanges parameters

AUTOMATICALLY SAvES ALL

WIRELESS CONNECTION?CAN IT START

AUTOMATICALLY AFTER FLUID

STARTS RUNNING?

GOALgets better

GOALis achieved

Nursedisconnects

nurse inserts weight

SAvEPROCESS

PRINTDATA

Nursetakes blood sample

nurse inserts BLOOD TEST RESULTS

PORTABLE SCREEN for INSERTING WEIGHT

INSTANTLY already in “weighting Cabinet”

JAAK, 62Pensioner. Doesn’t work, lives alone

in Mustamäe.

PIIA, 32Works as a project manager, studies

administrative management in TTU-s master program. Mother of two chil-

dren. Travels a lot

HOME MENU- PATIENT SELECTION-INSERTING WEIGHT

MACHINE NEEDS TO BE SET UP

BLOOD PRESSURE starts screening in a

patient page view


weight

inserts weight

Piias actings Jaaks actings Nurses actings NEW SCREEN Ns- Piias acting Ns- nurse acting Ns- Jaak acting

Interface structure

Home menu

�Patient selection ô

orders to stock?

suggested parameters

patient 1

Blood pressure (+ time)

as a screensaver

suggested parameters

WeigHt

History

treatment plan

Blood tests Food diary

edit

patient info

program

-Hemodialysis-Hemodiafiltration ô- Ultrafiltration

time

4:00 ô

uF goal

History- date-trend graphs

patient inFo

- name-barcode-doctors name-height-age-...

start

treatment plan

-medicaments-....

Food diary

Blood tests

-predictable graph-goal %-time %-blood pressure-uf rate-art press-ven press-...

WeigHtbeforeôafter ô

Back

alarm

- Blood FloW ô-dial. FloW ô- uF proFile ô

FinisH

suggestionsWeigHtprint

The information measured by the sensor is instantly displayed on the screen. To map out the user interface and keeping in mind the goal for values we went through patients journeys and built the structure for user interface.

Display

Display

Information displayed on the screen is translated into graphics so everyone, even elderly patient can grasp visually what is happening with their blood at this very moment.The most vital information for the patient ( blood pressure, % of the process effectiveness and time remained) is displayed as a screen saver.

If it now, for example, happens that the patient has been eating nonproper food on a previous day, the result instantly shows on the screen. This will help him to understand and assess how his lifestile and diet can influence his health. And that, in turn, motivates him to take control over his health...and not leaving it to the doctors only.

Display

Also the nurses will benefit of the new solution. It will make easierfor them to set up the dialysis machine according to each patientsneeds. The setup data of the most effective process for this patient is already automatcally displayed and the nurse doesnt have to guess which process gives the most positive result to the patient.

Nurses time is saved by not having to fill out papers by hand for each patient. All the data about the process wat now is edited by hand could be saved automaticallyby the screen and if paper version is still needed, it can be simply printed out.

Sensor case

Process of ideas for sensor case

dialysis product & interface

Design