Prescription staged · review · confirm
PBP and patient fluid removal are separate numbers in separate places. A known entry hazard is swapping them, so every change goes through a review step.
Fluid programming intake · requested net · pending · delivered
Staging only fills in the patient fluid removal field. Nothing changes until you Review and Confirm it above. PBP is a different number in a different place and is not part of this sum.
Access line workflow alert · finding · correction · restart · reassess
These buttons run the same actions as the Circuit and Bedside check panels. A step is marked done only when the machine records it: opening this drawer, reading the alarm or answering a question does not complete anything. Reversing the lumens is never the fix.
Terms in plain words optional · this lab's own wording
- Blood flow (Qb)
- How fast the blood pump draws blood from the patient through the access line, in mL/min.
- PFR · patient fluid removal
- The net water the machine takes off the patient, in mL/h. It is not the same as the effluent rate.
- PBP
- Fluid given before the blood pump, so it dilutes the blood before the filter. It does not remove anything from the patient.
- Effluent
- Everything that leaves the filter: dialysate, replacement, PBP and the patient's net removal added together.
- Dialysate · replacement
- Dialysate runs past the filter fibres and works by diffusion. Replacement is infused into the blood (before or after the filter) and works by convection.
- SCUF · CVVH · CVVHD · CVVHDF
- SCUF removes water only. CVVH uses replacement fluid. CVVHD uses dialysate. CVVHDF uses both.
- FF · filtration fraction
- Water pulled across the membrane divided by the plasma flowing in, counting any fluid added before the filter. The dose panel shows the model's value.
- TMP · transmembrane pressure
- The pressure pushing water across the membrane. Compare it with the filter pressure drop and effluent pressure to tell clotting from clogging.
- Access · return pressure
- Access is the pull on the catheter (very negative means the pump cannot draw blood). Return is the push back into the patient.
- Prescribed and delivered dose
- Prescribed is what was ordered, in mL/kg/h. Delivered is what the machine actually achieved once stops and holds are counted.
- Requested, delivered, estimated
- A setting is what you asked for. A delivered value is what is flowing now. An estimate (marked ~) is a value worked out at the set blood flow while the pump is stopped.
Plain definitions for teaching in this simulation. They are not a protocol or an order set, and the numbers in the panels are teaching values, not clinical thresholds.
Circuit
Bedside check what the screen can't show
Hourly intake everything counts
Sets the pending patient fluid removal (then review and confirm): 0 → even (removal = intake) → net negative (intake + ordered loss).
Circuit and patient flow path, access → return · 2.5D
Try it: how the settings link teaching model · changes nothing in the patient
Move a slider (or use the arrow keys, Home and End) and watch the results beside it respond. The sliders start at the prescription that is running. Nothing here changes the patient, the clock or your score.
Run this prescription forward teaching model · changes nothing in the patient
Use the sliders above as a trial prescription, choose how many model hours, and press Run. The lab runs its own simulation on a copy of the patient and draws potassium, phosphate, BUN, bicarbonate, blood volume, MAP, filter clot and delivered dose against the prescription that is running now (dashed). Back clears it.
Numbers by model hour
Model-based teaching projection, not an expected patient response. The run starts from the patient as they are now and switches off this case's scripted events, planned stops and the drifting filter clogging in the copy; "Circuit stopped, minutes in each hour" is not part of this run. The curves carry no axis marks, zones or bands: each is scaled to its own range.
TEACHING MODEL · simulation, not patient-specific, not for care. Uses this lab's own formulas (every coefficient IMPLEMENTATION_HEURISTIC) for a fresh filter and a healthy line, with this patient's haematocrit. The bars show size only and mark no zone. Filter life is in model hours, to compare settings with each other, not to predict a real filter.
Try it: clot or clog? teaching model · changes nothing in the patient
Set how clotted and how clogged the filter is, and read the pressures it would show at the running prescription. The two failures leave different fingerprints.
TEACHING MODEL · simulation, not patient-specific, not for care. The model's own pressure formulas at the running prescription (every coefficient IMPLEMENTATION_HEURISTIC; limits illustrative and device-dependent). Clot and clog run up to the level at which the model stops the set. Reading pressures to tell clot from clog follows the owner's teaching already cited in the Why panel.
Try it: where does the fluid go? teaching model · changes nothing in the patient
Change the patient fluid removal or the intake and watch the blood volume and the tissue fluid over the next model hours. The curves come from the lab's own simulation run on a copy of the patient; the dashed line is the prescription that is running now.
TEACHING MODEL · simulation, not patient-specific, not for care. Uses this lab's own refill law and insensible loss (IMPLEMENTATION_HEURISTIC). The intake slider starts at the hourly intake ledger; its range is borrowed from the removal slider. No zones or bands are drawn; each curve is scaled to its own range. The run starts from the patient as they are now and switches off this case's scripted events and planned stops in the copy.
Try it: bath and dose against potassium and phosphate teaching model · changes nothing in the patient
Pick one of the lab's three fluids and move the dose, then watch potassium and phosphate on a copy of the patient. The dashed line is the prescription that is running now.
TEACHING MODEL · simulation, not patient-specific, not for care. Fixed-pool teaching heuristic, CLIN-04 pending: one distribution volume per solute and no solute-mass ledger; an unused bath cannot change the patient. Only the lab's three fluids are offered. The dose is met with this modality's own dialysate or replacement within their slider limits. No zones or bands are drawn.
Looking back: stops, holds and bag changes read-only · records nothing
The strip shows when the circuit was stopped (solid bar), when the fluid pumps were held (hatched bar) and when a bag was changed (tick). Move the scrubber to see the dose that had been delivered by then and what each stop cost. Moving it changes nothing.
Read from this attempt's own dose ledger (an append-only record written by the simulation at the end of every segment). Prescribed and delivered are this lab's accounting in mL/kg/h averaged over the time shown; they are not targets. A stop's cost is the prescribed dose that accrued while it lasted, because nothing was delivered.
Bags fill · time to change
Inspect the bags identity · pathway · remaining · last change
Changing a bag here is the same action as the button on its tile. In this simulation a change is one abstract step; in practice the pumps are usually not paused for a bag change unless a bag runs dry, and the nurse is always preparing the next bags (owner's note), but the lab does not model set-up steps, connection checks or product preparation, and it models the hung fluid as the one ordered, so no wrong-bag mismatch is possible here.
Patient monitor observations
Case
Pressures operating-point windows
Limits are illustrative and device-dependent. The window re-centres after a blood-flow change or a restart.