Blood flow rate & amount of blood treated

Perhaps we could throw cell salvage in to the mix too - any use case where blood leaves the body, has something done to it, then is returned. I’d be happy to start a mind map if that would help.

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I remember to see some archetypes related to hemodialysis in Higmed CKM.
Dialysis has a lot of missing concepts in CKM. If we start an archetype only to this concept we might not see the all picture. For example, blood is not the only fluid that has to be recorded using flow rate, and total volume.

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Hi! Thank you all for your replies.

Since I do not want to create an archetype that will live only in this project that I am working on and I think that would be useful for many other modellers in the future, what do you all think of setting up a call this week?
Although I still need to have the whole modelling part made in the next 2 weeks, it would be nice to start something is this area.

@johngrant4est if you already have a mindmap in mind, that would be great to share :smiley:

@nuno.abreu I agree with you, but if possible I would start with small steps for an “entry” archetype (draft), until having a full picture it will take a while.

Happy to connect with clinical domain experts if required ! :smiley:

@videhasharma please :slight_smile:

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I’d be happy to join a call about this topic. :+1:

I’m happy to set up a zoom call later in the week - if you can give me a few days to draft a mind map?
I’m on UK time (GMT/UTC) but if you let me know availability I’m sure we can set something up.

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I’ve had a go at a mind map based on the general topic of “Extracorporeal Procedures”. This covers a lot of ground, in addition to Haemodialysis and filtration, but hopefully sets them in context with other procedures involving removing blood from the body, doing something to it, then putting it back in.
Focusing on dialysis, it would be really helpful if someone could provide examples of “prescription” sheets and observation charts used in a dialysis unit. In particular, it would be good to see how specialised variables like dialysate composition, temperature and pH are recorded. I expect there will be multiple observations of flow and volume, of both blood and dialysate.
There are some INSTRUCTIONS and OBSERVATIONS that are common to all extracorporeal procedures, such as anticoagulant prescription, vital signs etc. As there are existing archetypes for these, there doesn’t seem much point in including them in our model.
Comments please, here is a link to a PNG version of the mind map if you don’t have XMind.

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FYI, this is what have developed as part of the Nephro-Digital project: Clinical Knowledge Manager

Might not fit 100%, but could be a starting point

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Really useful, thanks. I didn’t include Peritoneal Dialysis as technically, it isn’t an extracorporeal procedure, but clearly it has to fit somewhere in Renal Replacement Therapy (RRT).

That’s a good starting point. I’m gone start a mind map focused on dialysis and mark which concepts could be used in instructions and observations, and then merge with your’s.

I only have in portuguese.

Me too

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We could possibly make use of this too:
https://britishrenal.org/wp-content/uploads/2020/04/Acute-Haemodialysis-Prescription.pdf

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Great topic and very happy to provide clinical input and connections around dialysis (haemo and PD) - only issue is that I am being drafted back in to front line clinical activity as we have many colleagues absent due to covid. Perhaps things will be more clear in a couple of weeks :slight_smile:

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Hi all! Sorry for no response in the last days, got some covid cases in my family so it delayed me a quite a bit.
What do you think about a call on friday morning at 10h? (GMT)
I will share here a link for the call later today.

I am also doing a mindmap with some info I could gather for hemodialysis in general which i will share too.
@birger.haarbrandt my WIP template is quite similar to yours and your sharing helped me in some doubts I had, thanks for sharing it.

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@birger.haarbrandt looking at this in more detail, I have a few questions. I see the archetype uses an ACTION entry type for the details of the HD. Thinking about the clinical workflow, I’d envisage an INSTRUCTION entry to hold the details of the HD prescription, an ACTION entry to say what flow rates were used and when, plus the timings of the events, and OBSERVATION archetypes to hold the vital signs, dialysate volumes, serum biochemistry etc. Does that make sense to anyone?
Say we want to record details of the HD machine and the consumables (e.g. dialyser), I’d see these as ACTIONS, although they could be INSTRUCTIONS too, as they’ll be part of the prescription. I probably need some more senior input here to clarify.
Also, when we record the access type - as it will be in place before HD starts, I’d record it as an observation. The type of catheter or AV fistula/graft probably isn’t that important, but for fistulae, I believe the insertion depth, diameter and maturation are usually recorded.
Here’s my latest RRT mind map in PNG and Xmind.

10am GMT good for me.

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Just finished the mind map. @johngrant4est i use your file and added another tab. I focused only data used in a regular dialysis session.

Renal Replacement Therapy (RRT).xmind (103.8 KB)

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10 am GMT (11:00 CET) works for me as well.

Hi!
here’s the link for the meeting for friday, january 14 at 10h GMT: MS Teams meeting

in case this one does not work, here’s a zoom link:

Entrar na reunião Zoom
Launch Meeting - Zoom
ID da reunião: 761 196 0694
Senha de acesso: 8egdN4

See you all and thanks for all work and interest!

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I am also doing a mindmap with some info I could gather for hemodialysis in general which i will share too.

Hi! here’s my starting point - there isn’t yet any reference to openehr classes - the namings there are just to organizing ideias but overall this is for a register:


I hope it can give some extra information for tomorrows meeting.

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seems that only zoom link is working properly, please join in that one, thank you

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Hi all! we had a good kickoff meeting with @nuno.abreu , @johngrant4est and @siljelb where we started to understand the different mindmaps presented and we started to do a mindmap for blood flow rate.
@siljelb has created a slack channel #hemodialysis where we can also discuss more in detail and all content is being shared there, in case you do not have an account to the openEHR clinical slack, here’s a link where you can join: Join openEHR Clinical on Slack | Slack

Next week we will have another meeting to keep going in the discussions from today at friday, january 21 at 10h GMT. The meeting room is at:

Entrar na reunião Zoom
Launch Meeting - Zoom
ID da reunião: 761 196 0694
Senha de acesso: 8egdN4

Thank you all for the interest and joint work.
Best regards, Vanessa

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