Introduction: The coronavirus disease 2019 (COVID-19) pandemic led to increased demand nationwide for dialysis equipment, including supplies and machines. To meet the demand in our institution, our surge plan included rapid mobilization of a novel continuous renal replacement treatment (CRRT) machine named SAMI. The SAMI is a push-pull filtration enhanced dialysis machine that can conjugate extremely high single-pass solute removal efficiency with very precise fluid balance control. Material and Methods: Machine assembly was conducted on-site by local biomedical engineers with remote assistance by the vendor. One 3-h virtual training session of 3 dialysis nurses was conducted before SAMI deployment. The SAMI was deployed in prolonged intermittent replacement therapy (PIRRT) mode to maximize patients covered per machine per day. Live on-demand vendor support was provided to troubleshoot any issues for the first few cases. After 4 weeks of the SAMI implementation, data on treatments with the SAMI were collected, and a questionnaire was provided to the nurse trainees to assess device usability. Results: On-site installation of the SAMI was accomplished with remote assistance. Delivery of remote training was successfully achieved. 23 PIRRT treatments were conducted in 10 patients. 7/10 of patients had CO-VID-19. The median PIRRT dose was 50 mL/kg/h (IQR [interquartile range] 44 – 62 mL/kg/h), and duration of the treatment was 8 h (IQR 6.3 – 8 h). Solute control was adequate. The user response was favorable to the set of usability questions involving user interface, on-screen instructions, machine setup, troubleshooting, and the ease of moving the machine. Conclusion: Assembly of the SAMI and training of nurses remotely are possible when access to vendor employees is restricted during states of emergency. The successful deployment of the SAMI in our institution during the pandemic with only 3-h virtual training supports that operating the SAMI is simple and safe.

1.
Goldfarb
DS
,
Benstein
JA
,
Zhdanova
O
,
Hammer
E
,
Block
CA
,
Caplin
NJ
, et al.
Impending shortages of kidney replacement therapy for COVID-19 patients
.
Clin J Am Soc Nephrol
.
2020
;
15
(
6
):
880
2
. .
2.
Abelson
R
,
Fink
S
,
Kulish
N
,
Thomas
K
.
An overlooked, possibly fatal coronavirus crisis: a dire need for kidney dialysis
.
The New York Times
;
2020
.
3.
Heung
M
,
Yessayan
L
.
Renal replacement therapy in acute kidney injury: controversies and consensus
.
Crit Care Clin
.
2017 Apr
;
33
(
2
):
365
78
. .
4.
Lee
K
,
Min
BG
,
Lee
KK
,
Yun
YM
,
Blagg
CR
.
Evaluation of a new method for pulse push/pull hemodialysis: comparison with conventional hemodialysis
.
ASAIO J
.
2012
;
58
(
3
):
232
7
. .
5.
Morti
SM
,
Zydney
AL
.
Protein-membrane interactions during hemodialysis: effects on solute transport
.
ASAIO J
.
1998 Jul–Aug
;
44
(
4
):
319
26
. .
6.
Buckberry
C
,
Hoenich
N
,
Krieter
D
,
Lemke
HD
,
Rüth
M
,
Milad
JE
.
Enhancement of solute clearance using pulsatile push-pull dialysate flow for the Quanta SC+: a novel clinic-to-home haemodialysis system
.
PLoS One
.
2020
;
15
(
3
):
e0229233
. .
7.
Teo
BW
,
Demirjian
S
,
Meyer
KH
,
Wright
E
,
Paganini
EP
.
Machine-generated bicarbonate dialysate for continuous therapy: a prospective, observational cohort study
.
Nephrol Dial Transplant
.
2007
;
22
(
8
):
2304
15
. .
8.
Marshall
MR
,
Creamer
JM
,
Foster
M
,
Ma
TM
,
Mann
SL
,
Fiaccadori
E
, et al.
Mortality rate comparison after switching from continuous to prolonged intermittent renal replacement for acute kidney injury in three intensive care units from different countries
.
Nephrol Dial Transplant
.
2010
;
26
(
7
):
2169
75
. .
9.
Schwenger
V
,
Weigand
MA
,
Hoffmann
O
,
Dikow
R
,
Kihm
LP
,
Seckinger
J
, et al.
Sustained low efficiency dialysis using a single-pass batch system in acute kidney injury: a randomized interventional trial: the REnal Replacement Therapy Study in Intensive Care Unit PatiEnts
.
Crit Care
.
2012 Jul 27
;
16
(
4
):
R140
.
10.
Kitchlu
A
,
Adhikari
N
,
Burns
KE
,
Friedrich
JO
,
Garg
AX
,
Klein
D
, et al.
Outcomes of sustained low efficiency dialysis versus continuous renal replacement therapy in critically ill adults with acute kidney injury: a cohort study
.
BMC Nephrol
.
2015 Aug 4
;
16
:
127
. .
11.
Edrees
F
,
Li
T
,
Vijayan
A
.
Prolonged intermittent renal replacement therapy
.
Adv Chronic Kidney Dis
.
2016 May
;
23
(
3
):
195
202
. .
12.
Kumar
VA
,
Craig
M
,
Depner
TA
,
Yeun
JY
.
Extended daily dialysis: a new approach to renal replacement for acute renal failure in the intensive care unit
.
Am J Kidney Dis
.
2000 Aug
;
36
(
2
):
294
300
. .
13.
Marshall
MR
,
Ma
T
,
Galler
D
,
Rankin
AP
,
Williams
AB
.
Sustained low-efficiency daily diafiltration (SLEDD-f) for critically ill patients requiring renal replacement therapy: towards an adequate therapy
.
Nephrol Dial Transplant
.
2004 Apr
;
19
(
4
):
877
84
. .
14.
Berbece
AN
,
Richardson
RM
.
Sustained low-efficiency dialysis in the ICU: cost, anticoagulation, and solute removal
.
Kidney Int
.
2006 Sep
;
70
(
5
):
963
8
. .
15.
Clark
JA
,
Schulman
G
,
Golper
TA
.
Safety and efficacy of regional citrate anticoagulation during 8-hour sustained low-efficiency dialysis
.
Clin J Am Soc Nephrol
.
2008 May
;
3
(
3
):
736
42
. .
16.
Gashti
CN
,
Salcedo
S
,
Robinson
V
,
Rodby
RA
.
Accelerated venovenous hemofiltration: early technical and clinical experience
.
Am J Kidney Dis
.
2008 May
;
51
(
5
):
804
10
. .
17.
Fiaccadori
E
,
Regolisti
G
,
Cademartiri
C
,
Cabassi
A
,
Picetti
E
,
Barbagallo
M
, et al.
Efficacy and safety of a citrate-based protocol for sustained low-efficiency dialysis in AKI using standard dialysis equipment
.
Clin J Am Soc Nephrol
.
2013 Oct
;
8
(
10
):
1670
8
. .
18.
Pistolesi
V
,
Morabito
S
,
Di Mario
F
,
Regolisti
G
,
Cantarelli
C
,
Fiaccadori
E
.
A guide to understanding antimicrobial drug dosing in critically ill patients on renal replacement therapy
.
Antimicrob Agents Chemother
.
2019
;
63
(
8
):
e00583
19
. .
19.
Buckberry
C
,
Hoenich
N
,
Krieter
D
,
Lemke
HD
,
Rüth
M
,
Milad
JE
.
Enhancement of solute clearance using pulsatile push-pull dialysate flow for the Quanta SC+: a novel clinic-to-home haemodialysis system
.
PLoS One
.
2020
;
15
(
3
):
e0229233
. .
20.
Szamosfalvi
B
,
Frinak
S
,
Yee
J
.
Sensors and hybrid therapies: a new approach with automated citrate anticoagulation
.
Blood Purif
.
2012
;
34
(
2
):
80
7
. .
21.
Szamosfalvi
B
,
Yessayan
L
.
Innovations in CKRT: individualized therapy with fewer complications
.
Nat Rev Nephrol
.
2020 Oct
;
16
(
10
):
560
1
.
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