Current Technology for CRRT: Current Technology for CRRT Dr. Peter Skippen, PICU. BC Children’s Hospital, Vancouver. CANADA.


Outline: Outline The ideal CRRT machine Hardware options Homemade Dedicated fully integrated Conclusions


The Ideal Machine for CRRT: I: The Ideal Machine for CRRT: I Inexpensive / user friendly / flexible Accurate / dedicated pumps Accurate scales Blood flows 5-300mls/min increments of 1 ml/min Continuous independent flow measurements Servo controlled Thermoregulation Full range of safety features


The Ideal Machine for CRRT: II: The Ideal Machine for CRRT: II Safety features Audible / visual alarms with over-ride Air / clot detectors Blood leak detectors Continuous display of circuit pressures Continuous Uf urea concentration Continuous circuit Hct Minimal alarms - maximum patient safety


The Ideal Circuit for CRRT: The Ideal Circuit for CRRT Minimal priming volume / low resistance Easy priming / recirculation procedure Exchangeable components Biocompatible Non inflammatory Hemodynamic stability Non thrombogenic


Integrated Hardware Options: Integrated Hardware Options Home made devices Dedicated “all in one” machine Edwards M 25 PRISMA Braun DIAPACT Fresenius


Edwards BM 25: 2 integrated modules Blood module (BM 11) Balancing module / scales (BM 14) Edwards BM 25


Edwards BM 25: Blood Pump Module: Edwards BM 25: Blood Pump Module Blood monitor pediatric flows: 5 - 150mls / min Increments of 1ml


Edwards BM 25: Effluent / Replacement Pump Module: Edwards BM 25: Effluent / Replacement Pump Module Balancing monitor Substitution pump / filtrate pump Integrated scales: claimed accuracy 1% (20mls in 2000mls) Replacement fluid heater TMP monitor Operational ranges Replacement fluid 100- 9000mls / hr (100ml increments) Filtrate pump 100 - 11,000mls / hr Net UFR 0.1 - 2000mls / hr


Edwards BM 25: Advantages: Edwards BM 25: Advantages Relatively lower cost Simplicity Easy priming Flexibility Separate arterial / venous tubing Use any filter Neonate to adult Any treatment option with modification With loss of simplicity Replacement fluid warmer


Edwards BM 25: Disadvantages: Edwards BM 25: Disadvantages Only 3 pumps For CVVHDF, extra pump creates problems Does not calculate FF No screen Troubleshooting requires training! Blood / air interface with bubble trap?


PRISMA CRRT Machine: PRISMA CRRT Machine Touch screen Complete range of therapies 3 weighing scales accuracy < +/- 0.5% Custom filter / circuitry


PRISMA CRRT Machine: Basic Layout: PRISMA CRRT Machine: Basic Layout Replacement Dialysate Effluent Blood Heparin Syringe Pump Pressure Pods Scales x 3


PRISMA Screen: PRISMA Screen


PRISMA Screen: PRISMA Screen


PRISMA Machine: Advantages: User friendly interface Step by step instructions Continuous display of treatment conditions Easy / rapid institution of therapies (self prime) Continuous 24 hour recording of treatment history Alarm explanations PRISMA Machine: Advantages


PRISMA Machine: Dis-advantages: Need for company specific filter Relatively high cost Limited blood flow ranges Can’t change therapies mid-course Scales sensitive to knocking Learning curve - don’t they all? PRISMA Machine: Dis-advantages


Diapact CRRT: Compact, self contained, flexible High resolution screen 3 pumps Blood flow 10-500mls/min Dialysate - substitution flow 0-250 mls/min UFR 0-300mls/min Automatic priming procedure Substitution fluid warmer Full range of therapies Battery power Diapact CRRT


Clinical Issues: Clinical Issues Biocompatability Hemodynamic stability


Conclusions: Conclusions Improving technology Ideal machines / circuits? Issues to be resolved Biocompatability / Thrombogenicity Flexibility Versatility Cost