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Current Technology for CRRT

Current Technology for CRRT. Dr. Peter Skippen, PICU. BC Children’s Hospital, Vancouver. CANADA. Outline. The ideal CRRT machine Hardware options Homemade Dedicated fully integrated Conclusions. The Ideal Machine for CRRT: I. Inexpensive / user friendly / flexible

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Current Technology for CRRT

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

  2. Outline • The ideal CRRT machine • Hardware options • Homemade • Dedicated fully integrated • Conclusions

  3. 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

  4. 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

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

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

  7. Edwards BM 25 • 2 integrated modules • Blood module (BM 11) • Balancing module / scales (BM 14)

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

  9. 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

  10. 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

  11. 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?

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

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

  14. PRISMA Screen

  15. PRISMA Screen

  16. 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

  17. 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?

  18. 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

  19. Clinical Issues • Biocompatability • Hemodynamic stability

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

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