"Machines and membranes"

Slides:

Advertisements

Similar presentations

Dear Tim, as far as I know this is the first patient treated with CAVH in the world. We performed this treatment in Vicenza in 1984 and the patient survived.

Advertisements

Transformation from PCRRT to PCRRT/PAKI Timothy E Bunchman Professor & Director Founder of PCRRT.

Pediatric CRRT: Ultrafiltration Control William E. Smoyer, M.D. Pediatric Nephrology University of Michigan.

Neonatal and Infant CRRT

Renal Replacement Therapy Options for Children

Pediatric CRRT: Terminology and Physiology

CRRT Machines Evolution of CRRT and machines Ideal CRRT machine

CVVH vs CVVHD Does it Matter?

1 Peritoneal Dialysis (PD) Principles Peritoneum Fluid and Solute Removal PD Fluid Treatment modes CAPD/APD Complications Treatment Strategy.

Sodium flux during dialysis

Hemofiltration Diafiltration Ultrafiltration CAVH CAVH D

Dialysis Allam Rizqallah The Palestinian Kidney Transplant Center S.A.H1/2/2005.

The Center for Acute Care Nephrology The Blended Dialysis/PICU Program Jerry Schwartz, RN, BSN, MHHA Clinical Director, PICU Cincinnati Children’s Hospital.

Continuous Renal Replacement Therapy. Why continuous Therapies? Continuous therapies closely mimic the GFR of native kidneys Large amounts of fluid.

Figure 1. Particle size distribution of a bentonite suspension after four settlings.

• Electrodialysis (ED). • Liquid membranes. • Pervaporation.

Welcome. Dear Tim, as far as I know this is the first patient treated with CAVH in the world. We performed this treatment in Vicenza in 1984 and the.

Dialysis and Replacement Solutions for CRRT

Dr Umut Selda Bayrakçı Yıldırım Beyazıt University, Dept of Pediatric Nephrology, Ankara, Turkey * Basics of CRRT Terminology.

Troubleshooting Issues in CVVH Timothy L. Kudelka RN, BSN Pediatric Dialysis Program C.S. Mott Children’s Hospital University of Michigan.

INBORN ERRORS OF METABOLISM Stefano Picca, MD Dept. of Nephrology and Urology, Dialysis Unit “Bambino Gesù” Pediatric Research Hospital ROMA, Italy 5th.

Downstream Processes BIE/CEE 5930/6930 Spring 2008.

Matthew L. Paden, MD Division of Pediatric Critical Care

1 TREATMENT STRATEGIES FOR AKI AFTER CPB (FENOLDOPAM, EARLY PD) STEFANO PICCA and ZACCARIA RICCI Dialysis Unit- Dept of Nephrology and Urology CICU- Dept.

Acute Renal Replacement Therapy for the Infant Jordan M. Symons, MD University of Washington School of Medicine Children’s Hospital & Regional Medical.

Md.Kausher ahmed Electrical department. Biomedical engineering Code:6875.

Dialysis and Replacement Solutions for Pediatric CRRT

Visit the Exhibitors!!! They are around the corner in room Coronado A-C Represented there are Dialysis Equipment Companies Solution Companies Access Companies.

Water Treatment for Dialysis Jeff Kaufhold, MD FACP Nephrology Associates of Dayton Oct 2008.

1 NON-RENAL INDICATIONS: INTOXICATIONS & INBORN ERRORS OF METABOLISM STEFANO PICCA, MD Dialysis Unit- Dept of Nephrology and Urology “Bambino Gesù” Pediatric.

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

RENAL REPLACEMENT THERAPY IN INBORN ERRORS OF METABOLISM Stefano Picca, MD Dept. of Nephrology and Urology, Dialysis Unit “Bambino Gesù” Pediatric Research.

Practical Considerations for CRRT Helen Currier RN, BSN, CNN Nancy McAfee RN, BSN, CNN.

Access in Pediatric CRRT

Experiences with plasmapheresis in our pediatric dialysis unit L. Koster-Kamphuis, E. Cornelissen, E. Levtchenko, N. van de Kar Dept. of Pediatric Nephrology.

"AKI in Critical Care: epidemiology and definitions" Stefano Picca, MD Department of Nephrology and Urology, Dialysis Unit “Bambino Gesù” Pediatric Research.

Sustained Low Efficiency Dialysis

Pediatric CRRT Programs: A tool-kit for evaluation Helen Currier BSN, RN, CNN Assistant Director, Renal/Pheresis Texas Children’s Hospital Houston, Texas.

Common Prescription Errors in Pediatric CRRT: a “Top 10 List” Jordan M. Symons, MD University of Washington School of Medicine Seattle Children’s Hospital.

University of Pittsburgh

David Askenazi MD, MSPH Associate Professor of Pediatrics 2Smaller Circuits for Smaller Patients Improving Renal Support with Aquadex™ Machine.

Complications of Pediatric CRRT Theresa A. Mottes RN Pediatric Dialysis/Research Nurse C.S. Mott Children’s Hospital University of Michigan.

PCRRT Multi-Center Registry Data Effective April 1, 2002 Multi-Center Pediatric CRRT Registry Stuart L. Goldstein, MD Assistant Professor of Pediatrics.

"Panel discussion: Inborn Errors of Metabolism – perspectives from a Nephrologist" Stefano Picca, MD Department of Nephrology and Urology, Dialysis Unit.

PCRRT Tûr'mə-nŏl'ə-jē Helen Currier BSN, RN, CNN Assistant Director, Renal/Pheresis Texas Children’s Hospital Houston, Texas.

6+ A variety of porous membrane materials are available for filtration of solutions which selectively retain large biomacromolecules. The solution can.

C2.3 - Applications of Cellular Transport in Industry and Medicine Neurotransmitter chemicals passing from one brain cell to another.

Principle of hemodialysis In haemodialysis, the blood of the patient via a tube system, controlled by the dialysis machine, passed through a filter. In.

Renal Stress Testing in the Assessment of Kidney Disease Lakhmir S. Chawla, Claudio Ronco Kidney International Reports Volume 1, Issue 1, Pages (May.

CRRT TERMINOLOGY Stefano Picca, MD

Renal Replacement Therapy in the CICU Stuart L. Goldstein, MD Professor of Pediatrics University or Cincinnati College of Medicine Director, Center for.

BASIC PRINCIPLES OF DIALYSIS

HAEMODIALYSIS EQUIPMENT

Pressure Ulcer Reducing Wheelchair Pad

Improving outcomes in AKI and CRRT: Does Quality matter?

"Machinery and membranes"

Practical Considerations for CRRT

Volume 54, Issue 1, Pages (July 1998)

Volume 54, Issue 3, Pages (September 1998)

Pediatric CRRT Terminology

Zaccaria Ricci, Claudio Ronco, Sergio Picardo Kidney International

Continuous renal replacement therapy in the critically ill patient

Effects of a reduced inner diameter of hollow fibers in hemodialyzers

Effects of a reduced inner diameter of hollow fibers in hemodialyzers

CRRT dialysis circuit using regional citrate anticoagulation with the Gambro Prisma machine. CRRT dialysis circuit using regional citrate anticoagulation.

Volume 60, Issue 4, Pages (October 2001)

Volume 58, Issue 2, Pages (August 2000)

Volume 58, Pages S148-S155 (August 2000)

Presentation transcript:

"Machines and membranes" Stefano Picca, MD Department of Nephrology and Urology, Dialysis Unit “Bambino Gesù” Pediatric Research Hospital, IRCCS ROMA, Italy

MACHINES AND MEMBRANES: BASIC NEEDS IN CHILDREN Machines/circuits: Accuracy and precision Circuit low priming volume Circuit inner pressures and resistance suitable for small catheters use Membranes: Filtration Absorption

Dear Tim, as far as I know this is the first patient treated with CAVH in the world. We performed this treatment in Vicenza in 1984 and the patient survived. After that we published the first series of 4 newborns treated with CAVH (Kidney International 1986) . You made a great deal of progress since then and even more with this meeting. Best Wishes Claudio Ronco

Error up to 12.5% 2 pumps (pre-post filter)= error up to 25%

Equaline® Amicon, 1991

Baxter BM25 Baxter Aquarius Baxter- Gambro Prisma Baxter- Gambro Prismaflex

SYNTHETIC MEMBRANES Symmetric Asymmetric Isotropes Anisotropes (microporous) Asymmetric Isotropes (uniform pores dimension) Anisotropes (non-uniform pores dimension) “skin layer” + highly porous supportive layer

Skin

REMOVAL OF SOLUTES AND MEDIATORS Filter cutoff CONVECTION/DIFFUSION ABSORPTION ß2 microglobulin myoglobin creatinine inulin IL-6 urea sucrose IL-8 albumin ionic compounds Vit B12 IL-1 TNF 101 102 103 104 105 MW (Daltons)

ABSORPTION Electrical Mechanical Binding binding In both cases, absorption depends on: Qb Quf Qd Surface Initial concentration Neri, 2012

HEMO(DIA)FILTERS IN NEWBORNS AND CHILDREN: PAST AND PRESENT MANUF. FILTER SURFACE (m2) MEMBRANE PRIMING (ml) Gambro-Hospal Miniflow10  0.045 AN69 3.5 Amicon, then Minntech Minifilter 0.07 Polysulfone 6 Bellco Carpediem 1 0.075 27.2 (circuit) Carpediem 2 0.147 33.5 (circuit) Carpediem 3 0.245 41.5 (circuit) Baxter-Gambro HF20 0.2 Polyarylether- sulfone (PAES) 60 (kit) Baxter-Edwards HF03 0.3 38 ST60 0.6 93 (kit) HF07 0.7 54 ST100 1.0 149 (kit)   

ACKNOWLEDGEMENTS All Dialysis Unit nurses All PICU and CICU doctors and nurses Tim Bunchman, Stu Goldstein and Claudio Ronco for precious advices and friendship through the years .

Dialysis Unit, “Bambino Gesù” Pediatric Hospital Roma, Italy. Doctor: S. Picca Headnurse: V. Bandinu Nurses: N. Avari D. Ciullo E. Iacoella P. Iovine P. Lozzi L. Stefani Nurse Coordinator: M. D’Agostino