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

2. 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

3. 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

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

7. Equaline® Amicon, 1991

8. Baxter
BM25
Baxter
Aquarius
Baxter- Gambro
Prisma
Baxter- Gambro
Prismaflex

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

12. Skin

15. 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
MW (Daltons)

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

18. 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)   

21. 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 .

22. 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