current technology for crrt dr. peter skippen, picu. bc children’s hospital, vancouver. canada
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Current Technology for Current Technology for
CRRTCRRT
Dr. Peter Skippen, PICU. BC Children’s Hospital,Dr. Peter Skippen, PICU. BC Children’s Hospital,
Vancouver. CANADA.Vancouver. CANADA.
CRRT TechnologyCRRT Technology
OutlineOutline
• The ideal CRRT machineThe ideal CRRT machine
• Hardware optionsHardware options
– HomemadeHomemade
– Dedicated fully integratedDedicated fully integrated
• ConclusionsConclusions
CRRT TechnologyCRRT Technology
The Ideal Machine for CRRT: IThe Ideal Machine for CRRT: I
• Inexpensive / user friendly / flexibleInexpensive / user friendly / flexible
• Accurate / dedicated pumpsAccurate / dedicated pumps
• Accurate scalesAccurate scales
• Blood flows 5-300mls/minBlood flows 5-300mls/min– increments of 1 ml/minincrements of 1 ml/min
• Continuous independent flow measurementsContinuous independent flow measurements
• Servo controlledServo controlled
• ThermoregulationThermoregulation
• Full range of safety featuresFull range of safety features
CRRT TechnologyCRRT Technology
The Ideal Machine for CRRT: IIThe Ideal Machine for CRRT: II
• Safety featuresSafety features
– Audible / visual alarms with over-rideAudible / visual alarms with over-ride
– Air / clot detectorsAir / clot detectors
– Blood leak detectorsBlood leak detectors
– Continuous display of circuit pressuresContinuous display of circuit pressures
– Continuous Uf urea concentrationContinuous Uf urea concentration
– Continuous circuit HctContinuous circuit Hct
• Minimal alarms - maximum patient safetyMinimal alarms - maximum patient safety
CRRT TechnologyCRRT Technology
The Ideal Circuit for CRRTThe Ideal Circuit for CRRT
• Minimal priming volume / low resistanceMinimal priming volume / low resistance
• Easy priming / recirculation procedureEasy priming / recirculation procedure
• Exchangeable componentsExchangeable components
• BiocompatibleBiocompatible– Non inflammatoryNon inflammatory
– Hemodynamic stabilityHemodynamic stability
– Non thrombogenicNon thrombogenic
CRRT TechnologyCRRT Technology
Integrated Hardware OptionsIntegrated Hardware Options
• Home made devicesHome made devices• Dedicated “all in one” machineDedicated “all in one” machine
– Edwards M 25Edwards M 25– PRISMAPRISMA– Braun DIAPACTBraun DIAPACT
– Fresenius Fresenius
• 2 integrated modules2 integrated modules
– Blood module (BM 11)Blood module (BM 11)
– Balancing module / Balancing module / scales (BM 14)scales (BM 14)
Edwards BM 25Edwards BM 25
Edwards BM 25: Edwards BM 25: Blood Pump ModuleBlood Pump Module
• Blood monitorBlood monitor
– pediatric flows:pediatric flows:
• 5 - 150mls / min5 - 150mls / min
– Increments of 1mlIncrements of 1ml
Edwards BM 25: Edwards BM 25: Effluent / Replacement Pump ModuleEffluent / Replacement Pump Module
• Balancing monitorBalancing monitor– Substitution pump / filtrate pumpSubstitution pump / filtrate pump
– Integrated scales: claimed accuracy Integrated scales: claimed accuracy 1% (20mls in 2000mls)1% (20mls in 2000mls)
– Replacement fluid heaterReplacement fluid heater
– TMP monitorTMP monitor
– Operational rangesOperational ranges• Replacement fluid 100- 9000mls / Replacement fluid 100- 9000mls /
hr (100ml increments)hr (100ml increments)
• Filtrate pump 100 - 11,000mls / hrFiltrate pump 100 - 11,000mls / hr
• Net UFR 0.1 - 2000mls / hrNet UFR 0.1 - 2000mls / hr
CRRT TechnologyCRRT Technology
Edwards BM 25: AdvantagesEdwards BM 25: Advantages
• Relatively lower costRelatively lower cost
• SimplicitySimplicity– Easy primingEasy priming
• FlexibilityFlexibility– Separate arterial / venous tubingSeparate arterial / venous tubing
– Use any filterUse any filter
– Neonate to adultNeonate to adult
– Any treatment option Any treatment option
• with modificationwith modification
• With loss of simplicityWith loss of simplicity
• Replacement fluid warmerReplacement fluid warmer
CRRT TechnologyCRRT Technology
EdwardsEdwards BM 25: Disadvantages BM 25: Disadvantages
• Only 3 pumpsOnly 3 pumps– For CVVHDF, extra pump creates For CVVHDF, extra pump creates
problemsproblems
• Does not calculate FFDoes not calculate FF
• No screenNo screen
• Troubleshooting requires training!Troubleshooting requires training!
• Blood / air interface with bubble trap?Blood / air interface with bubble trap?
PRISMA CRRT MachinePRISMA CRRT Machine
• Touch screenTouch screen
• Complete range of therapiesComplete range of therapies
• 3 weighing scales 3 weighing scales
– accuracy < +/- 0.5%accuracy < +/- 0.5%
• Custom filter / circuitryCustom filter / circuitry
PRISMA CRRT Machine: Basic LayoutPRISMA CRRT Machine: Basic Layout
ReplacementReplacement
DialysateDialysate
EffluentEffluent
BloodBlood
Heparin Heparin Syringe PumpSyringe Pump
Pressure Pods
Scales x 3Scales x 3
PRISMA ScreenPRISMA Screen
PRISMA ScreenPRISMA Screen
CRRT TechnologyCRRT Technology
• User friendly interfaceUser friendly interface
• Step by step instructionsStep by step instructions
• Continuous display of treatment Continuous display of treatment conditionsconditions
• Easy / rapid institution of Easy / rapid institution of therapies (self prime)therapies (self prime)
• Continuous 24 hour recording of Continuous 24 hour recording of treatment historytreatment history
• Alarm explanationsAlarm explanations
PRISMA Machine: AdvantagesPRISMA Machine: Advantages
CRRT TechnologyCRRT Technology
• Need for company specific filterNeed for company specific filter
• Relatively high costRelatively high cost
• Limited blood flow rangesLimited blood flow ranges
• Can’t change therapies mid-courseCan’t change therapies mid-course
• Scales sensitive to knockingScales sensitive to knocking
• Learning curve - don’t they all?Learning curve - don’t they all?
PRISMA Machine: Dis-advantagesPRISMA Machine: Dis-advantages
CRRT TechnologyCRRT Technology
• Compact, self contained, flexibleCompact, self contained, flexible
• High resolution screenHigh resolution screen
• 3 pumps3 pumps– Blood flow 10-500mls/minBlood flow 10-500mls/min
– Dialysate - substitution flow 0-250 mls/minDialysate - substitution flow 0-250 mls/min
– UFR 0-300mls/minUFR 0-300mls/min
• Automatic priming procedureAutomatic priming procedure
• Substitution fluid warmerSubstitution fluid warmer
• Full range of therapiesFull range of therapies
• Battery powerBattery power
Diapact CRRTDiapact CRRT
CRRT TechnologyCRRT Technology
Clinical IssuesClinical Issues
• BiocompatabilityBiocompatability
• Hemodynamic stabilityHemodynamic stability
CRRT TechnologyCRRT Technology
ConclusionsConclusions
• Improving technologyImproving technology
• Ideal machines / circuits?Ideal machines / circuits?
• Issues to be resolvedIssues to be resolved
– Biocompatability / ThrombogenicityBiocompatability / Thrombogenicity
– FlexibilityFlexibility
– VersatilityVersatility
– CostCost
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