Current Technology for CRRT

1
Current Technology for CRRT

• Dr. Peter Skippen, PICU. BC Childrens
  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

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Integrated Hardware Options

• Home made devices
• Dedicated all in one machine
• Edwards M 25
• PRISMA
• Braun DIAPACT
• Fresenius

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Edwards BM 25

• 2 integrated modules
• Blood module (BM 11)
• Balancing module / scales (BM 14)

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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

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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?

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PRISMA CRRT Machine

• Touch screen
• Complete range of therapies
• 3 weighing scales
• accuracy lt /- 0.5
• Custom filter / circuitry

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PRISMA CRRT Machine Basic Layout
Replacement
Effluent
Pressure Pods
Heparin Syringe Pump
Blood
Dialysate
Scales x 3
14
PRISMA Screen
15
PRISMA Screen
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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
• Cant change therapies mid-course
• Scales sensitive to knocking
• Learning curve - dont they all?

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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

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Clinical Issues

• Biocompatability
• Hemodynamic stability

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Conclusions

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