"Machines and membranes" Stefano Picca, MD Department of Nephrology and Urology, Dialysis Unit “Bambino Gesù” Pediatric Research Hospital, IRCCS ROMA, Italy
"Machines and membranes"
Stefano Picca, MDDepartment of Nephrology and Urology, Dialysis Unit“Bambino Gesù” Pediatric Research Hospital, IRCCS
ROMA, Italy
Machines/circuits:• Accuracy and precision• Circuit low priming volume• Circuit inner pressures and resistance suitable for small catheters use
Membranes:• Filtration • Absorption
MACHINES AND MEMBRANES: BASIC NEEDS IN CHILDREN
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- GambroPrismaflex
Baxter- GambroPrisma
SYNTHETIC MEMBRANES
Asymmetric
Isotropes(uniform pores dimension)
Anisotropes(non-uniform pores dimension)
Symmetric(microporous)
“skin layer” + highly porous
supportive layer
SkinSkin
REMOVAL OF SOLUTES AND MEDIATORS
101 102 103 104 105
creatinine inulin IL-6
urea sucrose IL-8 albumin
myoglobin
ionic compounds Vit B12 TNFIL-1
ß2 microglobulin
MW (Daltons)
Filter cutoff
CONVECTION/DIFFUSION ABSORPTION
ABSORPTION
Mechanical binding
ElectricalBinding
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 Polysulfone 27.2 (circuit)
Bellco Carpediem 2 0.147 Polysulfone 33.5 (circuit)
Bellco Carpediem 3 0.245 Polysulfone 41.5 (circuit)
Baxter-Gambro HF20 0.2 Polyarylether-
sulfone (PAES)
60 (kit)
Baxter-Edwards HF03 0.3 Polysulfone 38
Baxter-Gambro ST60 0.6 AN69 93 (kit)
Baxter-Edwards HF07 0.7 Polysulfone 54
Baxter-Gambro ST100 1.0 AN69 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 HospitalRoma, Italy.
Doctor:S. Picca
Headnurse:V. Bandinu
Nurses:N. AvariD. CiulloE. IacoellaP. IovineP. LozziL. Stefani
Nurse Coordinator:M. D’Agostino