"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