Pressure-related flow rates for continuous renal replacement therapy in very small children: an in vitro study

ObjectiveContinuous renal replacement therapy (CRRT) is extremely challenging in very small children, as most CRRT intravascular access devices are too large. We aimed to quantify flow rates through several alternative intravascular devices.DesignExperimental in vitro study simulating CRRT.SettingWh...

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Bibliographic Details
Published in:BMJ paediatrics open 2017-08, Vol.1 (1), p.e000013-e000013
Main Authors: Stevens-Harris, Isabella, Raffaj, Dusan, Davies, Patrick
Format: Article
Language:English
Subjects:
Catheters
Hemodialysis
Investigations
Medical equipment
Original
Pediatrics
Renal replacement therapy
Viscosity
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Summary:ObjectiveContinuous renal replacement therapy (CRRT) is extremely challenging in very small children, as most CRRT intravascular access devices are too large. We aimed to quantify flow rates through several alternative intravascular devices.DesignExperimental in vitro study simulating CRRT.SettingWhole milk and equine blood were used as human blood substitutes due to similar viscosity. Milk under gravity pressure was run through a standard CRRT circuit. Equine blood was run through a working CRRT machine.SubjectsEight intravenous access devices used in paediatrics, with a variety of connectors.InterventionsDevices were tested with milk for flow between 50 and 200 mm Hg pressure, and with blood for pressure at flows between 20 and 50 mL/min.Main outcome measuresFlows at each input pressure with milk, and pressures at each flow rate with blood.ResultsWith both experimental systems, 8Fr and 6.5Fr haemodialysis catheters, and 18G and 20G cannulae allowed excellent low pressure flow rates. 5Fr triple central catheter, 5Fr and 4Fr umbilical venous catheter, and 5Fr haemodialysis catheters did not allow flows at reasonable pressures for CRRT. A three-way tap did not impede flows, but a needle-free valve did. Flows increased with pressure non-linearly, presumably due to increasing turbulence.ConclusionsIn very small patients needing CRRT, where large haemodialysis catheters cannot be used due to the patient size, we advise the use of two 18G cannulae in different sites. A three-way tap can be added, but not any other connectors. In vitro this system gave suitable flow rates with some flexibility for in vivo variations.
ISSN:2399-9772
2399-9772
DOI:10.1136/bmjpo-2017-000013