【持续性肾脏替代治疗crrt英文精品课件】current technology for crrt

Current Technology for CRRT,Dr. Peter Skippen, PICU. BC Childrens Hospital, Vancouver. CANADA.,Outline,The ideal CRRT machine Hardware options Homemade Dedicated fully integrated Conclusions,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,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,The Ideal Circuit for CRRT,Minimal priming volume / low resistance Easy priming / recirculation procedure Exchangeable components Biocompatible Non inflammatory Hemodynamic stability Non thrombogenic,Integrated Hardware Options,Home made devices Dedicated “all in one” machine Edwards M 25 PRISMA Braun DIAPACT Fresenius,2 integrated modules Blood module (BM 11) Balancing module / scales (BM 14),Edwards BM 25,Edwards BM 25: Blood Pump Module,Blood monitor pediatric flows: 5 - 150mls / min Increments of 1ml,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,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,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?,PRISMA CRRT Machine,Touch screen Complete range of therapies 3 weighing scales accuracy +/- 0.5% Custom filter / circuitry,PRISMA CRRT Machine: Basic Layout,Replacement,Dialysate,Effluent,Blood,Heparin Syringe Pump,Pressure Pods,Scales x 3,PRISMA Screen,PRISMA Screen,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,PRISMA Machine: 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?,PRISMA Machine: Dis-advantages,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,Diapact CRRT,Clinical Issues,Biocompatability Hemodynami