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Pediatric hemofiltration: Normocarb dialysate solution with citrate anticoagulation
Timothy E Bunchman1, Norma J Maxvold, Joni Barnett
1Division of Pediatric Nephrology and Transplantation, Children's Hospital of Alabama, University of Alabama at Birmingham, CHT 735, 1600 7th Avenue S, Birmingham, AL 35233, USA. tbunchman@peds.uab.edu
Pediatric Nephrology (Berlin, Germany)
|April 17, 2002
Summary
This study evaluated a new bicarbonate-based, calcium-free dialysis solution (Normocarb) with citrate anticoagulation in pediatric continuous veno-venous hemofiltration with dialysis (CVVHD). The protocol demonstrated effective circuit patency and no bleeding complications in critically ill children.
Area of Science:
- Pediatric Nephrology
- Critical Care Medicine
- Renal Replacement Therapy
Background:
- Continuous veno-venous hemofiltration with dialysis (CVVHD) is crucial for pediatric critical care.
- Existing dialysis solutions and anticoagulation protocols may present challenges in pediatric patients.
- Standardization and quality assurance are vital for safe and effective CVVHD.
Purpose of the Study:
- To assess the efficacy and safety of a new bicarbonate-based, calcium-free dialysis solution (Normocarb) combined with citrate anticoagulation in pediatric CVVHD.
- To evaluate circuit patency and identify any adverse events, particularly bleeding, during CVVHD therapy.
- To explore the potential benefits of using industry-manufactured CVVHD machinery and solutions.
Main Methods:
- A cohort of 14 pediatric patients (newborn to 17 years) underwent CVVHD using the PRISMA system.
- The protocol utilized citrate anticoagulation (ACD-A) and a bicarbonate-based, calcium-free dialysate (Normocarb).
- Data on patient demographics, diagnoses (sepsis, tumor lysis syndrome), therapy duration, and circuit patency were collected.
Main Results:
- The mean circuit patency was 71.3 hours, influenced by manufacturer recommendations for circuit changes.
- No bleeding complications were reported in any of the 14 pediatric patients.
- The therapy was administered to children with sepsis (n=11) and tumor lysis syndrome (n=3).
Conclusions:
- The use of industry-manufactured CVVHD machinery and solutions, including Normocarb and citrate anticoagulation, is safe and effective in pediatric patients.
- This standardized protocol may reduce the risk of pharmacy errors and potentially decrease therapy costs.
- The protocol supports consistent quality assurance standards in pediatric renal replacement therapy.