Experiences with CVVH as a new treatment modality in our pediatric and neonatal ICU

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Experiences with CVVH as a new treatment modality
in our pediatric and neonatal ICU 

• L. Koster-Kamphuis,
• pediatric nephrologist

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History

• Starting the CVVH program
• Choice of the machine
• Developing protocols
• Treatment of the first child in 2003

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Experiences

• 2003 4 patients
• 2004 7 patients
• 2005 11 patients

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Experiences

• 22 patients
• Age 3 days 16 years
• Weight 2,2 kg 53 kg
• 5 in combination with ECMO

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Indications

• Multiple organ failure n8
• Renal insufficiency with fluid overload n6
• Fluid overload alone n3
• Renal insufficiency alone n2
• Hyperammonemia n3

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Underlying disorders

• Congenital hart defect after surgery n6
• Inborn error of metabolism n3
• Oncological disease n3
• Respiratory insufficiency n3
• Infection n3
• HUS n1
• Congenital diaphragmatic hernia n1
• Renal dysplasia n1
• Alpers-Hutenlocher syndrome n1

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Vascular access

• Femoral vein n9
• Jugular vein n3
• Subclavian vein n1
• Pulmonary artery n1
• Umbilical catheters n1
• ECMO circuit n5
• Unknown n2

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Materials and Methods

• M10 n7
• M60 n13
• M100 n2
• CVVH n11
• CVVHD n1
• CVVHDF n8
• Unknown n2

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Materials and Methods

• Heparin was used as anticoagulant
• Treatment time was 3 hours 17 days

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Results

• 8 patients died (36)
• Multiple organ failure n4
• Stopping all treatment n2
• Cerebral herniation n1
• Respiratory problems n1

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Results

• Failure of vascular access n3
• Clotting n4

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Problems

• Vascular access
• Anticoagulation
• Access location in the ECMO circuit
• Lack of experience of ICU nurses
• Called in to late

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Conclusion

• CVVH offers more expanded treatment options for
  very ill (small) children
• Extended education for all involved nurses and
  physicians is necessary
• Problems must be a challenge to solve them

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