infant dialysis

EricJRN, MSN, RN · Feb 8, 2011

In neonates and young infants, peritoneal dialysis is often thought to be more efficient than hemodialysis. That involves the use of a Tenckhoff catheter in the abdomen. A stopcock connects the catheter, a bag of dialysate and a drainage bag. The fluid both flows in and drains out by gravity, so at least in the beginning you don't use any of the machinery associated with hemodialysis.

If you're associated with a large children's hospital, it's likely that your neonatal ICU nurses have some experience caring for PD patients at this age.

outofherdeepth · Feb 9, 2011

thank youfor the reply but peritoneal dialysis is not an option in this case. Also when it cames to the heamodialysis of the children in the childrens hospital then it is our unit that does it so the neonatal nurse would not be to helpful with the machine or lines. This is a learning curve for all of us even the medical staff.

Pediatric Critical Care Columnist · Feb 9, 2011

If CRRT is an option it would be a better choice rather than hemodialysis. Gambro has a filter that is suitable for children (Prismaflex HF20) which the company recommends for use in children > 8 kg, but we've used it successfully several times in children smaller than that; one baby was only 2.9 kg and just hours old. The hemocath can be placed femorally or in the right internal jugular so that the largest possible catheter is used, but we've gotten the job done with an 8Fr. A blood prime is essential with little bodies; citrate anticoagulation gives a longer filter life (we only change them when we absolutely must in the tiny babies) and an external heat source such as a Bair Hugger or warming lamps is usually needed due to the significant extracorporeal circulation compared to the size of the patient. A very cautious increase in blood flow rates, from 30 to 50 to 100 mL per kg per minute, followed by gradual adjustment of fluid removal is important to maintain hemodynamic stability. And it's also important to assess the patient frequently because the estimated fluid removal can be inaccurate enough to either overload or dehydrate the baby fairly quickly. We always start out with the machine set to CVVHDF so that we have complete flexibility in adjusting our modalities. Dialysate and replacement rates can be as low as 250 mL/hr meaning your bags will last 20 hours. It's really not as bad as it sounds.