Department of Pediatrics, Division of Critical Care, University of Alabama at Birmingham, Birmingham, AL, 35233, USA.
Pediatr Nephrol. 2013 Dec;28(12):2383-7. doi: 10.1007/s00467-013-2578-5. Epub 2013 Sep 1.
Acute kidney injury (AKI) frequently occurs in neonates and infants after cardiopulmonary bypass (CPB) and may require renal replacement therapy (RRT). Peritoneal dialysis (PD) is the RRT modality of choice in neonates with AKI after CPB, but continuous renal replacement therapy (CRRT) may be necessary if PD is ineffective or contraindicated. Vascular access is challenging in this population, in part, due to small central vein size that may preclude placement. The risk of malfunction or morbidity associated with standard dialysis catheters may be excessive in neonates with congenital heart disease. We describe a unique approach to vascular access for CRRT in six small patients with AKI.
CASE-DIAGNOSIS/TREATMENT: This is a retrospective review of six patients with fluid overload and AKI that received CRRT because PD was contraindicated. In all cases, CRRT was performed via two hemostasis valve sheaths placed into separate veins for dialysis access and return. The low-resistance sheaths provided excellent blood flow with normalization of metabolic derangements and significant fluid removal (median negative 167 ml/kg at 72 h). Mean circuit life before the first change was 55.2 ± 30.4 h.
The use of two small single-lumen catheters in separate veins enables consistent and effective hemodiafiltration in neonates and infants with challenging vascular access.
体外循环 (CPB) 后新生儿和婴儿常发生急性肾损伤 (AKI)，可能需要肾脏替代治疗 (RRT)。腹膜透析 (PD) 是 CPB 后 AKI 新生儿的首选 RRT 方式，但如果 PD 无效或禁忌，则可能需要连续肾脏替代治疗 (CRRT)。由于中心静脉较小，可能会妨碍置管，该人群的血管通路存在挑战。对于患有先天性心脏病的新生儿，标准透析导管相关的故障或发病率风险可能过高。我们介绍了一种独特的方法，用于 6 名 AKI 小患者的 CRRT 血管通路。
病例诊断/治疗：这是对 6 名因 PD 禁忌而接受 CRRT 的液体超负荷和 AKI 患者的回顾性研究。在所有情况下，CRRT 均通过两个置于不同静脉的止血阀套进行，用于透析通路和返回。低阻力套管提供了出色的血流，代谢紊乱正常化，并显著去除液体（中位数为 72 小时时负 167ml/kg）。首次更换前的平均回路寿命为 55.2±30.4 小时。
在两条单独的静脉中使用两个小的单腔导管，可在血管通路具有挑战性的新生儿和婴儿中实现一致有效的血液透析滤过。
