CONTINUOUS ARTERIAL-VENOUS HEMOFILTRATION (CAVH) IN PEDIATRICS

Abstract

CAVH is a new extracorporeal technique for the treatment of renal failure. Slow continuous ultrafiltration, the driving force for blood flow being provided by the patient's own systemic blood pressure, results in the gradual removal of fluid and solutes. CAVH is especially applicable in the hemodynamically unstable, critically ill patient. Herein is described the first use of this technique in pediatric patients.A 1300 gram premature female, delivered by emergency Caesarian section because of abruptio placenta and fetal distress, developed renal failure secondary to intrapartum shock and asphyxia (APGARs 1/5). On day 3 of life CAVH was initiated by connecting the umbilical artery line to the blood inlet port of a miniature Amicon diafilter; the umbilical venous line was connected to the blood outlet port. Over 24 hours 68 cc of ultrafiltrate was generated, the patient's edema markedly diminished.A 10 year old boy with infantile polycystic kidney disease and congenital hepatic fibrosis had been suffering steadily declining renal and hepatic function over about 8 months. Diuretic resistant anasarca and uremia developed. CAVH was performed with an Amicon Diafilter - 20 connected via a Scribner shunt. Ultrafiltrate formed at 500-700 ml/hour necessitating partial replacement with a modified Ringer's solution. After 24 hours creatinine and BUN fell and the edema was markedly reduced.CAVH solute clearance is by convection. Measured transplant kinetics: Na, K, HCO3, BUN, creatinine, phosphorus-unrestricted; bilirubin-negligible; calcium-limited to free (ionized) moiety.