By Maureen Gilmer, IU Health senior journalist, firstname.lastname@example.org
Some of the smallest patients at Riley Hospital for Children now have one more medical advancement going for them.
It’s a “state-of-the-art” dialysis system that is offered at only about a dozen pediatric hospitals in North America, and Riley is among that select few, according to Dr. David Hains, Riley’s chief of pediatric nephrology.
“Whenever we want to do dialysis in the ICU, we have a number of challenges,” he said. “We have machines that require very high blood flow rates, which is fine in an adult or older kiddo, but in babies it can be a real challenge. And now we have this teeny, tiny machine that can do some low-level dialysis, can pull fluid very easily and has simplified the entire process.”
“A game changer” is how Dr. Michelle Casey Starr describes the three new machines at Riley that offer a gentler, safer alternative to large, high-flow machines.
Dr. Starr is a pediatric nephrologist and clinical lead for the new program at Riley, which went online April 30. She arrived in Indianapolis two years ago from a fellowship at Seattle Children’s, the second pediatric hospital in the country to roll out the Aquadex Flex Flow System for use in infants.
“One of the reasons I was asked to come here was to help bring this program here,” she said. “I was really excited because it’s a huge benefit for a lot of our patients.”
The product itself is not new. It has traditionally been used to remove excess fluid from adult heart failure patients, Dr. Starr said.
“One of the many challenges in pediatric critical care and pediatric nephrology is that a lot of the technology we use is adult technology that we adapt to children. That’s especially the case with dialysis,” she said.
“So that means using big dialysis machines on very, very small patients and that’s very challenging for a variety of reasons. This is a much smaller machine, which means it’s much better tolerated in our smaller patients. It’s allowed us to dialyze smaller patients with fewer complications and more clinical stability.”
For comparison’s sake, a typical dialysis machine is about 3 feet tall, 19 inches deep and 1½ feet wide and can weigh up to 300 pounds. The new machines are about a foot tall and wide and come on a rolling pedestal.
Typically, patients are hooked up to the device continuously for several days or even weeks at a time, until their kidneys recover or they can be transitioned to peritoneal dialysis or another long-term option, Dr. Starr said.
The smallest NICU baby dialyzed with the new machine to date at Riley was 2 kilos, or about 4.6 pounds, she added.
With traditional dialysis machines, the benefits would not outweigh the risks in patients smaller than 4 or 5 kilograms (8-11 pounds).
“We couldn’t have tried regular dialysis with our smallest kiddos, but now we can.”
Dr. Mara Nitu, pediatric critical care division chief at Riley, said a group of specially trained nurses in the PICU and CVICU run the machines. A NICU baby might receive dialysis in the cardiovascular intensive care unit if he or she had a heart problem in conjunction with renal failure, or come to the PICU if the reason for dialysis stems from sepsis or another serious infection that can attack the kidneys.
“It’s a new machine, and it opens a whole new array of possibilities for tinier babies with congenital heart disease, or tinier babies with sepsis in the PICU or even tiny babies in the NICU,” she said. “We are developing protocols and practice guidelines, and we are very excited.”
The smaller machines operate with a much lower blood flow, as mentioned by Dr. Hains, and patients require a smaller central line, or dialysis catheter, so they typically don’t need a blood thinner to prevent blood clots.
For now, the team is in the ramping-up phase, Dr. Nitu said, troubleshooting new scenarios as they come along.
“We are learning very fast and becoming better and better. We think there are a lot of new opportunities to take care of patients.”
Kristen Freeman is among those specially trained CCRT (continuous renal replacement therapy) nurses in the PICU who see firsthand the benefits of the new system.
“It has been exciting to learn this new machine and adapt it to our patient population,” she said, adding that the Aquadex allows the staff to improve patient outcomes with less invasive interventions, including large dialysis catheters. It’s also easy to move around.
“From a nursing perspective, this machine is ideal for mobilizing patients and traveling to procedures around the hospital,” Freeman said. “It's smaller, it's on wheels, and it does not have to be continuously plugged in.”
Dr. Starr said the investment in the new machines reflects Riley’s commitment to provide the therapy necessary “to care for our sickest and our smallest patients.”
“It’s a really exciting time in pediatric critical care nephrology because there are a lot of different things coming down the pike,” she said.
Seeing the new dialysis technology come to fruition is a testament to the multidisciplinary team approach Riley has to patient care, say both Dr. Starr and Dr. Hains.
“Watching this has been really exciting,” Dr. Hains said. “Seeing everybody work together – pharmacy, supply chain, engineering, nursing, nephrology and critical care – we all have to be on the same page to do this.”