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Access for PCRRT

Access for PCRRT. Timothy E. Bunchman Professor Pediatrics. The System is Down due to poor Access!. My first choice is…. Factors affecting choice of access. Size of access relative to size of child Placement of access does it matter where it is placed? Configuration Side by side

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Access for PCRRT

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  1. Access for PCRRT Timothy E. Bunchman Professor Pediatrics

  2. The System is Down due to poor Access!

  3. My first choice is….

  4. Factors affecting choice of access • Size of access relative to size of child • Placement of access • does it matter where it is placed? • Configuration • Side by side • Double D • Co-axial

  5. Access Choice • The optimal access • Large internal diameter • to minimize resistance due to internal diameter • Short length • to minimize resistance due to length • In the case of vascular access • SIZE DOES MATTER

  6. Access Choice • Patient Size Access Size Location Company • Neonate DL 7 Fr IJ/SC/Fem Cook/Med Comp • 3-15 Kg DL 7 Fr IJ/SC/Fem Cook/Med Comp • DL 8 Fr IJ/SC/Fem Med Cp/Quinton • 15-30 Kg DL 8 Fr IJ/SC/Fem Quinton • DL 9 Fr IJ/SC/Fem Med Comp • > 30 Kg DL 10 Fr IJ/SC/Fem Multiple Choices

  7. 7 French access • Cook mini-puncture • soft • 10 cm, side by side configuration • BFR: 0-100 mls/min • venous pressure: 200-250 mm Hg • recirculation rate: < 5%

  8. 7 French access • Med Comp soft line • soft • 10 cm, side by side configuration • BFR: 0-100 mls/min • venous pressure: 200-250 mm Hg • recirculation rate: < 5%

  9. 7 French access • Cook Bunchman co-axial • stiff • 10 cm, coaxial • BFR: 0-75 mls/min • venous pressure: 200-300 mm Hg • recirculation rate: < 5%

  10. 8 French access • Quinton (Kendall) • stiff • 9, 12, 15 cm, double D configuration • BFR: 0-250 mls/min • venous pressure: 50-250 mm Hg • recirculation rate: < 5%

  11. 8 French access • Arrow • soft • 11 cm, side by side • BFR: 0-200 mls/min • venous pressure: 100-300 mm Hg • recirculation rate: < 5%

  12. 9 French access • Med Comp • soft • 10 cm, co-axial • BFR: 0-200 mls/min • venous pressure: 100-300 mm Hg • recirculation rate: < 7 %

  13. 12 French access • Arrow triple lumen • stiff • 16 cm, side by side • BFR: 0-350 mls/min • venous pressure: 50-250 mm Hg • recirculation rate: < 5%

  14. Location of Access • Is there an optimal location • Does the location affect • ? BFR • ? Flow resistance • ? Recirculation

  15. Bunchman Bias • All access should be Rt IJ if possible due to effect on patient care, turning in bed, flexing the legs all of which affect BFR • Study in Children < 20 kg • Quinton (Kendall) 8 Fr catheter • “Above” vs “”Below” the diaphragm

  16. Comparison of upper vs. lower body location line placement(n = 20; 120 Treatments) P value NS NS NS NS

  17. Access-Conclusion • Anticoagulation requirements, BFR, flow resistance, “happiness” at bedside is all correlated to good access • Best access is that which correlates to the size of the child • Without good access “you might as well go home”

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