"In-Series" Continuous Renal Replacement Therapy and Therapeutic Plasma Exchange: Single-Center Retrospective Cohort, 2018-2022.

OBJECTIVES

To describe our use and experience with an "in-series" approach for patients requiring both continuous renal replacement therapy (CRRT) as well as therapeutic plasma exchange (TPE).

DESIGN

Retrospective review of case notes.

SETTING

General and cardiac PICUs at the Royal Children's Hospital in Melbourne, VIC, Australia.

PATIENTS: Children (0-18 yr old) requiring both CRRT and TPE between 2018 and 2022.

INTERVENTIONS: None.

MEASUREMENTS AND MAIN

RESULTS

Twelve children were successfully and safely treated with 32 TPE sessions and 38 CRRT sessions with our in-series CRRT and TPE setup using a total of 20 extracorporeal circuits and 11 additional plasma filters or hemofilters. This represents a reduction of 71% in standard circuit usage.

CONCLUSIONS

Our approach to providing "in-series" CRRT and TPE used existing access and circuits, a single device, and resulted in efficient treatments, reduced infection risk, reduced exposure to circuits, less hemodilution, and less blood product use. Small potential cost and waste reductions were also achieved. This approach was performed safely with no unexpected adverse events.