Dialysis care evolving for the Littlest Victors

Members of the team that helps run the pediatric continuous renal replacement therapy (CRRT) program at Mott.

Approximately a 4-minute read

Key takeaways:

  • 24-hour continuous dialysis for children is now being offered at Mott.
  • The therapy uses a machine known as CARPEDIEM and is being provided for patients in the PCTU and PICU.
  • The CARPEDIEM machine and availability of care is rare, making Mott a national leader in this type of innovation, safety and quality, and access – all pillars of U-M Health’s BASE strategic priorities.

While dialysis care is common for adults and children whose kidneys stop working properly, what happens when a baby is born needing the specialized care?

“Historically, there has only been a limited option for continuous hemodialysis – or CRRT — for infants,” said Michele Derheim, clinical nursing director of the Pediatric Intensive Care Unit, Pediatric Rapid Response Team, and Pediatric Dialysis Unit at Mott. “It’s always revolved around adapting adult machines and adult filters for little babies.”

Dialysis treatments help remove waste and excess fluids from the bloodstream by using a large machine that filters and cleans the blood. Many patients need the treatment three to four times per week and each treatment can take several hours. For patients who are too sick to tolerate these intermittent dialysis treatments, they may require continuous hemodialysis.

CRRT for infants

“We’re excited because the field is changing dramatically along with the care available for small patients,” said Katie Plomaritas, clinical care coordinator and program manager of the pediatric continuous renal replacement therapy (CRRT) program at Mott. CRRT is a non-stop, 24-hour dialysis therapy for children.

“Our pediatric patients needing CRRT often have multiple organ failure and need help with their kidneys for their critical illness,” Plomaritas said.

The team explained that in the past they have had to treat infants using a CRRT machine that is built for people weighing 45 pounds or greater. Now, thanks to a new device that received authorization from the Food and Drug Administration in 2020, infants weighing between 5 and 20 pounds can receive CRRT safely.

The device is called Cardio-Renal Pediatric Dialysis Emergency Machine, or as the Mott team and other medical providers call it for short, CARPEDIEM.

CRRT through the CARPEDIEM is currently provided to Mott patients in the PCTU and PICU, but they hope to be able to work with the NICU teams in the future, too.

“This new technology required an extensive amount of training for our dialysis team as it requires more daily care than previous dialysis machines,” Plomaritas said. “Nurses must have a high-level of skill to safely care for these patients. Our specialized CRRT nurses had many hours of training, and the rest of our ICU nurses also had a several hour training with an education plan that allows them to receive continuing medical education credits.”

CARPEDIEM and living out our BASE

The CARPEDIEM machine and availability of care is rare.

“Because there are so few children that need kidney support nationally, centers around the country collaborate together and we knew about it through our colleagues nationally,” Plomaritas said. “When it was available, we strongly advocated and Michele advocated for us and backed us up to place a capital request, knowing that it is costly. She advocated for us because she knew how revolutionary it is and its ability to treat patients.”

Having this technology and treatment option allows the Littlest Victors at Mott Access to revolutionary care and improves the patient Experience for Mott patient families, two pillars of U-M Health’s BASE strategic priorities. In addition, the provider team is improving Safety and Quality in dialysis care for this patient population, yet another pillar.

“I feel lucky to work at an institution that values this treatment and wants to help the smallest patients,” Plomaritas said. “Sara Hoatlin is the pediatric CRRT educational nurse coordinator. She has been a tremendous partner in the development of a CARPEDIEM program at Mott and I am so grateful to work with her.”

The team is looking to expand the number of patients that receive CARPEDIEM care.

“We have had three patients that have had this therapy and our hope is to be able to grow the program to expand and treat a new neonatal patient population,” Plomaritas said.

Putting Mott on the map nationally

Plomaritas and her physician colleagues are a part of a national collaborative and Plomaritas is on the collaborative’s steering committee.

“We are a part of the ‘Improving CARPE DIEM in Neonates and Infants Through Collaboration Iconic’ multicenter quality improvement and research collaborative,” Plomaritas said.

Derheim quickly chimed in, “Katie is recognized nationally as an expert in CRRT care. She has presented at national conferences at the national level, and we are lucky to have her here at Mott. Without her work and her training of her colleague Sara Hoatlin, we wouldn’t have the national level of CRRT care available at Mott.”

March is National Kidney Month and the organization would like to recognize Michele, Katie, Sara and all of the pediatric dialysis team at Mott for their incredible work and living out our BASE!