Pediatric and Infant Center for Acute Nephrology (PICAN)
The Pediatric and Infant Center for Acute Nephrology (PICAN) was established in 2013 as a service of Pediatric Nephrology at Children’s of Alabama.
The mission of PICAN is to improve global outcomes through innovation, education, and provision of high-quality, multi-disciplinary clinical care for children and their families with acute kidney injury and those who require blood purification.
To achieve its mission, PICAN has adopted a five-pronged model that focuses on excellence in the following areas. For more detailed information regarding these pillars, see tab on the left side.
The PICAN Team at Children’s of Alabama is dedicated to the children of Alabama and proud of the babies, kids and their parents we have been able to care for and treat.
We strive to provide state-of the art comprehensive care for each of our patients, maintaining excellence at every level (bedside, dialysis, ICU). We frequently look to perform quality assessment and improvement while seeking ways to innovate our clinical care.
Acute Dialysis and Pheresis Team (ADAPT)
The Acute Dialysis and Pheresis Team under PICAN provides trailblazing therapies for the patients at Children’s of Alabama. We work closely with our intensive care teams to provide the most appropriate therapies for our patients with the latest technology the world has to offer.
There are a variety of reasons a child needs renal replacement therapy, including acute kidney injury, fluid overload, sepsis, chronic kidney disease, and/or congenital kidney disease. Each child receives a treatment plan, created in collaboration with our ICU teams, tailored to their individual needs.
There are multiple types of Dialysis (also referred to as Kidney Support Therapy). At COA we provide the following:
Acute Peritoneal Dialysis (PD): The most common and preferred method of dialysis in children, acute PD is a non-blood dialysis, using the peritoneum, or the cavity inside the belly, to remove waste products and excess water. We use this form of dialysis frequently in our neonatal congenital heart disease population after cardiopulmonary bypass, ensuring better fluid balance in these babies.
Renal Replacement Therapy (RRT): (hyperlink to education sheet) This method of dialysis is used in the intensive care unit to support a child’s kidneys when they are not working properly. We use an IV catheter to circulate blood into a machine or, cleaning it and removing fluid.
CRRT: Continuous, usually performed 24 hours a day. This is reserved for our sickest patients.
PIRRT: Prolonged Intermittent, usually performed 6-18 hours a day. This is used when our sick patients start to get better but still may need dialysis.
SCUF: Fluid removal only. No cleaning of the blood happens with this therapy.
ECMO: Renal Replacement Therapy can be performed with Extracorporeal Membrane Oxygenation (ECMO) if patients need it. We can use our machine or their machine to do this therapy.
Neonatal Renal Replacement Therapy: Many babies are born without functioning kidneys. Other babies get really sick because they are born early or have other medical problems. These babies may all require renal replacement therapy. Until recently, machines made for dialysis were not created for such tiny babies. We provide renal replacement therapy for these small infants using the Aquadex machine, modified to not only remove fluid, as intended, but to provide waste clearance and electrolyte balance as well. Using innovation and some basic engineering, our PICAN Team at Children’s of Alabama was the first hospital to try this novel method! Please see below for more information!
Therapeutic Plasma Exchange (Plasmapheresis)
We are proud to work with many other specialties in the hospital to provide plasma exchange to treat a number of different diseases.
We place a large IV catheter and remove blood from the body. We separate the blood from the plasma to remove antibodies or abnormal proteins that are making the patient sick, and replace the plasma with donor or man-made plasma.
The PICAN team provides infrastructure to conduct innovative research on pediatric and neonatal acute kidney injury. Our success is to be measured by:
• Grants/contracts
• Abstracts to national meetings
• Speaking engagements
• Original manuscripts
• Reviews/book chapters
AWAKEN
Assessment of Worldwide Acute Kidney Injury Epidemiology in Neonates was a 3-month restrospective chart review on eligible critically ill neonates admitted to neonatal intensive care units from centers in the Neonatal Kidney Collaborative (NKC).
AWAKEN is the first research study from the NKC, an international collaborative multi-disciplinary group made up of neonatologists and pediatric nephrologist to investigate important questions related to neonatal AKI. (See below for more information regarding the NKC).
For information, click here.
SCD
The major goal of this multi-center, pilot study sponsored by CytoPherx, Inc. is to evaluate the safety and efficacy of Selective Cytopheretic Device (SCD) therapy in pediatric patients with acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT).
NKC
The Neonatal Kidney Collaborative (NKC) is dedicated to improving outcomes in neonates at risk for acute kidney injury. Spearheaded by Dr. David Askenazi, the group has developed a robust infrastructure to support collaboration among an international network of neonatologists, pediatric nephrologists, obstetricians and pediatricians.
Please see babykidney.org for more information!
Here is some recent data that our PICAN has presented at meetings!
Bival poster
PD poster
6 french abstract poster
Improving confidence poster
Aquadex for Renal Replacement Therapy
Our PICAN Team is always thinking of innovative ways to treat our patient population. We were the first to use the Aquadex for Renal Replacement Therapy. See video for more information (Aquadex - Wryn
or see this paper for additional details.
https://pubmed.ncbi.nlm.nih.gov/31462396/
Zorro-Flow®
Collecting urine in small babies can sometimes be very difficult. Dr. Askenazi, the director of PICAN, has recognized the gap in products available for this population. In response, he and his amazing engineering team at Children’s of Alabama and University of Alabama at Birmingham created Zorro-Flow®. Zorro-Flow® a SAFE and EFFECTIVE external urine collection device designed for newborns and small children. The patent pending ergonomic design makes it easy for the clinician to obtain timely urine collection. It was created here at COA!
https://www.childrensal.org/news/childrens-and-uab-launch-new-urine-collection-device-critically-ill-premature-infants-and
We are always trying to help infants and kids with kidney issues through innovation! More to come soon!!
The PICAN team at Children’s of Alabama is dedicated to the education of our collaborating teams. Many of the therapies our Acute Dialysis and Pheresis Team provide are provided in other areas of the hospital. It is important that the Intensive Care Unit faculty and staff are knowledgeable as well in this area.
Our ADAPT Nurses and APPs are dedicated to real time education of our ICUs. We round several times a day and use any opportunity for learning.
Resident Training
Our inpatient Nephrology team provides education for Residents on a daily basis. We are always staffed with a Junior Resident (doctor in their first Post Grad Year) and an additional Resident (Post Grad Year 2 or 3). We give on the job training in acute and chronic kidney disease, our extracorporeal and dialysis therapies and other interesting topics.
Fellow/Advanced Practice Provider Training
A fellow is a physician who opts for an additional 4-6 years of Post Grad training.
Nephrology fellows who are part of our team receive on the job training with our PICAN team for 3 years. They must pass a series of hands on and didactic exams to graduate their fellowship.
We provide education for our NICU, PICU, CVICU and surgery fellows twice a year.
Advanced practice providers (APPs) are Nurse Practitioners or Physician Assistants. These Masters Prepared Providers are proficient in the area in which they work. They often have many years of experience in the medical field. They are included in our twice-yearly Fellow/APP Education sessions, and we also provide additional education during their own conferences and learning days throughout the year.
We offer all Attending Physicians in our ICUs the chance to attend our Fellow/APP talks as well and many come over and over.
Nurse Training
Bedside nurses in our ICU and Dialysis help perform many of our acute therapies. We provide courses for all therapies, with beginner and advanced courses.
These courses utilize the following:
- Computer Based Training
- Class didactic lecture
- Hands on Practice and Learning
- Simulations supported by our incredible Simulation Team (link to their website) - https://www.childrensal.org/services/pediatric-simulation-center
Family Education
We are dedicated to the education of our patients and families. We offer several different education methods to help our families cope with their diagnoses. We offer bedside education and classes for our longer-term therapies, should a patient need them. We have lots of education material for several different disease processes and therapies.
What do the kidneys do? (Link)
AKI (link)
CRRT (Link)
PD (link)
For more information on Kidney Disease Family Education, please email kara.short@childrensal.org.
Outside Institution Education Opportunities
In 2020, ADAPT acknowledged the need for sharing information about our program with others. The Neonatal and Infant Course for Kidney Support (NICKS) has taught nephrology, neonatology and intensive care providers in all six habitable continents! Please see our NICKS page for more information.
LINK TO NICKS PAGE - https://www.childrensal.org/services/nephrology/pediatric-and-infant-center-acute-nephrology-pican/neonatal-and-infant-course
The PICAN team is always looking to increase knowledge regarding the health of neonatal kidneys. We will be hosting the first International Neonatal Nephrology Symposium in September 2024! For more details, please see the INNS (new tab) website.
We are honored to be faculty of several international conferences and meetings.
The International Symposium on AKI in Children, hosted by Cincinnati Children's Heart Institute and Center for Acute Care Nephrology, is a triyearly conference for nephrology and intensive care healthcare workers who show in interest in acute kidney injury in children. We are excited for the 5th conference in 2025.
https://www.cincyhearteducationseries.org/akisymposium
The first International Conference Of Critical Care Nephrology In Children will take place in London, England in July 2023.
https://whova.com/web/40Kv1v2nIxfnbOmwgwP6u83KOW8DaCZzulKfNw3Dvu0=/
The International Conference on Advances in Critical Care Nephrology in San Diego, California meets yearly to discuss the latest in ICU medicine as it relates to kidneys and renal replacement therapy!
https://crrtonline.com/crrtconference/
