Texas Children’s Austin Team Collaborates to Deliver Advanced Dialysis Care in our NICU 

When a premature newborn born earlier this year at Texas Children’s Hospital North Austin developed neonatal acute kidney injury (AKI), the Level IV NICU care team turned to a technology rarely used outside the country’s largest pediatric hospitals. Designed specifically for newborns and infants who are too small for standard dialysis machines, the cardio-renal pediatric dialysis emergency machine known as Carpediem™ allows providers to deliver continuous renal replacement therapy at a scale safe for even the smallest patients. 

It was the first opportunity for a baby in Austin to receive Carpediem™ treatment locally. For the nurses and specialists involved, it marked an important step forward for Texas Children’s newest campus and underscored how teamwork, expertise and technology come together in the care of our tiniest patients. 

NICU Nurses at the Bedside 

Amy Gunderson, one of the NICU nurses who cared for the infant, highlights how vital communication and building trust with the family are in a complex case. “There are so many machines and monitors in play that it can be overwhelming for parents,” she says. “Part of our job is helping them understand what each one does, so they feel included in their baby’s care.” 

Amy stayed closely connected to the family, explaining alarms and helping them feel comfortable even when they couldn’t hold their son. “You want them to know their baby is still their baby,” she says. “They can talk to him, sing to him, and be present. Those things matter.” 

ECMO Support Behind the Scenes 

While Amy managed the baby’s day-to-day needs, respiratory therapist and ECMO specialist Rachel Snellenberger monitored the circulatory side of care. Her expertise with life-support systems helped bridge the gap between the NICU and dialysis teams. 

“My role is to make sure blood is flowing safely through the circuit,” Rachel explains. “With Carpediem™, the volumes are so small that even minor changes matter. We’re constantly checking anticoagulation levels, looking for air bubbles, and helping the bedside nurses troubleshoot.” 

Rachel describes the experience as a true collaboration. “We all rely on each other’s eyes and skills. The NICU nurses know these babies best, and the renal team understands the machine’s nuances. It takes everyone working together.” 

Engineering Care for the Smallest Patients 

For Yadira Muñoz, a dialysis nurse with two decades of experience, seeing Carpediem™ in action was both familiar and entirely new. 

“It resembles a regular hemodialysis machine, but it’s smaller and designed for babies based on their exact weight,” she says. “We’re able to do safely for infants what we used to only do for bigger kids or adults.” 

Before treating the first patient, the team spent hours training with the manufacturer, running simulations and learning how to handle potential issues. “We got a really good in-service,” Yadira recalls. “They walked us through everything so that when the time came, we were ready. We followed every step, and the treatments went safely.” 

Even with preparation, there were challenges. “There was a lot of troubleshooting,” she says. “We’d all put our brains together—nurses, physicians, ECMO specialists—to figure out what might be causing an alarm or pressure change. Everyone communicated constantly, and we kept each other updated.” 

Serving Families Closer to Home 

Having the technology available in Austin changes what care looks like for families. “They don’t have to travel hours away,” Yadira says. “They can stay here, close to their baby. It’s less stress on the parents and gives siblings and relatives more opportunities to be involved.” 

Yadira often spent time one-on-one with this family to answer questions and ease fears. “We went over the machine together so they could see it’s safe,” she says. “You want them to feel that their baby is in good hands.” 

A Team That Learns Together 

Throughout the case, collaboration was constant. Yadira explains how input from each role shaped care decisions. “The NICU nurses would tell us, ‘The machine runs better when he’s on his left side,’ or ‘He gets cold when the treatment goes longer.’ That information helps us adjust flow rates or temperature. It’s all connected.” 

Amy saw the same spirit at the bedside. “It’s not just about what one person does,” she says. “When you have a small, tight-knit group that communicates well, you can take on something this complex with confidence.” 

That culture of support is something Rachel says defines the Austin campus. “Everyone is willing to help,” she says. “If you have a question, someone will stop and work through it with you. It’s a learning environment for all of us.” 

Growing Skills, Growing Impact 

For Yadira, who previously worked in adult dialysis, joining Texas Children’s has meant rediscovering why she became a nurse. “It’s rewarding to see these babies grow and to know you’re helping them get one step closer to going home,” she says. “When I see him now on peritoneal dialysis and gaining weight, it feels amazing.” 

She also sees the professional opportunity in mastering a rare skill set. “This kind of experience is one-of-a-kind,” she says. “You might never see it again in your career. I’m proud to be one of the few nurses who’ve had the chance to manage it.” 

Rachel agrees that the case deepened her appreciation for innovation. “Every time we take on something new like this, it reminds me how much potential there is in pediatric care when we have the right people and the right tools.” 

Building the Future of Care for Newborns in Austin 

As Texas Children’s Hospital North Austin continues to grow, team members like Amy, Rachel, and Yadira are shaping its identity. They are building a close, collaborative culture that delivers advanced care with expertise and teamwork. 

“It gives me a sense of accomplishment to know we can do this here,” Yadira says. “If another baby needs this treatment, we’ll be ready.” 

Join the team: Nurses and specialists at Texas Children’s Hospital North Austin are part of something extraordinary, bringing advanced pediatric care to families across Central Texas. Explore opportunities and see how you can make a life-changing difference for our tiniest patients.