Hemodialysis Catheters in Infants: A Retrospective Single-Center Cohort Study

Abstract

PURPOSE Evaluate technical aspects and outcomes of insertion/maintenance of hemodialysis (HD) central venous catheter (CVC) during infancy. MATERIALS AND METHODS Single-center retrospective study of 29 infants who underwent 49 HD-CVC insertions between 2002 and 2016. Demographics, procedural, and post-procedural details, interventional radiology (IR) maintenance procedures, technical modifications, complications, and outcomes were evaluated. Technical adjustments during HD-CVC placement to adapt catheter length to patient size were labeled "modifications." CVCs requiring return visit to IR were called IR-maintenance procedures. Mean age and weight at HD-CVC insertion were 117 days and 4.9 kg. RESULTS Of the 29 patients, 13 (45%) required renal-replacement-therapy (RRT) as neonates, 10 (34%) commenced RRT with peritoneal dialysis (PD), and 19 (66%) with HD. Fifteen nontunneled and 34 tunneled HD-CVCs were inserted while patients were 1 year. Technical modifications were required placing 25/49 (51%) HD-CVCs: 5/15 (33%) nontunneled and 20/34 (59%) tunneled catheters (P = .08). Patients underwent 6 dialysis-cycles/patient during infancy (mean 2.3), and a mean of 4.1 and 49 HD-sessions/catheter for nontunneled and tunneled HD-CVCs, respectively. Mean primary and secondary device service, and total access site intervals for tunneled HD-CVCs were 75, 115, and 201 days, respectively. A total of 26 of 49 (53%) patients required IR-maintenance procedures. Nontunneled lines had greater catheter-related bloodstream infections per 1,000 catheter-days than tunneled HD-CVCs (9.25 vs. 0.85/1,000 catheter days; P = .02). Nineteen patients (65%) survived over 1 year. At final evaluation (December 2017): 8/19 survived transplantation, 5/19 remained on RRT, 2/19 completely recovered, 1/19 lost to follow-up, and 3 died at 1.3, 2, and 10 years. CONCLUSIONS Placement/maintenance of HD-CVCs in infants pose specific challenges, requiring insertion modifications, and IR-maintenance procedures to maintain function.

Splenic Vessels as a Rescue for Pediatric Kidney Retransplantation in Children With Iliac-caval Agenesis or Thrombosis

“…Peritoneal dialysis (PD), generally preferred as the simpler and most effective treatment, can be complicated by peritonitis, ultrafiltration/depuration inefficiency, or catheter-related complications, whereas hemodialysis (HD), which requires a proper vascular access by the mean of comparatively large central venous catheters, may lead to endothelial damage, infection, and thrombosis and result in progressive venous depletion. 1 Chronic dialysis, however, even if supplemented by optimized medical therapy, only partially substitutes renal function and might be associated with growth retardation, mineral bone disorders, loss of school time, and developmental delays, all of which can be overcome by transplantation. Therefore, kidney transplantation (KT) in infants is indicated as soon as they reach reasonable weight and height, even if thrombosis or vascular malformations of the iliac-caval system may require tailored solutions.…”

Hemodialysis Catheter Breakage in an Infant

“…This leaves few options besides making off-label technical adjustments during catheter placement, such as catheter tip trimming or extension of the subcutaneous tunnel. 3…”

“…This leaves few options besides making off-label technical adjustments during catheter placement, such as catheter tip trimming or extension of the subcutaneous tunnel. 3 Complications related to hemodialysis central venous catheters in children are common. Catheter-related infection and mechanical malfunction are the leading complications.…”