ESPN 51th Annual Meeting

ESPN 2018


 
Central venous catheters for acute extracorporeal dialysis: a promising experience of two-way PICC power injectable in young children
Luigi Annicchiarico Petruzzelli 1 Ugo Graziano 1 Vittorio Serio 1 Ilaria Luongo 1 Lorenza Lepore 1 Daniela Molino 1 Carmen Lubrano 1 Carmine Pecoraro 1

1- Unit of Nephrology and Dialysis, Children Hospital Santobono, Naples, Italy
 
Introduction:

Acute extracorporeal dialysis is ashorttermtreatment, performed by a central venous catheter of large size, ensuring high flow. These devices have limitations: high caliber, excessive length, impossibility of tunneling and exit-site location in the supraclavicular region, with a subsequent highrisk of dislocation and contamination. The authors report a new approachto dialytic central venous catheters selectionin children.

Material and methods:

 From January 2013 to December 2017, 16 children weighing less than 15 kg needed acute extracorporeal dialysis. Patients received an ultrasound guided percutaneous implantation of a two-way PICC power injectable catheter, in the right internal jugular vein or in the anonymous right vein. The device sizealways respected the ratio of 1/3; the catheters were cut to be adaptedto child height, and subclaveartunnelizations and stabilizations were ensured. The hemodialysis was performed with the Prismaflex Gambro system. The effectiveness of treatment was evaluated by recirculation test and by measuring the KT/Vat the third hour, expressing the dialysis adequacy.

Results:

 Two-way power injectable central venous catheter,sized from 5 to 7 Fr and long from 8 to 15 cm were used. The recorded blood flow ranged from 4.7ml/min/kg to 7ml/min/kg; a KT/V variable from 0.5 to 1 was detected; the recycling rate was between 32% and 40%. No catheter related complications were observed.

Conclusions:

In children weighing less than 15 kg, PICC power injectable have lower blood flow and higher recirculation rate compared to traditional dialysis catheters. However, the dialytic adequacy was suitable for an acute hemodialysis treatment. In addition, these catheters are available in a wide range of calibers and result moreadaptableto the venous system of younger children.