ESPN 51th Annual Meeting

ESPN 2018


 
Central vascular catheters for hemodialysis:a five years pediatric nephrology center experience.
VITTORIO SERIO UGO GRAZIANO 1 ROSAMUNDA DARCANGELO 1 MICHELE SAGLIANO 1 LUIGI ANNICCHIARICO PETRUZZELLI 1 ALFONSO FERRETTI 1 BRUNO MINALE 1 FRANCESCA NUZZI 1 CARMINE PECORARO 1

1- UNIT OF NEPHROLOGY AND DIALYSIS, CHILDREN HOSPITAL SANTOBONO, NAPLES, ITALY
 
Introduction:

Central vascular access is mandatoryfor extracorporeal dialytic treatment in children. Device selection is difficult inpediatric population: dialysis requires large catheters in spite ofthe small vein sizeof pediatric patients.  Theauthors report a retrospective analysis ofimplantation and use of hemodialysis catheters in a single pediatric nephrology center,from 2012 to 2017.

Material and methods:

69 children (29 females and 40 males; aged 1 day to 13 years)undergoing hemodialysis were observed. Their body weight varied from 3.4 kg to 85.0 kg. The children were divided into two subgroups according to therapeutic needs (8 chronic hemodialysis;61 acute hemodialysis). The veins selected for the implant were: right internal jugular vein (49), right anonymous vein (15), femoral vein (5).Twenty long-term cuffed and tunneled catheters and 49 short-term catheters were implanted. All devices were two-way, sized from 5Fr to 11Fr. Functional duration and secondary complicationswere recorded.

Results:

Devices were used for 2810 days. Secondary complications were3.5 ‰ catheter-days:1 ‰ for tunneled catheters, and 14 ‰ for non-tunneled catheters. In the latter group the rate of complication was respectively 30 ‰catheter-days forfemoral vein catheters 9 ‰for jugular vein catheters and 5 ‰for anonymous vein devices.

Conclusions:

In children, implantation of tunneled central catheters for hemodialysis in the large veins of the cervico-thoracic district, preferentially on the right side, reduced the rate of secondary complications. Subcutaneous tunneling in the sub-clavear region provided stability and efficiency of the catheter,during the dialytic treatment. Non-tunneled catheters showed a high rate of displacement, in particular when located in femoral vein,whereas anonymousvein position was the most stable and secure