title: Survival and complications of cuffed catheters in children on chronic hemodialysis.
abstract: Central venous catheters are being increasingly used as hemodialysis vascular access. We evaluated catheter survival, outcome predictors, and complications in a total of 36 catheters used in 13 children and young adults undergoing chronic maintenance hemodialysis through catheter for a duration of 10.4+/-5.6 months. Reasons for catheter failure were: thrombosis 12 of 36 (33%), infection 6 of 36 (17%), and extrusion 2 of 36 (5.4%). Catheters were lost to infection and thrombosis at 1.1 and 2.2 episodes per 1,000 catheter days, respectively. Symptomatic infections, Gram-negative and polymicrobial sepsis increased the risk of catheter failure. Most of the thrombotic episodes occurred in patients with inherent thrombotic tendency. The survival of the 36 catheters was 62% at 1 year. The survival of 13 randomly chosen catheters, 1 from each patient, was 85% at 1 year. The time from insertion to first complication correlated significantly with the outcome (P<0.03). We conclude that central venous catheters are still associated with a high rate of failure and may be a regular access choice only in a selected patient population with no inherent thrombotic tendency and no other option available for long-term hemodialysis.
authors.affiliation: Division of Pediatric Nephrology, University of Miami/Jackson Children's Hospital, FL 33101, USA.
authors.forename: A
authors.initials: A
authors.lastname: Sharma
authors.forename: G
authors.initials: G
authors.lastname: Zilleruelo
authors.forename: C
authors.initials: C
authors.lastname: Abitbol
authors.forename: B
authors.initials: B
authors.lastname: Montane
authors.forename: J
authors.initials: J
authors.lastname: Strauss
mesh_terms: D000293:Adolescent; D001424:Bacterial Infections / Q000453:epidemiology / Q000209:etiology; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000295:instrumentation; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D011446:Prospective Studies; D006435:Renal Dialysis / Q000295:instrumentation*; D013927:Thrombosis / Q000453:epidemiology / Q000209:etiology; D013995:Time; D016896:Treatment Outcome