title: Central venous catheters as a vascular access modality for pediatric hemodialysis.
abstract: BACKGROUND
  The use of hemodialysis catheters is an essential component of dialysis practice. Children are particularly likely to require multiple courses of dialysis over their lifetime, hence the repeated need for vascular access. These catheters remain a significant source of morbidity and mortality.
  
  
  METHODS
  All catheters inserted for hemodialysis at the Center of Pediatric Nephrology and Transplantation, Cairo University over a period of 40 months were studied. Patient data as well as data of catheter insertion, dwell, cause of removal and complications were reported.
  
  
  RESULTS
  A total of 195 uncuffed central venous catheters were used for temporary access in 131 patients for a mean duration of 35.7 days. Of attempted insertions, 87.4% achieved successful access, of which 56% remained for the required period, 8.9% were accidentally dislodged, and 35.1% were removed due to complications--mostly infection. The overall rate of possible catheter-related bacteremia was 9.6 episodes/ 1,000 catheter days. Infection increased with longer catheter dwell. Nineteen cuffed tunneled catheters were surgically inserted and used for up to 11 months (mean 117 days). Loss of these catheters was attributed mainly to infection (ten episodes) and catheter thrombosis (six episodes). During the study, 317 femoral catheters were inserted.
  
  
  CONCLUSIONS
  Uncuffed central venous catheters are both needed and useful for short-term hemodialysis. Vascular access for extended durations may be provided by cuffed tunneled catheters. Infection is the major serious concern with both uncuffed and cuffed catheters.
authors.affiliation: Pediatrics Department, Center of Pediatric Nephrology and Transplantation, Faculty of Medicine, Cairo University, Egypt.
authors.forename: Fatina Ibrahim
authors.initials: FI
authors.lastname: Fadel
authors.forename: Hesham Nabil
authors.initials: HN
authors.lastname: Abdel Mooty
authors.forename: Hafez Mahmoud
authors.initials: HM
authors.lastname: Bazaraa
authors.forename: Samar Mohamed
authors.initials: SM
authors.lastname: Sabry
mesh_terms: D000293:Adolescent; D016470:Bacteremia / Q000209:etiology; D002405:Catheterization, Central Venous / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D004867:Equipment Design; D005260:Female; D006801:Humans; D007223:Infant; D007601:Jugular Veins; D008297:Male; D006435:Renal Dialysis / Q000295:instrumentation*; D013350:Subclavian Vein