title: The effect of vascular access location and size on circuit survival in pediatric continuous renal replacement therapy: a report from the PPCRRT registry.
abstract: OBJECTIVE
  Well-functioning vascular access is essential for the provision of adequate CRRT. However, few data exist to describe the effect of catheter size or location on CRRT performance in the pediatric population.
  
  
  METHODS
  Data for vascular access site, size, and location, as well as type of anticoagulant used and patient demographic data were gathered from the ppCRRT registry. Kaplan-Meier curves were generated and then analyzed by log-rank test or Cox Proportional Hazards model.
  
  
  RESULTS
  Access diameter was found to significantly affect circuit survival. None of the 5 French catheters lasted longer than 20 hours. Seven and 9 French, but not 8 French, catheters fared worse than larger diameter catheters (p=0.002). Circuits associated with internal jugular access survived longer than subclavian or femoral access associated circuits (p<0.05). Circuit survival was also found to be favorably associated with the CVVHD modality (p<0.001).
  
  
  CONCLUSIONS
  Functional CRRT circuit survival in children is favored by larger catheter diameter, internal jugular vein insertion site and CVVHD. For patients requiring catheter diameters less than 10 French, CRRT circuit survival might be optimized if internal jugular vein insertion is feasible. Conversely, when a vascular access site other than the internal jugular vein is most prudent, consideration should be given to using the largest diameter catheter appropriate for the size of the child. The CVVHD modality was associated with longer circuit survival, but the mechanism by which this occurs is unclear.
authors.affiliation: Department of Pediatrics and Human Development, Michigan State University, Grand Rapids, MI, USA. richard.hackbarth@devoschildrens.org
authors.forename: R
authors.initials: R
authors.lastname: Hackbarth
authors.forename: T E
authors.initials: TE
authors.lastname: Bunchman
authors.forename: A N
authors.initials: AN
authors.lastname: Chua
authors.forename: M J
authors.initials: MJ
authors.lastname: Somers
authors.forename: M
authors.initials: M
authors.lastname: Baum
authors.forename: J M
authors.initials: JM
authors.lastname: Symons
authors.forename: P D
authors.initials: PD
authors.lastname: Brophy
authors.forename: D
authors.initials: D
authors.lastname: Blowey
authors.forename: J D
authors.initials: JD
authors.lastname: Fortenberry
authors.forename: D
authors.initials: D
authors.lastname: Chand
authors.forename: F X
authors.initials: FX
authors.lastname: Flores
authors.forename: S R
authors.initials: SR
authors.lastname: Alexander
authors.forename: J D
authors.initials: JD
authors.lastname: Mahan
authors.forename: K D
authors.initials: KD
authors.lastname: McBryde
authors.forename: M R
authors.initials: MR
authors.lastname: Benfield
authors.forename: S L
authors.initials: SL
authors.lastname: Goldstein
mesh_terms: D000293:Adolescent; D000328:Adult; D002405:Catheterization, Central Venous; D002406:Catheterization, Peripheral; D002408:Catheters, Indwelling; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D006440:Hemofiltration; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007676:Kidney Failure, Chronic / Q000628:therapy*; D016016:Proportional Hazards Models; D012042:Registries; D006435:Renal Dialysis; D014481:United States