Vascular access: choice and complications in European paediatric haemodialysis units.
BACKGROUND
European and U.S. guidelines emphasise that permanent vascular access in the form of arteriovenous fistulae (AVF) or grafts (AVG) are preferable to central venous catheters (CVC) in paediatric patients on long-term haemodialysis. We report vascular access choice and complication rates in 13 European paediatric nephrology units.


METHODS
A survey of units participating in the European Pediatric Dialysis Working Group requesting data on type of vascular access, routine care and complications in patients on chronic haemodialysis between March 2010 and February 2011.


RESULTS
Information was complied on 111 patients in 13 participating centres with a median age of 14 (range 0.25-20.2) years. Central venous catheters were used in 67 of 111 (60%) patients, with 42 patients (38%) having an AVF and two patients (2%) having an AVG. Choice of vascular access was significantly related to patient age, with patients with AVF/AVG having a median age of 16 years compared to 12 years for patients with CVCs (p < 0.001). Routine CVC exit site care and catheter lock solution use differed between centres. CVC infections requiring intravenous antibiotics were reported at a rate of 1.9 and exit site infections at a rate of 1.8 episodes/1000 catheter days. Overall infective complications necessitating CVC change occurred at a rate of 0.9 episodes/1000 catheter days. No infective complications were reported in patients with AVF/AVG access. The rate of CVC infections requiring intravenous antibiotics was significantly lower in patients in whom CVC exit sites were cleaned weekly as opposed to every dialysis session (relative risk with every session cleaning vs. weekly cleaning 2.58, 95% confidence interval 1.17-5.69). Catheter malfunction (inadequate blood flow) was a more prevalent complication necessitating 22.4 thrombolytic interventions/1000 catheter days and 2.1 CVC changes/1000 catheter days.


CONCLUSIONS
Central venous catheters remain the predominant choice of vascular access in Europe despite problems of malfunction and infection. AVF/AVG were predominantly used in adolescents without reported complications. More regular exit site cleaning may predispose to CVC infection, but this observation requires prospective evaluation.
Paediatric Nephrology, Nottingham Children's Hospital, QMC Campus, Derby Road, Nottingham, NG7 2UH, UK.
Wesley N
WN
Hayes
Alan R
AR
Watson
Nichola
N
Callaghan
Elizabeth
E
Wright
Constantinos J
CJ
Stefanidis
D000293:Adolescent; D017677:Age Distribution; D000367:Age Factors; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000639:trends*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000639:trends*; D055499:Catheter-Related Infections / Q000453:epidemiology / Q000628:therapy; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation / Q000639:trends*; D002408:Catheters, Indwelling / Q000009:adverse effects / Q000639:trends; D002648:Child; D002675:Child, Preschool; D020878:Device Removal / Q000639:trends; D004868:Equipment Failure; D005060:Europe; D019983:Guideline Adherence; D019538:Health Care Surveys; D006801:Humans; D007223:Infant; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000639:trends*; D006435:Renal Dialysis / Q000639:trends*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000628:therapy; D015912:Thrombolytic Therapy / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome; D056824:Upper Extremity Deep Vein Thrombosis / Q000453:epidemiology / Q000628:therapy; D055815:Young Adult
D000900:Anti-Bacterial Agents