title: Radiologically placed tunneled hemodialysis catheters: a single pediatric institutional experience of 120 patients.
abstract: OBJECTIVE
  To report the outcome of tunneled dialysis catheter insertion in 120 patients.
  
  
  METHODS
  A retrospective review of the interventional radiology database and electronic medical records of 120 patients who had tunneled dialysis catheters inserted from April 1997 to July 2010 was performed with institutional review board approval. There were 61 female patients and 59 male patients, with a mean age of 13.3 years (range, 0.2-28.5 y). A total of 193 primary insertions and 330 salvage procedures were performed.
  
  
  RESULTS
  The technical success rate for primary catheter insertions was 100%. Immediate complications included self-limiting tract bleeding and air embolism in two of 193 insertions each (1.03%). Mean indwell duration for primary insertions was 66 catheter-days (range, 1-765 d), compared with a total mean of 159.4 catheter-days (range, 1-1,034 d). Rates of infection and mechanical complications were 0.21 and 0.9 per 100 total catheter-days, respectively. Mechanical and infections complications were increased in children younger than 9 years of age and weighing less than 20 kg. The catheter removal rates for infection and mechanical complications were 0.084 and 0.081 per 100 catheter-days, respectively. Medical salvage procedures, ie, intracatheter thrombolytic agent use or antibiotic therapy (52.1%) and interventional radiologic catheter salvage procedures (47.1%), increased catheter survival by an average of 54.8 days (range, 0-959 d).
  
  
  CONCLUSIONS
  Radiologic placement of tunneled hemodialysis catheters is a safe and technically successful procedure in pediatric patients. However, there is a high rate of infectious and mechanical complications, particularly in younger and smaller patients.
authors.affiliation: Department of Radiology, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia 19104, USA. adebm@email.chop.edu
authors.forename: Melkamu
authors.initials: M
authors.lastname: Adeb
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Baskin
authors.forename: Marc S
authors.initials: MS
authors.lastname: Keller
authors.forename: Ganesh
authors.initials: G
authors.lastname: Krishnamurthy
authors.forename: Els
authors.initials: E
authors.lastname: Nijs
authors.forename: Kevin
authors.initials: K
authors.lastname: Meyers
authors.forename: Madhura
authors.initials: M
authors.lastname: Pradhan
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: Cahill
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001835:Body Weight; D055499:Catheter-Related Infections / Q000209:etiology; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation*; D002408:Catheters, Indwelling / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D004867:Equipment Design; D004868:Equipment Failure; D005260:Female; D006801:Humans; D007223:Infant; D007601:Jugular Veins / Q000000981:diagnostic imaging*; D053208:Kaplan-Meier Estimate; D008297:Male; D016017:Odds Ratio; D015143:Philadelphia; D015641:Radiography, Interventional; D006435:Renal Dialysis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult