Hemodialysis vascular access in children – A retrospective study in a pediatric dialysis unit

Objective: Permanent access in the form of a fistula is the preferred form of vascular access for most pediatric patients on maintenance hemodialysis (HD) therapy; however, the technical aspects of the procedure that are unique to the pediatric population, the expectation of a short waiting time for kidney transplantation and the need to cannulate every other day (with the pain and fear associated with it) limit its use. Our objective was to analyze the long-term outcomes of pediatric arteriovenous fistulas in our institution. Methods: A retrospective review was performed of all arteriovenous fistula (AVF) created in a HD population aged 0 to 18 years at a single institution from 2007 to 2019. Data abstracted included age, weight, etiology of renal failure, time on dialysis, central venous catheter history and transplantation history. Data were analyzed to determine the primary and secondary patency. Results: During the study period, 19 AVFs were performed in 16 patients, of whom 9 patients (56.3%) were male. Mean patient age was 12.3 years (range 5-17 years), and mean weight was 38.3kg (range 12-83kg). At the time of AVF creation, 9 patients were on dialysis and 7 patients had a central venous catheter (CVC), with a median length of CVC dependence of 10 months. Procedures performed included 4 radiocephalic fistulas, 11 brachiocephalic fistulas and 4 brachiobasilic. Five accesses failed to mature (26.3%). Mean follow-up was 6 years. The 2-year primary and secondary patency rates were 92.3% and 100%, respectively. The 4-year primary and secondary patency rates were 76.9% and 100%, respectively. No thrombosis was documented during follow-up. During the postoperative period, 10 patients (62.5%) received a kidney transplant, in a mean time of 23 months. Conclusions: AVFs demonstrate excellent long-term patency in pediatric HD patients. No significant complications were reported and no thrombosis occurred.

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Effectiveness, safety and cost reduction of long-term tunneled central venous catheter insertion in outpatients performed by an interventional nephrologist

Brazilian Journal of Nephrology ◽

10.1590/2175-8239-jbn-2019-0108 ◽

2020 ◽

Vol 42 (1) ◽

pp. 53-58

Author(s):

Artur Quintiliano ◽

Marcel Rodrigues Gurgel Praxedes

Keyword(s):

Central Venous Catheter ◽

Vascular Access ◽

Survival Rates ◽

Cost Savings ◽

Venous Catheter ◽

Central Venous ◽

Catheter Survival ◽

Stage Renal Disease ◽

End Stage

Abstract Introduction: Invasive procedures performed by trained nephrologists can reduce delays in making a definitive vascular access, complications, number of procedures on the same patient, and costs for the Public Health System. Objective: to demonstrate that a long-term tunneled central venous catheter (LTCVC) implanted by a nephrologist is safe, effective, and associated with excellent results. Methods: A retrospective study analyzed 149 consecutively performed temporary-to-long-term tunneled central venous catheter conversions in the operating room (OR) from a dialysis facility from March 2014 to September 2017. The data collected consisted of the total procedures performed, demographic characteristics of the study population, rates of success, aborted procedure, failure, complications, and catheter survival, and costs. Results: the main causes of end stage renal disease (ESRD) were systemic arterial hypertension and diabetes mellitus, 37.9% each. Patients had a high number of previous arteriovenous fistula (1.72 ± 0.84) and temporary catheter (2.87 ± 1.9) attempts until a definitive vascular access was achieved, while the preferred vascular site was right internal jugular vein (80%). Success, abortion, and failure rates were 93.3%, 2.7% and 4%, respectively, with only 5.36% of complications (minors). Overall LTCVC survival rates over 1, 3, 6, and 12 months were 93.38, 71.81, 54.36, and 30.2%, respectively, with a mean of 298 ± 280 days (median 198 days). The procedure cost was around 496 dollars. Catheter dysfunction was the main reason for catheter removal (34%). Conclusion: Our analysis shows that placement of LTCVC by a nephrologist in an OR of a dialysis center is effective, safe, and results in substantial cost savings.

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A Stuck Hemodialysis Central venous Catheter

The Journal of Vascular Access ◽

10.1177/112972980800900415 ◽

2008 ◽

Vol 9 (4) ◽

pp. 301-303 ◽

Cited By ~ 27

Author(s):

M. Field ◽

J. Pugh ◽

J. Asquith ◽

S. Davies ◽

A.D. Pherwani

Keyword(s):

Case Report ◽

Central Venous Catheter ◽

Vascular Access ◽

Insertion Site ◽

Venous Catheter ◽

Hemodialysis Patients ◽

Central Venous Catheters ◽

Central Venous

Background A growing number of hemodialysis patients are dependent upon central venous catheters (CVCs) for long-term vascular access. Although many complications of CVCs have been documented, the phenomenon of the stuck catheter is described relatively infrequently. Case report We describe a case where attempts to remove the line by exploration of the jugular insertion site in theater were unsuccessful and the line was internalized. Discussion The case is then discussed with all available cases in the literature to suggest principles of managing and preventing the stuck catheter phenomenon.

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Long term parenteral therapy by percutaneous tunneled silicone central venous catheter—A follow-up of 300 catheters

Clinical Nutrition ◽

10.1016/0261-5614(82)90033-4 ◽

1982 ◽

Vol 1 (2) ◽

pp. 117-124 ◽

Cited By ~ 17

Author(s):

F. Hesselvik ◽

B. Schildt ◽

B. Nilehn

Keyword(s):

Central Venous Catheter ◽

Venous Catheter ◽

Parenteral Therapy ◽

Central Venous

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CATHETER SALVAGE STRATEGY FOR LONG-TERM CENTRAL VENOUS CATHETER-ASSOCIATED STAPHYLOCOCCUS AUREUS INFECTIONS IN CHILDREN

10.26226/morressier.58fa1765d462b80290b50a75 ◽

2017 ◽

Author(s):

Julie Toubiana

Keyword(s):

Staphylococcus Aureus ◽

Central Venous Catheter ◽

Venous Catheter ◽

Central Venous

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Incidence of bloodstream infection among patients on hemodialysis by central venous catheter

Revista Latino-Americana de Enfermagem ◽

10.1590/s0104-11692010000100012 ◽

2010 ◽

Vol 18 (1) ◽

pp. 73-80 ◽

Cited By ~ 14

Author(s):

Cibele Grothe ◽

Angélica Gonçalves da Silva Belasco ◽

Ana Rita de Cássia Bittencourt ◽

Lucila Amaral Carneiro Vianna ◽

Ricardo de Castro Cintra Sesso ◽

...

Keyword(s):

Central Venous Catheter ◽

Bloodstream Infection ◽

Severe Infection ◽

Venous Catheter ◽

Central Venous Catheter Insertion ◽

Central Venous ◽

Double Lumen ◽

One Year ◽

Very High

This study evaluated the incidence and risk factors of bloodstream infection (BSI) among patients with a double-lumen central venous catheter (CVC) for hemodialysis (HD) and identified the microorganisms isolated from the bloodstream. A follow-up included all patients (n=156) who underwent hemodialysis by double-lumen CVC at the Federal University of São Paulo - UNIFESP, Brazil, over a one-year period. From the group of patients, 94 presented BSI, of whom 39 had positive cultures at the central venous catheter insertion location. Of the 128 microorganisms isolated from the bloodstream, 53 were S. aureus, 30 were methicillin-sensitive and 23 were methicillin-resistant. Complications related to BSI included 35 cases of septicemia and 27 cases of endocarditis, of which 15 cases progressed to death. The incidence of BSI among these patients was shown to be very high, and this BSI progressed rapidly to the condition of severe infection with a high mortality rate.

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Precision in Central Venous Catheter Tip Placement: A Review of the Literature

Journal of the Association for Vascular Access ◽

10.2309/java.15-3-3 ◽

2010 ◽

Vol 15 (3) ◽

pp. 112-125 ◽

Cited By ~ 21

Author(s):

Russell Hostetter ◽

Nadine Nakasawa ◽

Kim Tompkins ◽

Bradley Hill

Keyword(s):

Central Venous Catheter ◽

Selection Criteria ◽

Weighted Average ◽

Venous Catheter ◽

Central Venous ◽

Catheter Tip ◽

Tip Position ◽

Landmark Technique ◽

The Ideal

Abstract Background: Long term venous catheters have been used to deliver specialized therapies since 1968. The ideal tip position of a central venous catheter provides reliable venous access with optimal therapeutic delivery, while minimizing short-and long-term complications. Ideal position limits have evolved and narrowed over time, making successful placement difficult and unreliable when depending exclusively on the landmark technique. Objective: To review and analyze contemporary literature and calculate an overall accuracy rate for first attempt placement of a PICC catheter in the ideal tip position. Methods: Key PICC placement terms were used to search the database PubMED-indexed for MEDLINE in June and October, 2009. The selection of studies required: a patient cohort without tip placement guidance technology; a documented landmark technique to place catheter tips; data documenting initial catheter placement and, that the lower third of the SVC and the cavo-atrial junction (CAJ) were included in the placement criteria. With few exceptions, articles written between 1993 and 2009 met the stated selection criteria. A composite of outcomes associated with tip placement was analyzed, and an overall percent proficiency of accurate catheter tip placement calculated. Results: Nine studies in eight articles met the selection criteria and were included for analysis. Rates of first placement success per study ranged from 39% to 75%, with the majority (7/9) being single center studies. The combined overall proficiency of these studies calculated as a weighted average was 45.87%.

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