Skip to main content

Advertisement

SpringerLink
Log in

Catheter survival and comparison of catheter exchange methods in children on hemodialysis

  • Original Article
  • Published:
Pediatric Nephrology Aims and scope Submit manuscript

Abstract

This retrospective study was done to compare the infection-free and overall survival of first and subsequent tunneled cuffed hemodialysis catheters in children. Subsequent catheters were exchanged by two different methods (a) removal and replacement (R&R), or (b) wire-guided exchange (WGE) using the same tunnel and vessel. The study involved 59 children (27 male, 32 female; mean age 13.9 ± 4.6 years) undergoing maintenance hemodialysis in a pediatric unit over a period of 60 months. From a total of 175 catheters (57 first catheters, 81 WGE, 37 R&R) and 38,888 catheter days, 74/175 (42%) catheters were exchanged because of catheter-related bacteremia (CRB) and 43/175 (25%) for malfunction or cuff extrusion. One-year survival rates for first and consecutive catheters was 26% and 21%, respectively. The overall survival of first catheters, and those exchanged by WGE and R&R for both infectious and non-infectious reasons, was not statistically different. However, infection-free survival of first catheters was significantly prolonged in comparison with that of subsequent catheters (P < 0.001). The infection-free survival and the overall survival were not affected by etiology of primary disease, gender, serum albumin, or hemoglobin. Overall catheter survival increased with age >10 years. There was a significant association between gram-negative and polymicrobial CRB and requirement for R&R (P < 0.02). Our findings suggest that WGE is safe in a clinically stable child if the tunnel and the exit site are not infected and has the potential benefit of preserving the vascular access site. The shorter infection-free survival in subsequent catheters suggests a cumulative disadvantage with prolonged catheter use.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. No authors listed (2006) Clinical practice recommendation 8: vascular access in pediatric patients. Am J Kidney Dis 48 [Suppl 1]:S274–S276

    Google Scholar 

  2. Bourquelot P, Raynaud F, Pirozzi N (2003) Microsurgery in children for creation of arteriovenous fistulas in renal and non-renal diseases. Ther Apher Dial 7:498–503

    Article  PubMed  Google Scholar 

  3. Gradman WS, Lerner G, Mentser M, Rodriguez H, Kamil ES (2005) Experience with autogenous arteriovenous access for hemodialysis in children and adolescents. Ann Vasc Surg 19:609–612

    Article  PubMed  Google Scholar 

  4. Finelli L, Miller JT, Tokars JI, Alter MJ, Arduino MJ (2005) National surveillance of dialysis-associated diseases in the United States, 2002. Semin Dial 18:52–61

    Article  PubMed  Google Scholar 

  5. Ramage IJ, Bailie A, Tyerman KS, McColl JH, Pollard SG, Fitzpatrick MM (2005) Vascular access survival in children and young adults receiving long-term hemodialysis. Am J Kidney Dis 45:708–714

    Article  PubMed  Google Scholar 

  6. Lumsden AB, MacDonald MJ, Allen RC, Dodson TF (1994) Hemodialysis access in the pediatric population. Am J Surg 168:197–201

    Article  CAS  PubMed  Google Scholar 

  7. Sharma A, Zilleruelo G, Abitbol C, Montane B, Strauss J (1999) Survival and complications of cuffed central venous catheters in children and young adults on chronic hemodialysis. Pediatr Nephrol 13:245–248

    Article  CAS  PubMed  Google Scholar 

  8. Onder AM, Chandar J, Coakley S, Abitbol C, Montane B, Zilleruelo G (2006) Predictors and outcome of catheter related bacteremia in children on chronic hemodialysis. Pediatr Nephrol 21:1452–1458

    Article  PubMed  Google Scholar 

  9. Goldstein SL, Macierowski CT, Jabs K (1997) Hemodialysis catheter survival and complications in children and adolescents. Pediatr Nephrol 11:74–77

    Article  CAS  PubMed  Google Scholar 

  10. No authors listed (2003) 2002 Annual Report: ESRD clinical performance measures project. Am J Kidney Dis 42:S1–S96

    Google Scholar 

  11. No authors listed (2004) North American Pediatric Renal Transplant Cooperative Study (NAPRTCS) 2004 Annual Report. Boston, MA, NAPRTCS Administrative Office

  12. Marr KA, Sexton D, Conlon PJ, Corey GR, Schwab SJ, Kirkland KB (1997) Catheter-related bacteremia and outcome of attempted catheter salvage in patients undergoing hemodialysis. Ann Intern Med 127:275–280

    Article  CAS  PubMed  Google Scholar 

  13. Krishnasami Z, Carlton D, Bimbo L, Taylor ME, Balkovetz DF, Barker J, Allon M (2002) Management of hemodialysis catheter-related bacteremia with an adjunctive antibiotic lock solution. Kidney Int 61:1136–1142

    Article  PubMed  Google Scholar 

  14. Capdevila JA, Segarra A, Planes AM, Ramirez-Arellano M, Pahissa A, Pierra L, Martinez-Vazquez JM (1993) Successful treatment of hemodialysis catheter-related sepsis without catheter removal. Nephrol Dial Transplant 8:231–234

    CAS  PubMed  Google Scholar 

  15. Robinson D, Suhocki P, Schwab SJ (1998) Treatment of infected tunneled venous access hemodialysis catheters with guidewire exchange. Kidney Int 53:1792–1794

    Article  CAS  PubMed  Google Scholar 

  16. Tanriover B, Carlton D, Saddekni S, Hamrick K, Oser R, Westfall A, Allon M (2000) Bacteremia associated with tunneled dialysis catheters: comparison of two treatment strategies. Kidney Int 57:2151–2155

    Article  CAS  PubMed  Google Scholar 

  17. Bloembergen BE, Port FK (1996) Epidemiological perspective on infections in chronic dialysis patients. Adv Renal Replace Ther 3:201–207

    Article  CAS  Google Scholar 

  18. Hoen B, Paul-Dauphin A, Hestin D, Kessler M (1998) EPIBACDIAL: a multicenter prospective study of risk factors for bacteremia in chronic hemodialysis patients. J Am Soc Nephrol 9:869–876

    CAS  PubMed  Google Scholar 

  19. U.S. Renal Data System (1997) USRDS 1997 Annual Data report. National Institutes of Health, NIDDK, Bethesda

    Google Scholar 

  20. Allon M (2004) Dialysis catheter-related bacteremia: treatment and prophylaxis. Am J Kidney Dis 44:779–791

    Article  PubMed  Google Scholar 

  21. Powe NR, Jaar B, Furth SL, Hermann J, Briggs W (1999) Septicemia in dialysis patients: incidence, risk factors, and prognosis. Kidney Int 55:1081–1090

    Article  CAS  PubMed  Google Scholar 

  22. Mermel LA, Farr BM, Sherertz RJ, Raad II, O’Grady N, Harris JS, Craven DE (2001) Guidelines for the management of intravascular catheter-related infections. Clin Infect Dis 32:1249–1267

    Article  CAS  PubMed  Google Scholar 

  23. Beathard GA (1999) Management of bacteremia associated with tunneled-cuffed hemodialysis catheters. J Am Soc Nephrol 10:1045–1049

    CAS  PubMed  Google Scholar 

  24. Shaffer D (1995) Catheter-related sepsis complicating long-term, tunneled central venous dialysis catheters: management by guidewire exchange. Am J Kidney Dis 25:593–596

    Article  CAS  PubMed  Google Scholar 

  25. Centers for Medicare and Medicaid Services (2004) 2003 Annual report: end-stage renal disease clinical performance measures project. Am J Kidney Dis 44 [Suppl 2]:S1–S92

    Google Scholar 

  26. Trerotola SO (2000) Hemodialysis catheter placement and management. Radiology 215:651–658

    Article  CAS  PubMed  Google Scholar 

  27. Swartz RD, Messana JM, Boyer CJ, Lunde NM, Weitzel WF, Hartman TL (1994) Successful use of cuffed central venous hemodialysis catheters inserted percutaneously. J Am Soc Nephrol 4:1719–1725

    CAS  PubMed  Google Scholar 

  28. Twardowski ZJ (1995) Percutaneous blood access for hemodialysis. Semin Dial 8:175–186

    Article  Google Scholar 

  29. Brem AS, Lambert C, Kitsen J, Somers M, Shemin DG (2005) Chronic dialysis and access-related morbidities in children. Nephrol Dial Transplant 34:278–289

    Google Scholar 

  30. Kovalik E, Albers F, Raymond J, Conlon P (1996) A clustering of cases of spinal epidural abscess in hemodialysis patients. J Am Soc Nephrol 7:2264–2267

    CAS  PubMed  Google Scholar 

  31. Robinson DL, Fowler VG, Sexton DJ, Corey RG, Conlon PJ (1997) Bacterial endocarditis in hemodialysis patients. Am J Kidney Dis 30:521–524

    Article  CAS  PubMed  Google Scholar 

  32. Kuter DJ (2004) Thrombotic complications of central venous catheters in cancer patients. Oncologist 9:207–216

    Article  PubMed  Google Scholar 

  33. Tielemans CL, Lenclud CM, Wens R, Collart FE, Dratwa M (1989) Critical role of iron overload in the increased susceptibility of haemodialysis patients to bacterial infections: beneficial effects of desferrioxamine. Nephrol Dial Transplant 4:883–887

    Article  CAS  PubMed  Google Scholar 

  34. Boelaert JR, Daneels RF, Schurgers ML, Matthys EG, Gordts BZ, Van Landuyt HW (1990) Iron overload in haemodialysis patients increases the risk of bacteremia: a prospective study. Nephrol Dial Transplant 5:130–134

    Article  CAS  PubMed  Google Scholar 

  35. Sheth R, Kale A, Brewer ED, Brandt ML, Nuchtern JG, Goldstein SL (2001) Successful use of Tesio catheters in pediatric patients receiving chronic hemodialysis. Am J Kidney Dis 38:553–559

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pediatrics, Division of Pediatric Nephrology, University of Miami Miller School of Medicine, Miami, FL, USA

    Ali Mirza Onder, Jayanthi Chandar, Marie Saint-Vil, Gabriela Lopez-Mitnik, Carolyn L. Abitbol & Gaston Zilleruelo

  2. Division of Pediatric Nephrology, University of Miami Miller School of Medicine, P.O. Box 016960 (M—714), Miami, FL, 33101, USA

    Jayanthi Chandar

Authors
  1. Ali Mirza Onder
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jayanthi Chandar
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marie Saint-Vil
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Gabriela Lopez-Mitnik
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Carolyn L. Abitbol
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Gaston Zilleruelo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jayanthi Chandar.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Onder, A.M., Chandar, J., Saint-Vil, M. et al. Catheter survival and comparison of catheter exchange methods in children on hemodialysis. Pediatr Nephrol 22, 1355–1361 (2007). https://doi.org/10.1007/s00467-007-0510-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00467-007-0510-6

Keywords

Search

Navigation