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.
Similar content being viewed by others
References
No authors listed (2006) Clinical practice recommendation 8: vascular access in pediatric patients. Am J Kidney Dis 48 [Suppl 1]:S274–S276
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
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
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
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
Lumsden AB, MacDonald MJ, Allen RC, Dodson TF (1994) Hemodialysis access in the pediatric population. Am J Surg 168:197–201
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
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
Goldstein SL, Macierowski CT, Jabs K (1997) Hemodialysis catheter survival and complications in children and adolescents. Pediatr Nephrol 11:74–77
No authors listed (2003) 2002 Annual Report: ESRD clinical performance measures project. Am J Kidney Dis 42:S1–S96
No authors listed (2004) North American Pediatric Renal Transplant Cooperative Study (NAPRTCS) 2004 Annual Report. Boston, MA, NAPRTCS Administrative Office
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
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
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
Robinson D, Suhocki P, Schwab SJ (1998) Treatment of infected tunneled venous access hemodialysis catheters with guidewire exchange. Kidney Int 53:1792–1794
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
Bloembergen BE, Port FK (1996) Epidemiological perspective on infections in chronic dialysis patients. Adv Renal Replace Ther 3:201–207
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
U.S. Renal Data System (1997) USRDS 1997 Annual Data report. National Institutes of Health, NIDDK, Bethesda
Allon M (2004) Dialysis catheter-related bacteremia: treatment and prophylaxis. Am J Kidney Dis 44:779–791
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
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
Beathard GA (1999) Management of bacteremia associated with tunneled-cuffed hemodialysis catheters. J Am Soc Nephrol 10:1045–1049
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
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
Trerotola SO (2000) Hemodialysis catheter placement and management. Radiology 215:651–658
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
Twardowski ZJ (1995) Percutaneous blood access for hemodialysis. Semin Dial 8:175–186
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
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
Robinson DL, Fowler VG, Sexton DJ, Corey RG, Conlon PJ (1997) Bacterial endocarditis in hemodialysis patients. Am J Kidney Dis 30:521–524
Kuter DJ (2004) Thrombotic complications of central venous catheters in cancer patients. Oncologist 9:207–216
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
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
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
Author information
Authors and Affiliations
Corresponding author
Rights 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
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00467-007-0510-6