Hemodialysis Catheters in Infants: A Retrospective Single-Center Cohort Study |
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| Institution: | 1. Image Guided Therapy, Department of Medical Imaging, The Hospital for Sick Children, University of Toronto, 555 University Ave, Toronto, ON M5G 1X8, Canada;2. Division of Nephrology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, 555 University Ave, Toronto, ON M5G 1X8, Canada;3. Pediatric Interventional Radiology, Department of Diagnostic Imaging, Pediatric Interventional Radiology, University Children’s Hospital Zurich, Switzerland;1. Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, 510 South Kingshighway Boulevard, CB 8131, St. Louis, MO 63139;2. Department of Biostatistics, Washington University in St. Louis, St. Louis, Missouri;1. Department of Interventional Radiology, Chinese PLA General Hospital, 28 Fu-xing Rd., Beijing 100853, P.R. China;2. Department of Radiology, Chinese PLA General Hospital, 28 Fu-xing Rd., Beijing 100853, P.R. China;3. Department of Pathology, Chinese PLA General Hospital, 28 Fu-xing Rd., Beijing 100853, P.R. China;4. Academy of Military Medical Sciences, Institute of Pharmacology and Toxicology, Beijing, P.R. China;5. Department of Urology Surgery, Second Hospital of Beijing Municipality, Beijing, P.R. China;1. Department of Medical Imaging, National Taiwan University Hospital, No. 7, Chung-Shan South Rd., Taipei 100, Taiwan, R.O.C.;2. Department of Traumatology, National Taiwan University Hospital, No. 7, Chung-Shan South Rd., Taipei 100, Taiwan, R.O.C.;3. Department of Stroke Center and Department of Neurology, National Taiwan University Hospital, No. 7, Chung-Shan South Rd., Taipei 100, Taiwan, R.O.C.;1. Department of Radiology, Gifu University School of Medicine, 1-1 Yanagido, Gifu 501-1194, Japan;2. Department of Pediatrics, Gifu University School of Medicine, 1-1 Yanagido, Gifu 501-1194, Japan;1. Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, INF 110, 69120 Heidelberg, Germany;2. Department of Neuroradiology, University Hospital Heidelberg, INF 110, 69120 Heidelberg, Germany;3. Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei Sheng, China;4. Department of General Pathology, University Hospital Mainz, Mainz, Germany;5. Clinic for Radiology, Minimally-invasive Therapies and Nuclear Medicine, SLK Kliniken Heilbronn GmbH, Heilbronn, Germany;6. Clinic for Diagnostic and Interventional Radiology, Klinikum Stuttgart, Stuttgart, Germany |
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| Abstract: | PurposeEvaluate technical aspects and outcomes of insertion/maintenance of hemodialysis (HD) central venous catheter (CVC) during infancy.Materials and MethodsSingle-center retrospective study of 29 infants who underwent 49 HD-CVC insertions between 2002 and 2016. Demographics, procedural, and post-procedural details, interventional radiology (IR) maintenance procedures, technical modifications, complications, and outcomes were evaluated. Technical adjustments during HD-CVC placement to adapt catheter length to patient size were labeled “modifications.” CVCs requiring return visit to IR were called IR-maintenance procedures. Mean age and weight at HD-CVC insertion were 117 days and 4.9 kg.ResultsOf the 29 patients, 13 (45%) required renal-replacement-therapy (RRT) as neonates, 10 (34%) commenced RRT with peritoneal dialysis (PD), and 19 (66%) with HD. Fifteen nontunneled and 34 tunneled HD-CVCs were inserted while patients were ≤1 year. Technical modifications were required placing 25/49 (51%) HD-CVCs: 5/15 (33%) nontunneled and 20/34 (59%) tunneled catheters (P = .08). Patients underwent ≤6 dialysis-cycles/patient during infancy (mean 2.3), and a mean of 4.1 and 49 HD-sessions/catheter for nontunneled and tunneled HD-CVCs, respectively. Mean primary and secondary device service, and total access site intervals for tunneled HD-CVCs were 75, 115, and 201 days, respectively. A total of 26 of 49 (53%) patients required IR-maintenance procedures. Nontunneled lines had greater catheter-related bloodstream infections per 1,000 catheter-days than tunneled HD-CVCs (9.25 vs. 0.85/1,000 catheter days; P = .02). Nineteen patients (65%) survived over 1 year. At final evaluation (December 2017): 8/19 survived transplantation, 5/19 remained on RRT, 2/19 completely recovered, 1/19 lost to follow-up, and 3 died at 1.3, 2, and 10 years.ConclusionsPlacement/maintenance of HD-CVCs in infants pose specific challenges, requiring insertion modifications, and IR-maintenance procedures to maintain function. |
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