Abstract
Central venous lines (CVL) continue to be the most commonly used vascular access device for children on hemodialysis (HD). Despite their frequent use, little is known regarding the frequency of CVL-related intradialytic complications that could interfere with delivery of effective dialysis. To better assess this, we conducted a cross-sectional study of ten HD centers within the Midwest Pediatric Nephrology Consortium. Vascular access was provided by CVL in 61 of the 83 patients (73%) included. CVL dysfunction (defined as reduced blood flows, need for reversed lines, or frequent intradialytic alarms) occurred in 46% in the prior month. Treatment for suspected clots occurred in 16 patients. Intraluminal tissue plasminogen activator (tPA) was the preferred treatment for a suspected clot. The survey also inquired about the preferred treatment for documented clots, and intraluminal tPA was most preferred, followed by CVL stripping, CVL removal, CVL brushing, and systemic tPA. As for preventative strategies, most HD centers locked the CVL with intraluminal heparin in concentrations ranging from 1,000 to 5,000 U/ml. In conclusion, catheter usage rates and complications were highly prevalent in pediatric HD units in this study. As treatment strategies varied greatly, future prospective studies are needed to determine the effectiveness of each individual therapy.
Similar content being viewed by others
References
Chand DH, Brier M, Strife CF (2005) Comparison of vascular access type in pediatric hemodialysis patients with respect to urea clearance, anemia management, and serum albumin concentration. Am J Kidney Dis 45:303–308
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
Leonard MB, Donaldson LA, Ho M, Geary DF (2003) A prospective cohort study of incident maintenance dialysis in children: an NAPRTC study. Kidney Int 63:744–755
Sharma A, Zilleruelo G, Abitbol C, Montane B, Strauss J (1999) Survival and complications of cuffed catheters in children on chronic hemodialysis. Pediatr Nephrol 13:245–248
Goldstein SL, Macierowski CT, Jabs K (1997) Hemodialysis catheter survival and complications in children and adolescents. Pediatr Nephrol 11:74–77
Schillinger F, Schillinger D, Montagnac R, Milcent T (1991) Post catheterisation vein stenosis in haemodialysis: comparative angiographic study of 50 subclavian and 50 internal jugular accesses. Nephrol Dial Transplant 6:722–724
Trerotola SO, Kuhn-Fulton J, Johnson MS, Shah H, Ambrosius WT, Kneebone PH (2000) Tunneled infusion catheters: increased incidence of symptomatic venous thrombosis after subclavian versus internal jugular venous access. Radiology 217:89–93
Wilkin TD, Kraus MA, Lane KA, Trerotola SO (2003) Internal jugular vein thrombosis associated with hemodialysis catheters. Radiology 228:697–700
Sakiewicz PG, Paganini EP, Wright E (2000) Introduction of a switch that can reverse blood flow direction on-line during hemodialysis. ASAIO J 46:464–468
Daeihagh P, Jordan J, Chen J, Rocco M (2000) Efficacy of tissue plasminogen activator administration on patency of hemodialysis access catheters. Am J Kidney Dis 36:75–79
Twardowski ZJ (1998) High-dose intradialytic urokinase to restore the patency of permanent central vein hemodialysis catheters. Am J Kidney Dis 31:841–847
Clase CM, Crowther MA, Ingram AJ, Cina CS (2001) Thrombolysis for restoration of patency to haemodialysis central venous catheters: a systematic review. J Thromb Thrombolysis 11:127–136
Gray RJ, Levitin A, Buck D, Brown LC, Sparling YH, Jablonski KA, Fessahaye A, Gupta AK (2000) Percutaneous fibrin sheath stripping versus transcatheter urokinase infusion for malfunctioning well-positioned tunneled central venous dialysis catheters: a prospective, randomized trial. J Vasc Interv Radiol 11:1121–1129
Trerotola SO, Johnson MS, Harris VJ, Shah H, Ambrosius WT, McKusky MA, Kraus MA (1997) Outcome of tunneled hemodialysis catheters placed via the right internal jugular vein by interventional radiologists. Radiology 203:489–495
Hoshal VL Jr, Ause RG, Hoskins PA (1971) Fibrin sleeve formation on indwelling subclavian central venous catheters. Arch Surg 102:253–258
Ahmed N (1976) Thrombosis after central venous cannulation. Med J Aust 1:217–220
Brismar B, Hardstedt C, Jacobson S (1981) Diagnosis of thrombosis by catheter phlebography after prolonged central venous catheterization. Ann Surg 194:779–783
Crain MR, Mewissen MW, Ostrowski GJ, Paz-Fumagalli R, Beres RA, Wertz RA (1996) Fibrin sleeve stripping for salvage of failing hemodialysis catheters: technique and initial results. Radiology 198:41–44
Rockall AG, Harris A, Wetton CW, Taube D, Gedroyc W, Al-Kutoubi MA (1997) Stripping of failing haemodialysis catheters using the Ampltaz gooseneck snare. Clin Radiol 52:616–620
Cox K, Vesely TM, Windus DW, Pilgram TK (2000) The utility of brushing dysfunctional hemodialysis catheters. J Vasc Interv Radiol 11:979–983
Yevzlin AS, Conley EL, Sanchez RJ, Young HN, Becker BN (2006) Vascular access outcomes and medication use: a USRDS study. Semin Dial 19:535–539
Mokrzycki MH, Jean-Jerome K, Rush H, Zdunek MP, Rosenberg SO (2001) A randomized trial of minidose warfarin for the prevention of late malfunction in tunneled, cuffed hemodialysis catheters. Kidney Int 59:1935–1942
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Valentini, R.P., Geary, D.F. & Chand, D.H. Central venous lines for chronic hemodialysis: survey of the Midwest Pediatric Nephrology Consortium. Pediatr Nephrol 23, 291–295 (2008). https://doi.org/10.1007/s00467-007-0658-0
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00467-007-0658-0