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

Pediatric Nephrology volume 22, pages 1355–1361 (2007)Cite this article

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.

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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

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  1. Ali Mirza Onder
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  2. Jayanthi Chandar
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  3. Marie Saint-Vil
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  4. Gabriela Lopez-Mitnik
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  5. Carolyn L. Abitbol
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  6. Gaston Zilleruelo
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Correspondence to Jayanthi Chandar.

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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

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

Keywords

  • Tunneled cuffed hemodialysis catheters
  • Catheter survival in children
  • Wire-guided exchange
  • Catheter exchange