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Vascular access: choice and complications in European paediatric haemodialysis units

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Abstract

Background

European and U.S. guidelines emphasise that permanent vascular access in the form of arteriovenous fistulae (AVF) or grafts (AVG) are preferable to central venous catheters (CVC) in paediatric patients on long-term haemodialysis. We report vascular access choice and complication rates in 13 European paediatric nephrology units.

Methods

A survey of units participating in the European Pediatric Dialysis Working Group requesting data on type of vascular access, routine care and complications in patients on chronic haemodialysis between March 2010 and February 2011.

Results

Information was complied on 111 patients in 13 participating centres with a median age of 14 (range 0.25–20.2) years. Central venous catheters were used in 67 of 111 (60%) patients, with 42 patients (38%) having an AVF and two patients (2%) having an AVG. Choice of vascular access was significantly related to patient age, with patients with AVF/AVG having a median age of 16 years compared to 12 years for patients with CVCs (p < 0.001). Routine CVC exit site care and catheter lock solution use differed between centres. CVC infections requiring intravenous antibiotics were reported at a rate of 1.9 and exit site infections at a rate of 1.8 episodes/1000 catheter days. Overall infective complications necessitating CVC change occurred at a rate of 0.9 episodes/1000 catheter days. No infective complications were reported in patients with AVF/AVG access. The rate of CVC infections requiring intravenous antibiotics was significantly lower in patients in whom CVC exit sites were cleaned weekly as opposed to every dialysis session (relative risk with every session cleaning vs. weekly cleaning 2.58, 95% confidence interval 1.17–5.69). Catheter malfunction (inadequate blood flow) was a more prevalent complication necessitating 22.4 thrombolytic interventions/1000 catheter days and 2.1 CVC changes/1000 catheter days.

Conclusions

Central venous catheters remain the predominant choice of vascular access in Europe despite problems of malfunction and infection. AVF/AVG were predominantly used in adolescents without reported complications. More regular exit site cleaning may predispose to CVC infection, but this observation requires prospective evaluation.

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Authors and Affiliations

  1. Paediatric Nephrology, Nottingham Children’s Hospital, QMC Campus, Derby Road, Nottingham, NG7 2UH, UK

    Wesley N. Hayes, Alan R. Watson & Nichola Callaghan

  2. Great Ormond Street Hospital, London, UK

    Elizabeth Wright

  3. “A & P Kyriakou” Children’s Hospital, Athens, Greece

    Constantinos J. Stefanidis

Authors
  1. Wesley N. Hayes
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  2. Alan R. Watson
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  3. Nichola Callaghan
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  4. Elizabeth Wright
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  5. Constantinos J. Stefanidis
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Consortia

On behalf of the European Pediatric Dialysis Working Group

Corresponding author

Correspondence to Alan R. Watson.

Additional information

The European Pediatric Dialysis Working Group comprises (in alphabetical order): Gema Ariceta, Pediatric Nephrology, Hospital Cruces, Barakaldo, Vizcaya, Spain; Sevcan A Bakkaloglu, Gazi University Hospital, Ankara, Turkey; Nichola Callaghan, Nottingham Children’s Hospital, Nottingham, UK (co-opted); Alberto Edefonti, Clinica Pediatrica De Marchi, Fondazione IRCCS Policlinico, Mangiagalli e Regina Elena, Milan, Italy; Mesiha Ekim, Ankara University Hospital, Ankara, Turkey; Michel Fischbach, Hopital de Hautepierre, Strasbourg, France; Wesley Hayes, Nottingham Children’s Hospital, Nottingham, UK (co-opted); Tuula Holtta, Children’s Hospital, University of Helsinki, Finland; Gunter Klaus, KfH Pediatric Kidney Center, Marburg, Germany; Claus Peter Schmitt, Center for Pediatric and Adolescent Medicine, Heidelberg, Germany; Rukshana Shroff, Great Ormond Street Hospital, London, UK; Constantinos J Stefanidis, “A & P Kyriakou” Children’s Hospital, Athens, Greece; Johan Van de Walle, University Hospital, Ghent, Belgium; Karen Vondrak, University Hospital Motol Prague, Czech Republic; Alan R Watson, Nottingham Children’s Hospital, Nottingham UK (Convenor); Elizabeth Wright, Great Ormond Street Hospital, London, UK (co-opted); Aleksandra Zurowska, Gdansk University Medical School, Poland

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Hayes, W.N., Watson, A.R., Callaghan, N. et al. Vascular access: choice and complications in European paediatric haemodialysis units. Pediatr Nephrol 27, 999–1004 (2012). https://doi.org/10.1007/s00467-011-2079-3

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  • DOI: https://doi.org/10.1007/s00467-011-2079-3

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