[Are permanent catheters a safe vascular access in chronically hemodialysed children?]

The paper's aim is an analysis of the complications related to permanent catheters used as a vascular access in chronically hemodialysed (HD) children. From 1998 to 2005. 34 surgically implanted permanent catheters were used as a vascular access for HD in 21 patients at average age of 13,6 (range 5-26) yrs. The catheters were placed mainly into right internal jugular vein or less often into left i.j.v., left subclavian v. and femoral veins. In 12 patients only one catheter was used for HD, in the others--the catheters had to be replaced. The average patient's observation period was 17 (range 3-73) months and the average catheter's usage period was 10,6 (range 0.5-40) months. In 9 children the catheter function period was shorter than 12 months. No complications were observed only in 2 patients with short observation's period (< 6 months). The complication frequency rate amounted to 0,7 epizode/observation month (range 0.0-5.0), the thrombotic complications rate was 0,3 and the infectious complications index was 0.2 episode/month, respectively. The rare mechanical dysfunctions were noted in 2 patients (the catheter's rupture and falling out). The serious thrombotic complications were noted in 2 cases (carotic veins bilateral severe stenosis with marked collateral circulation accompanied and extensive thrombosis of the femoral and iliac veins). The diagnostic and therapeutic angio-graphic investigation of carotic venous system and catheter placement were performed in 2 patients. The Urokinase was used in 13 children (repeatedly in 8 HD subjects). In the follow up, among 34 analyzed catheters--the function of 11 (32%) was appropriate, 13 (38%) were exchanged, 6 (18%)--surgically replaced, in 6 cases the catheters were removed with subsequent changing the vascular access or dialysis modatlity (in 1 case on patient's demand).

The use of permanent catheter as a chronic vascular access for HD in children is associated with high rate of complications. However, this type of vascular access should be considered as a last resort when creation of the other vascular access is unlikely.