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Continuous venous access in children with urological diseases
J C Springer1, R G Azizkhan, H G Mesrobian
1Department of Surgery, University of North Carolina School of Medicine, Chapel Hill.
Insights
Multipurpose silicone right atrial catheters provide essential continuous venous access for children with complex urological conditions, enabling outpatient treatment and survival with a low complication rate.
Area of Science:
- Pediatric Urology
- Vascular Access
- Medical Devices
Background:
- Complex urological diseases in children often necessitate long-term venous access for critical treatments.
- The use of silicone right atrial catheters has become a vital option for managing these complex cases.
Purpose of the Study:
- To evaluate the safety and efficacy of multipurpose silicone right atrial catheters for continuous venous access in pediatric patients with urological diseases.
- To analyze the types and frequency of complications associated with these catheters.
Main Methods:
- Retrospective review of 26 pediatric patients (aged 1 day to 15 years) who received right atrial catheters between September 1985 and September 1987.
- Detailed analysis of catheter indications, placement techniques, duration of use (4,500 catheter days), and complications.
Main Results:
- A total of 11 complications occurred over 4,500 catheter days, with 10 mechanical and 1 infectious.
- Complications necessitated catheter replacement in only 3 patients; others were managed nonoperatively.
- Catheter use facilitated outpatient treatment and survival for many patients.
Conclusions:
- Multipurpose silicone right atrial catheters are a safe and effective option for long-term venous access in children with complex urological conditions.
- Low complication rates and the ability to manage patients as outpatients support the integration of these techniques into urological practice.
Abstract:
The placement of multipurpose silicone right atrial catheters for continuous venous access in children with complex urological diseases has become increasingly necessary. Between September 1985 and September 1987, 26 children with a variety of urological diseases required long-term central venous access, primarily for delivery of chemotherapy and blood products in 13 patients with malignancies, hemodialysis access in 7 undergoing renal transplantation, total parenteral nutrition in 5 (2 of whom were born with cloacal exstrophy), and fluid and antibiotic administration in 1 with dermatomyositis and acute pyelonephritis. Patient age at catheter placement ranged from 1 day to 15 years. A total of 11 complications was encountered during 4,500 catheter days: 10 were mechanical and 1 was infectious in nature. These complications led to replacement of the catheter in 3 patients and the remainder were managed successfully nonoperatively. The surgical techniques involved in placement of these catheters are discussed. The catheters not only allowed many of these patients to receive treatment on an outpatient basis but also ensured their survival. Our favorable experience with prolonged venous access in children should encourage urologists to include these techniques in their armamentarium.