Melkamu Dessie Adeb MD, Presenter: Nothing to Disclose

Kevin Marin Baskin MD, Abstract Co-Author: Speakers Bureau, Cook Group Incorporated Consultant, Siemens AG

Ganesh Krishnamurthy MD, Abstract Co-Author: Nothing to Disclose

Els L.F. Nijs MD, Abstract Co-Author: Nothing to Disclose

Kevin Meyers, Abstract Co-Author: Nothing to Disclose

Anne Marie Cahill MBBCh, Abstract Co-Author: Nothing to Disclose

To review our technique and outcomes related to tunneled dialysis catheter insertion in children.

A retrospective review of 123 children who had tunneled dialysis catheter insertion in the period between January 1999 and July 2010 was performed after institutional review board approval. There were 62 females and 61 males with mean age of 13 yrs (range 0.1-28.5 yrs). A total of 197 primary insertions and 338 salvage procedures were performed.

The most common indications for catheter insertion were renal failure in 178 (90.3%), transplant rejection in 12 (6%), and graft or fistula malfunction in 4 (2%) of primary insertions. Technical success for the primary insertions was 100%. Venous access for primary insertions was as follows: RIJV 146/197 (74.1%), LIJV 36/197 (18.3%), SCV 7/197 (3.6%) and FV in 5/197 (2.5%) insertions. Primary insertion procedural complications included tract bleeding in 2/197 (1.02%) and air embolism in 2/197 (1.02%) which resolved without significant sequel. The average catheter days for the primary insertions was 66.1 days (range 1-765days) while the average total catheter days was 160.4 days (range 1-1034 days). The rate of infection and mechanical complications for primary insertions alone was 0.18 and 0.72 per 100 catheter days respectively and for total catheter days including salvage procedures was 0.33 and 0.94 per 100 per total catheter days respectively. Medical salvage i.e. tPA, Urokinase, antibiotics use (52.1% procedures) and IR salvage (47.1% procedures) procedures performed increased the catheter days by an average of 54.8 days (range 0-959 days). Catheter exchange was the most common IR salvage procedure (80.2%).

Our study is the largest series to date describing radiologically placed percutaneous dialysis catheter insertion in children. These catheters incur a high rate of mechanical and infectious complications especially in children and should only be placed as a last resort.

Though technically safe and successful, tunneled dialysis catheter insertions are associated with high rate of mechanical and infectious complications in the pediatric population.

Adeb, M, Baskin, K, Krishnamurthy, G, Nijs, E, Meyers, K, Cahill, A, Radiologically-placed Tunneled Dialysis Catheter Insertion in Children: A Twelve-year Single Institution Retrospective Experience.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11015976.html