婴儿血液透析导管：一项回顾性单中心队列研究。

Hemodialysis Catheters in Infants: A Retrospective Single-Center Cohort Study.

机构信息

Image Guided Therapy, Department of Medical Imaging, The Hospital for Sick Children, University of Toronto, 555 University Ave, Toronto, ON M5G 1X8, Canada.

出版信息

J Vasc Interv Radiol. 2020 May;31(5):778-786. doi: 10.1016/j.jvir.2020.01.020. Epub 2020 Apr 15.

DOI:10.1016/j.jvir.2020.01.020

PMID:32305244

Abstract

PURPOSE

Evaluate technical aspects and outcomes of insertion/maintenance of hemodialysis (HD) central venous catheter (CVC) during infancy.

MATERIALS AND METHODS

Single-center retrospective study of 29 infants who underwent 49 HD-CVC insertions between 2002 and 2016. Demographics, procedural, and post-procedural details, interventional radiology (IR) maintenance procedures, technical modifications, complications, and outcomes were evaluated. Technical adjustments during HD-CVC placement to adapt catheter length to patient size were labeled "modifications." CVCs requiring return visit to IR were called IR-maintenance procedures. Mean age and weight at HD-CVC insertion were 117 days and 4.9 kg.

RESULTS

Of the 29 patients, 13 (45%) required renal-replacement-therapy (RRT) as neonates, 10 (34%) commenced RRT with peritoneal dialysis (PD), and 19 (66%) with HD. Fifteen nontunneled and 34 tunneled HD-CVCs were inserted while patients were ≤1 year. Technical modifications were required placing 25/49 (51%) HD-CVCs: 5/15 (33%) nontunneled and 20/34 (59%) tunneled catheters (P = .08). Patients underwent ≤6 dialysis-cycles/patient during infancy (mean 2.3), and a mean of 4.1 and 49 HD-sessions/catheter for nontunneled and tunneled HD-CVCs, respectively. Mean primary and secondary device service, and total access site intervals for tunneled HD-CVCs were 75, 115, and 201 days, respectively. A total of 26 of 49 (53%) patients required IR-maintenance procedures. Nontunneled lines had greater catheter-related bloodstream infections per 1,000 catheter-days than tunneled HD-CVCs (9.25 vs. 0.85/1,000 catheter days; P = .02). Nineteen patients (65%) survived over 1 year. At final evaluation (December 2017): 8/19 survived transplantation, 5/19 remained on RRT, 2/19 completely recovered, 1/19 lost to follow-up, and 3 died at 1.3, 2, and 10 years.

CONCLUSIONS

Placement/maintenance of HD-CVCs in infants pose specific challenges, requiring insertion modifications, and IR-maintenance procedures to maintain function.

摘要

目的

评估婴儿时期血液透析（HD）中心静脉导管（CVC）插入/维护的技术方面和结果。

材料和方法

对 2002 年至 2016 年间进行的 49 例 HD-CVC 插入术的 29 例婴儿进行单中心回顾性研究。评估了人口统计学、程序和程序后细节、介入放射学（IR）维护程序、技术修改、并发症和结果。为适应患者体型而对 HD-CVC 放置进行的技术调整标记为“修改”。需要返回 IR 进行的 CVC 称为 IR 维护程序。HD-CVC 插入时的平均年龄和体重为 117 天和 4.9 公斤。

结果

29 例患者中，13 例（45%）在新生儿期需要肾脏替代治疗（RRT），10 例（34%）开始腹膜透析（PD）RRT，19 例（66%）开始 HD-CVC。≤1 岁的患者插入了 15 根非隧道和 34 根隧道 HD-CVC。需要对 25/49（51%）根 HD-CVC 进行技术修改：5/15（33%）非隧道和 20/34（59%）隧道导管（P=0.08）。婴儿期每个患者接受的透析周期/患者≤6 个（平均 2.3），非隧道和隧道 HD-CVC 分别为每个导管 4.1 和 49 次 HD 治疗。隧道 HD-CVC 的主要和次要装置服务以及总通路部位间隔分别为 75、115 和 201 天。49 例患者中有 26 例（53%）需要进行 IR 维护程序。非隧道导管的每千导管日血源性感染率高于隧道 HD-CVC（9.25 比 0.85/1,000 导管日；P=0.02）。19 例患者（65%）存活超过 1 年。在最后评估（2017 年 12 月）时：8/19 例患者存活并接受移植，5/19 例患者继续接受 RRT，2/19 例患者完全康复，1/19 例患者失访，3 例患者分别在 1.3、2 和 10 岁时死亡。