Image Guided Therapy, Department of Medical Imaging, The Hospital for Sick Children, University of Toronto, 555 University Ave, Toronto, ON M5G 1X8, Canada.
Image Guided Therapy, Department of Medical Imaging, The Hospital for Sick Children, University of Toronto, 555 University Ave, Toronto, ON M5G 1X8, Canada.
J Vasc Interv Radiol. 2020 May;31(5):778-786. doi: 10.1016/j.jvir.2020.01.020. Epub 2020 Apr 15.
Evaluate technical aspects and outcomes of insertion/maintenance of hemodialysis (HD) central venous catheter (CVC) during infancy.
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.
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.
Placement/maintenance of HD-CVCs in infants pose specific challenges, requiring insertion modifications, and IR-maintenance procedures to maintain function.
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。
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。
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。
婴儿时期 HD-CVC 的放置/维护带来了特殊的挑战，需要进行插入修改和 IR 维护程序以维持功能。
