The effect of vascular access location and size on circuit survival in pediatric continuous renal replacement therapy: A report from the PPCRRT registry

Richard Hackbarth, T. E. Bunchman, A. N. Chua, M. J. Somers, M. A. Baum, J. M. Symons, P. D. Brophy, D. Blowey, J. D. Fortenberry, D. Chand, F. X. Flores, S. R. Alexander, J. D. Mahan, K. D. Mcbryde, M. R. Benfield, S. L. Goldstein

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    87 Scopus citations

    Abstract

    Purpose: Well-functioning vascular access is essential for the provision of adequate CRRT. However, few data exist to describe the effect of catheter size or location on CRRT performance in the pediatric population. Methods: Data for vascular access site, size, and location, as well as type of anticoagulant used and patient demographic data were gathered from the ppCRRT registry. Kaplan-Meier curves were generated and then analyzed by log-rank test or Cox Proportional Hazards model. Results: Access diameter was found to significantly affect circuit survival. None of the 5 French catheters lasted longer than 20 hours. Seven and 9 French, but not 8 French, catheters fared worse than larger diameter catheters (p=0.002). Circuits associated with internal jugular access survived longer than subclavian or femoral access associated circuits (p<0.05). Circuit survival was also found to be favorably associated with the CWHD modality (p<0.001). Conclusions: Functional CRRT circuit survival in children is favored by larger catheter diameter, internal jugular vein insertion site and CWHD. For patients requiring catheter diameters less than 10 French, CRRT circuit survival might be optimized if internal jugular vein insertion is feasible. Conversely, when a vascular access site other than the internal jugular vein is most prudent, consideration should be given to using the largest diameter catheter appropriate for the size of the child. The CWHD modality was associated with longer circuit survival, but the mechanism by which this occurs is unclear.

    Original languageEnglish
    Pages (from-to)1116-1121
    Number of pages6
    JournalInternational Journal of Artificial Organs
    Volume30
    Issue number12
    DOIs
    StatePublished - Dec 2007

    Keywords

    • Child
    • Critical care
    • Hemofiltration
    • Kidney failure
    • Renal replacement therapy
    • Vascular access

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