Central venous access for hemodialysis: Use and practice with children in France

Central venous catheter (CVC) are being increasingly used as hemodialysis vascular access. In order to evaluate the indications, practice and uses in the pediatric population, we conducted a study in children with renal failure (RF). A questionnaire was sent to the 21 french paediatric hemodialysis centers to inquire population desserved, number, type, site and indications of CVC, procedure of management and attitude towards infection and thrombosis. A prospective survey was added to compile information about CVC during the period 7/2000-31/12/2000. Results (exhaustivity response 80%) showed 1. large diversity in choice of material with predominance of pediatric permcath QUINTON; 2. exclusive surgical insertion for 8 out of 19 centers; 3. rare use of femoral route (never and exceptionnaly reported, respectively by 4 and 6 centers and predominantly in acute RF; 4. heterogene attitude towards fixing, dressing, heparine locking and procedure of urokinase administration in case of thrombosis, whilst procedure towards infection was homogeneous; 5. indications of insertion of the 31 prospective study CVC were distribued in 4 subgroups a) breakdown of vascular permanent access (6 cases) or of peritoneal dialysis (2 cases), b) unexpected terminal renal failure (6 cases), c) deliberate choice to wait transplantation (4 cases) or to face breakdown of transplantation (4 cases), d) dysfunction of a previous CVC (7 cases); 6. a rate of 20% of dysfunction (flow problem); 7. a rate of replacement of 11%. AVC are effective forms of vascular access. However CVC indications should be carefully analysed and balanced if possible with alternative route such as anticipated creation of arterioveinous fistula, peritoneal dialysis and preemptive transplantation.