Pediatrics Access Problems in hemodialysis with a permanent central venous catheter

• Published in: Hemodialysis international Vol. 9; no. 1; pp. 98 - 99
• Main Authors: Muscheites, J., Drueckler, E., Stolpe, H.J., Wigger, M.
• Format: Journal Article
• Language: English
• Published: Oxford, UK; Malden, USA Blackwell Science Inc 01.01.2005
• ISSN: 1492-7535; 1542-4758
• DOI: 10.1111/j.1492-7535.2005.1121bz.x

Hemodialysis is a common treatment of chronic renal failure, also in childhood. Due to the high standard of technique there are only few contraindications for this treatment at present. Limitations are given by the vessel access. But in the last years, hemodialysis has been made practicable by the permanent central venous catheter, however, with more problems. As an example for potential complications in the treatment with the permanent catheter we present an unusual case report about a twenty‐one‐ year‐old girl suffering from chronic renal failure due to reflux nephropathy, Prader‐Willi‐ syndrome, myelonatrophia of undetermined origin with spastic diplegia of the legs, and increasing sphincter ani dysfunction. We started the renal replacement therapy when the girl was 15 years old. It was not possible to create an AV fistula due to very small vessels. Two Gore‐Tex ® implants were clotted in absence of thrombophilia. Afterwards, the hemodialysis was performed by a permanent central venous catheter. The catheter had to be changed 15 times. The reasons for changing the catheter were problems of flow during hemodialysis due to clotting, dislocations, spontaneous removing of the catheter by herself, and infections. Altogether a sepsis occurred four times. The first transplantation failed due to a rupture of the transplanted kidney. A second transplantation was not possible because of the high BMI. Intermittently, the girl was treated with peritoneal dialysis (PD) in the hospital, because the PD couldn’t be done at home due to different reasons. Only on weekends could the girl go home. The PD had to be finished after 6 months due to a severe psychotic syndrome. The girl died at age 21, caused by a sepsis following the 15th change of the catheter. A huge problem of frequent catheter changing is the limited availability of vessel accesses – the limits of treatment by hemodialysis.