Split catheters in children on chronic hemodialysis: a single-center experience

Tunneled central venous catheters (CVCs) play an increasing role as vascular access for chronic hemodialysis (HD) in children, but limited data exist about the optimal CVC choice. We analyzed the outcome, efficacy, and complications of tunneled CVCs, placed in our unit in the last 3 years. Nineteen 10 F Split-Cath CVCs (two separate catheters fused along their length) were placed in 10 children, median age 9.19 years (range 2.15-13.31) and body weight (BW) between 10 and 40 kg. CVCs survival at 1, 3, 6, and 12 months was 94%, 77%, 51%, and 34%, respectively. Catheter survival was higher in children with BW > 20 kg than in smaller patients. Median survival was higher than that of 11 Quinton Permcath CVCs, placed in five children in the preceding 2 years (280 vs. 45 days, P < 0.05). Median blood flow rate and indices of HD adequacy were higher in children with lower BW (<20 kg vs. 20-30 kg vs. >30 kg) than in those with higher BW. Incidence of exit site and bloodstream infections was 2.32 and 0.66/1000 CVC days, respectively. One case of hemothorax due to subclavian artery puncture occurred during CVC placement. In conclusion, Split-Cath 10 F CVC allows for effective dialysis in children undergoing HD, particularly those between 10 and 30 kg BW. Catheter survival is acceptable, but could be improved in small children.