Percutaneous caths have become an essential form of access for children with chronic renal failure on HD. Caths are the initial vascular access for 63% of pediatric HD patients (NAPRTCS). Caths also serve as temporary access while waiting for subcutaneous access maturation, PD cath placement and transplantation. There is little reported experience with cuffed (CC) and uncuffed (UnCC) caths in a single group of pediatric patients (pt) on chronic HD. One-year survival rates of 23-74% have been reported in adults. Infection is the most common complication (0.26-1.23/pt-yr). We assessed the survival and complications of CC and UnCC used for chronic HD from 1/90 to 12/94 at Children's Hospital. 56 UnCC (52 SC, 3 IJ, 1 Fem) and 22 CC (18 SC, 3 IJ, 1 EJ) were placed in 23 pts (median age 12.6 yr; range 0.9-21.6) for HD access. 5 caths were functioning at the end of the review period, 28 were removed electively and 45 were removed for a complication. One-month and 2-month actuarial survival for UnCC were 69% and 48%, respectively. Median UnCC survival was 31 days (4-157). Causes of UnCC removal were: elective (39%), kinking leading to dysfunction (36%), trauma (9%), infection (8%) and other(8%). Kinked caths were more likely to have smaller diameters. UnCC kinking was not associated with cath site, length or diameter/patient weight ratio. 2-month and 1-year actuarial survival for CC were 75% and 27%, respectively. Median CC survival was 123 days (1-971). Causes of CC removal were: infection(44%), kinking (17%), elective (11%), trauma (11%) and other (17%). 12 caths(8CC, 4 UnCC) were removed for infection in 8 pts. Infection rates were 0.58/pt-yr for UnCC and 0.71/pt-yr for CC. Median time to infection was 11 days for UnCC (7-157) and 211 days for CC (129-971). 10 caths grew Staph species. 5 caths were infected with multiple organisms.

We conclude that: (1) cath survival and infection rate in children is comparable to that reported in adults; (2) UnCC function well for short-term HD access of up to 2 months duration; (3) UnCC are most often removed secondary to kinking; (4) CC are successful for long-term access; and(5) CC are most often lost secondary to infection. These findings show that caths serve well for HD access in children.