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Most of the guidelines for adults are applicable to children. Functional CRRT circuit survival in children is favored by larger catheter size686 that should be adapted to patient size (Table 20).687 Recent data from the Prospective Pediatric CRRT Registry group shows that internal jugular catheters may be associated with longer functional CRRT circuit survival, compared to femoral and subclavian access.686 In addition, the Prospective Pediatric CRRT Registry group showed extremely poor circuit survival with two singlelumen 5 F catheters; these catheters should therefore be avoided. Future permanent access in the form of an arteriovenous graft or fistula for patients who develop CKD may be
| Patient size | Catheter size | Site of insertion |
|---|---|---|
| Neonate | Double-lumen 7F | Femoral artery or vein |
| 3–6 kg | Double- or triple-lumen 7F | Jugular, subclavian, or femoral |
| 6–30 kg | Double-lumen 8F | Jugular, subclavian, or femoral |
| > 15 kg | Double-lumen 9F | Jugular, subclavian, or femoral |
| > 30 kg | Double-lumen 10F or triple-lumen 12F | Jugular, subclavian, or femoral |
Reprinted from Bunchman TE, Brophy PD, Goldstein SL. Technical considerations for renal replacement therapy in children. Semin Nephrol 2008; 28: 488–492687, copyright 2008, with permission from Elsevier; accessed http://www.seminarsinnephrology.org/article/S0270-9295(08)00117-4/fulltext
compromised if acute access is placed in a subclavian vein. Clinicians must therefore consider the potential long-term vascular needs of patients who may be expected to develop CKD, especially children who have demonstrated excellent long-term survival with CKD and ESRD.688
Analysis of a pediatric database (1989–1999) showed that surgically placed Tenckhoff catheters for PD induce less complications than more stiff percutaneously placed catheters.689 A more recent retrospective analysis with historical controls reports that, compared to the surgically placed Tenckhoff catheter, using a more flexible catheter for percutaneous insertion may achieve a comparable catheter survival and complication rate.690
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