Catheter-related complications among children treated with hemodialysis

Catheter-related complications among children treated with hemodialysis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Catheter-related complications among children treated with hemodialysis Shailza Mahajan, Lesa Dawman, Karalanglin Tiewsoh, Thakurvir Singh, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7234349/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objectives Central venous catheters (CVCs) used for hemodialysis access are associated with various complications and pose significant risks of morbidity and mortality. Complications can occur during insertion, dwell time, and catheter removal. This study was conducted to identify the risk factors and estimate the incidence of catheter-related complications in children undergoing hemodialysis. Methods This prospective cohort study was conducted between July 2021 and December 2022. Incidence rates per 1000 catheter days were calculated for complications, including catheter-related bloodstream infection (CRBSI), mechanical complications, and thrombosis. Results Ninety-seven children were included in the study. The mean age was 103.48 ± 34.98 months. The right internal jugular vein was the most common insertion site (72.2%). Non-tunneled catheters were used in 93.8% of the cases and tunneled in 6.2% of the total cases. Of the total complications observed, 87.5% were seen in the non-tunneled catheters and 12.5% in the tunneled catheters. CRBSI was the most common complication (3.21 episodes/1000 catheter days), followed by mechanical catheter dysfunction (1.84/1000 catheter days) and thrombosis (1.38 episodes/1000 catheter days). The mean duration of the catheter in situ was 17.41 days, with a moderate positive correlation between the occurrence of complications and the catheter duration (rho = 0.34, p = 0.018). Risk factors for complications included a history of hemodialysis, low serum albumin levels, tunneled catheters, and right femoral site placement. Conclusion In children undergoing hemodialysis, the most common complications were CRBSI, mechanical catheter dysfunction, and thrombosis. An extended duration of CVC use is associated with a higher likelihood of complications. Children Central venous catheters CRBSI Hemodialysis Internal jugular vein Figures Figure 1 Introduction Chronic kidney disease (CKD) affects 10% of the total population and has a prevalence of 1–10 per 1000 children [ 1 ]. End-stage kidney disease (ESKD), with an annual incidence of 5–10 per million children, represents a significant burden on healthcare systems globally, often necessitating renal replacement therapy (RRT)[ 2 ]. Hemodialysis in these patients requires well-functioning access, such as an arteriovenous fistula (AVF), graft, or central venous catheter (CVC). Despite the preferential use of AVF, CVCs are still commonly used due to their relative ease of insertion and ability to initiate dialysis immediately [ 3 ]. However, CVCs are associated with an increased risk of complications, morbidity, and mortality. Complications can arise during insertion, dwell time, and catheter removal. These include catheter-related bloodstream infections (CRBSI), bleeding and hematoma during placement, catheter misplacement, breakage, kinking, displacement, accidental removal, clot formation, and thrombosis. Larger trials have reported an overall complication rate of 25–50% or 4.6 to 11 per 1000 catheter days [ 4 ]. Complications include loss of access site, severe systemic infections, interruption of medical management, and the need for reinsertion. Therefore, identifying and preventing catheter-related complications are important for improving patient care [ 5 ]. This study was conducted to address the lack of available information and reports, along with limited experience regarding the long-term use of CVC in pediatric hemodialysis, to investigate and define the current occurrence of both infectious and non-infectious complications related to CVC usage, and to identify the causative agents responsible for infectious complications. Material and Methods This prospective cohort study was conducted from July 2021 to December 2022 at our tertiary care hospital. The study was approved by the Institute's Ethics Committee (INT/IEC/2021-21-1308) and conducted according to Good Clinical Practice principles and the Helsinki Convention. Study participants were children aged 3–14 years weighing over 15 kg who required hemodialysis. Patients were observed from catheter placement through hospitalization for catheter-related complications. Clinical, medical, and family history data were collected along with routine investigations. Hemodialysis duration was calculated. Data included catheter insertion date, size, type (tunnelled or non-tunnelled), insertion site, placement technique (ultrasound-guided or blind), and BSI prevention bundle compliance. Complications during insertion, such as bleeding, hematoma, and arterial puncture, were noted. CRBSI was suspected in patients who showed infection symptoms without alternate sources, and confirmed when identical organisms were cultured from the catheter hub and peripheral vein, with a differential time to positivity of 2 hours. For CRBSI, simultaneous peripheral venous and central-line blood cultures were used. If blood cultures were positive without other clinical reasons, bacteremia was considered catheter-related and managed per CRBSI guidelines[ 6 ]. Infection incidence was expressed as episodes per 1000 catheter days. Statistical analysis The study data were analyzed using IBM SPSS Statistics for Windows, version 26.0 (IBM Corp., Armonk, NY, USA). Descriptive statistics, including means, standard deviations, medians, and interquartile ranges, were used to summarize the continuous variables. Categorical variables were summarized as frequencies and percentages. Comparisons between the two groups were assessed using the Student’s unpaired t-test or Mann–Whitney U test for continuous variables and the chi-square test for categorical variables. Pearson's correlation was used for linear relationships between two continuous variables with a normal distribution, while Spearman's correlation was used for non-normally distributed data. The study also examined the relationship between the time from catheter insertion to the first complication and catheter survival using Kaplan-Meier curves. Fisher's exact test was used to explore the association between CRBSI and catheter outcomes. Statistical significance was defined as a p-value less than 0.05. Results Baseline demographic characteristics Catheters were inserted in 97 children during the study. Mean age of patients was 103.48 ± 34.98 months. There were 15 (15.5%) patients aged 2–5 years, 48 (49.5%) aged 5–10 years and 34 (35.1%) aged 10–15 years. Of the total, 56 (57.7%) were male and 41(42.3%) were female (Table 1 ). Table 1 Baseline demographic characteristics Mean ± SD || Median (IQR) || Min-Max OR N (%) Age (Months) 103.48 ± 34.98 || 101.00 (84.00-132.00) || 26.00–170.00 Age Group 2–5 Years 15 (15.5%) 5–10 Years 48 (49.5%) 10–15 Years 34 (35.1%) Gender Male 56 (57.7%) Female 41 (42.3%) Diagnosis CKD 30 (30.9%) HUS 12 (12.4%) GBS 1 (1.0%) TLS 2 (2.1%) RPGN 13 (13.4%) Nephrotic syndrome 22 (22.7%) PSGN 2 (2.1%) MPGN 2 (2.1%) Transverse myelitis 2 (2.1%) Myasthenia gravis 1 (1.0%) Tropical infection 7 (7.2%) Nephroblastoma 1 (1.0%) Optic neuritis 1 (1.0%) PIGN 1 (1.0%) Past History Of Haemodialysis (Present) 20 (20.6%) Abbreviations: CKD: Chronic Kidney Disease HUS: Hemolytic Uremic Syndrome , GBS: Guillian Barre Syndrome, TLS: Tumor Lysis Syndrome , RPGN: Rapidly Progressive Glomerulonephritis, PSGN: Post-streptococcal glomerulonephritis, MPGN: Mesangio-proliferative Glomerulonephritis, PIGN: Post-infectious Glomerulonephritis. Indications for hemodialysis The most prevalent underlying diagnosis was chronic kidney disease with 30 cases (30.9%), followed by nephrotic syndrome with 22 cases (22.7%), rapidly progressive glomerulonephritis (RPGN) with 13 cases (13%), and hemolytic uremic syndrome (HUS) with 12 cases (12%). Twenty patients (20.6%) were undergoing maintenance hemodialysis or had prior hemodialysis history. Type of Catheter Inserted Non-tunneled catheters were inserted in 91 cases (93.8%), while tunneled catheters were used in six cases (6.2%). Non-tunneled catheter duration ranged from 2 to 90 days, with a median of 13 days (7–18 days). Tunneled catheter duration ranged from 4 to 120 days, with a median of 36.5 days (25.75–48.75 days). Site of CVC insertion The right internal jugular vein (IJV) was the most frequent site for catheter insertion in 70 (72.2%) patients. The right femoral vein was the second most common site, used in 21 (21.6%) cases. The left IJV and left femoral vein were each used in 3 (3.1%) patients. The subclavian vein was not used as an access site for CVC insertion. Past history of hemodialysis Of enrolled patients, 20 (20.6%) had hemodialysis history. Mean catheter survival was 52.56 days (95% CI: 29.46–59.61) in patients with hemodialysis history, versus 72.23 days (95% CI: 59.61–84.85) in those without (p < 0.020). Complications Primary outcome measure CRBSI The incidence of CRBSI was 3.21/1000 catheter days. Of 97 patients, 21 (21.6%) developed CRBSI. Among these, 12 (12.4%) had possible CRBSI, 7 (7.2%) had culture-proven CRBSI, and 2 (2.1%) had probable CRBSI. Species isolated Table 2 shows bacterial isolates from blood cultures. Most isolates were gram-positive bacteria. Polymicrobial sepsis was uncommon, observed in one case showing growth of E. coli and Enterococcus faecalis. Table 2 Bacterial isolates from blood cultures Species Isolated Frequency Percentage 95% CI MRSA 1 1.0% 0.1% − 6.4% MSSA 2 2.1% 0.4% − 8.0% Acinetobacter baumanii 1 1.0% 0.1% − 6.4% Others (Achromobacter xylosidans and Non lactose fermenting GNB) 2 2.1% 0.4% − 8.0% Enterococcus faecalis 2 2.1% 0.4% − 8.0% Pseudomonas aeruginosa 1 1.0% 0.1% − 6.4% Abbreviations: MRSA: Methicillin resistant Staphylococcus aureus, MSSA: Methicillin sensitive Staphylococcus aureus, GNB: Gram Negative Bacilli Presence of CRBSI and catheter outcome Mean time to catheter outcome with and without CRBSI was 7(4–14) days and 120(14–120) days, respectively. A significant correlation existed between CRBSI and catheter outcome requiring reinsertion, seen in eight (38.1%) cases; dialysis continued in eight (38.1%) cases and catheter removal in five (23.8%), based on clinical condition. Secondary outcome measures Thrombosis Thrombosis occurred in 9 (9.3%) cases, with an incidence of 1.38/1000 catheter days. The study showed thrombosis was associated with shorter survival of 31.56 (6.78–56.34) days versus 72.14 (60.34–83.94) in the thrombosis-absent group. Catheter outcome in thrombosis A significant correlation existed between catheter outcome and thrombosis presence (χ2 = 17.830, p = 0.002). In six (66.7%) thrombosis cases, catheter reinsertion was required, dialysis continued in one patient (11.1%) after heparin use, and in two (22.2%) cases, dialysis was discontinued. Catheter dysfunction The incidence of catheter dysfunction was 1.84/1000 catheter days. The main cause was nonfunctional catheters in 12 (12.4%) cases, mostly due to thrombosis or clots. In five (5.2%) cases, catheter dysfunction was from misplaced sutures, and in two (2.1%) cases, accidental removal occurred. No loss of catheter integrity was observed. No catheter dysfunction was observed in 78 (80.4%) cases. Bleeding/ hematoma formation The incidence of bleeding and hematoma during insertion was 1.99/1000 catheter days, with hematoma in 13 (13.4%) cases. No complications related to sedation or embolism formation were observed. Risk factors associated with CVC-related complications Bleeding/ hematoma formation The absence of bleeding or hematoma during the procedure was linked to a reduced risk of complications (HR = 0.00, 95% CI: 0.00–0.00, p < 0.001). Site of catheter insertion Catheter placement site was a significant factor. Catheters in the right IJV had mean survival of 77.91 (65.33–90.49) days, followed by right femoral vein catheters with mean survival of 49.81 (25.6–73.9) days. Catheters in the left IJV and left femoral had mean survival of 9 (4.02–13.98) and 3.33 (2.7–3.8) days, respectively (p < 0.001). Patients with right femoral catheters had increased hazard (HR: 1.98, 95% CI: 1.03–3.80, p = 0.040), while those with left femoral catheters faced higher hazard (HR: 9.71, 95% CI: 2.70-34.89, p < 0.001) compared to right internal jugular vein. Thrombosis The absence of thrombosis was associated with a lower risk of complications (HR = 0.37, 95% CI: 0.11–1.31, p = 0.123). Dwell time of the catheter in situ The mean (SD) duration of catheter in situ was 17.41 (17.27) days. The median (IQR) duration was 14 (7–20) days. During the study, dwell time ranged from 2-120 days. A positive correlation existed between complication occurrence time and catheter duration (rho = 0.34, p = 0.018) (Fig. 1 ). For every 1 unit increase in catheter duration (days), complication occurrence time increased by 0.75 units. Past history of hemodialysis Patients without a history of hemodialysis experienced a significantly lower risk of complications than those with a previous history of hemodialysis (HR, 0.49; 95% CI: 0.27–0.91, p = 0.024). Serum albumin at insertion Serum albumin levels at the time of catheter insertion proved to be a significant predictor, with patients having serum albumin levels above 3 g/dL exhibiting a lower hazard of complications (HR: 0.43, 95% CI: 0.18–1.05, p = 0.065) Outcome of catheter-related complications Elective removal of the CVC occurred in 47 (48.5%) cases when dialysis was no longer needed. Reinsertion was required in 16 (16.5%) cases − 5 due to infection, 5 to thrombosis, and 6 to catheter dysfunction. Resuturing was needed in 5 cases (5.2%) and guidewire exchange in 1 case (1%). A tunnelled catheter (Permcath) was inserted in eight patients (8.2%) requiring chronic dialysis. In seven (7.2%) cases, dialysis stopped due to hemodynamic instability, with patients either shifting to peritoneal dialysis or dying, and one left against medical advice. The remaining 13 patients (13.4%) continued dialysis during hospitalization without requiring catheter reinsertion or manipulations. Survival analysis of catheter This study analyzed various factors affecting catheter survival (Fig. 1 ). Site of catheter insertion Individuals with right IJV catheters had mean survival of 77.91 (65.33–90.49) days, followed by right femoral vein catheters with mean survival of 49.81 (25.6–73.9) days. Left IJV and left femoral catheters had minimum mean survival of 9 (4.02–13.98) and 3.33 (2.7–3.8) days, respectively (p < 0.001). Presence of hematoma Children with no history of bleeding/hematoma during catheter insertion showed significantly longer survival time of 78.37 (66.8–89.5) days compared to those with bleeding and hematoma history of 3.62 (1.3–5.9) days, as indicated by log rank test p-value (0.001). Presence of CRBSI Children without CRBSI had significantly longer mean and median catheter survival than those with CRBSI (p < 0.001). Presence of thrombosis Individuals with no history of thrombosis showed longer catheter survival time, 72.14 (60.34–83.94) days versus those with positive thrombosis history, 31.56(6.78–56.34) days, as indicated by p-value < 0.008. Discussion Due to limited data on catheter-related complications in children, this study assessed their incidence and risk factors in 97 pediatric hemodialysis patients. Catheters inserted in the right IJV and femoral showed better survival and fewer complications compared to left IJV and femoral placements. These findings were similar to those reported by Fry et al.[ 7 ]and Sulek et al.[ 8 ], showing maximum catheter survival in IJV followed by femoral insertion. The lower survival of catheters in left IJV and femoral region is due to technical difficulty, more insertion attempts, and higher complications. Catheter survival is also influenced by tunneling, with 87.5% of complications occurring in non-tunneled catheters and 12.5% in tunneled ones. Our findings aligned with Weijmer et al.[ 9 ], showing non-tunneled CVCs have 2–3 times greater complication risk than tunneled catheters. Tunneled catheter fixation using subcutaneous cuff reduces bacterial migration, improving survival. Non-tunneled catheter duration ranged from 2–90 days with a median of 13 (7–18) days. Our research shows uncuffed catheters can perform effectively for longer durations, with 50% of participants maintaining access for up to 30 days. These catheters remained functional until removal by choice in 46 cases (50.5%). CRBSI was identified as the most prevalent CVC complication, occurring at 3.21episodes/1000 catheter days, mostly due to gram-positive organisms. Common gram-positive isolates were Enterococcus faecalis, MSSA, and MRSA. Gram-negative isolates included Acinetobacter baumannii, Acinetobacter xylosidans, Pseudomonas aeruginosa, and Escherichia coli. Only one patient had polymicrobial CRBSI with Enterococcus faecalis and Escherichia coli. The organism growth matched reports by Kumar et al. and Onder et al[ 10 ][ 11 ]. Kumar reported 1.72/1000 CVC days incidence with Staphylococcus aureus being most common, while Onder reported 1.6/1000 catheter-days with predominant gram-positive isolates. Their lower CRBSI rates were due to tunneled catheters, whereas our study included both types. Shimon et al.[ 12 ]found 51.8% gram-negative organisms, mainly Enterobacteriaceae and Pseudomonas, though their infections were mostly urinary or abdominal. Current CLABSI rates are lower than previous studies (25%-50%)[ 13 ], likely due to aggressive antibiotic use. In a study by Tokars et al. [ 14 ], hypoalbuminemia was identified as a risk factor for CRBSI, increased hospitalization, and changes in distribution volume. Our study showed reduced catheter-related complications and improved catheter survival in patients with albumin > 3gm/dl at insertion. Good nutritional counselling, high protein diet, and increased dialysis frequency can reduce septicemia risk and improve catheter survival. Thrombosis had an incidence of 1.38 episodes per 1000 catheter days. In a study by Napalkov et al. [ 15 ], the incidence was 4.4% for catheters or 1.3/1000 catheter days, lower than previous studies (0.6%-33%) [ 16 ]. This difference can be attributed to the study population having primarily hematological malignancies, increasing thrombosis incidence. Evidence shows an association between prolonged CVC placement, infections, and thrombosis, common reasons for CVC replacement [ 17 ]. This association relates to fibrin sheath formation during infections and thrombotic events. However, our study found no significant correlation between these factors, possibly due to heparin locks, early thrombosis screening, and prompt antibiotic treatment in suspected CRBSI. The only peri-procedural complications were bleeding during CVC insertion, seen in 9 cases with 1.99 episodes/1000 catheter days, which responded to manual compression or stitching at catheter exit, as seen by Kander et al. [ 18 ]. Their study showed 0.9% of insertions caused bleeding requiring prolonged compression. No kinking or malpositioning occurred in our study, attributed to image-guided insertion, which reduces complications. Accidental removal of catheters occurred in two cases (2%) in the right IJV, as reported by Kojima et al.[ 19 ]. The neck region's easier accessibility compared to the inguinal area explains the higher incidence of accidental removal in IJV. This incidence was lower than the 9.3% reported by Levy et al. [ 20 ], who used tape instead of sutures to secure catheters. This single-center study may limit the generalizability of findings to other settings. The results may not fully capture the diversity of catheter-related complications across different healthcare environments. Conclusion CRBSI was the most frequent complication, followed by mechanical dysfunction and thrombosis. Gram-positive organisms were predominant in CRBSI cases. Absence of CRBSI and thrombosis reduces complication risk, while CVC-related infections increase thrombosis risk. Femoral site catheters presented a higher risk than right internal jugular vein catheters. Declarations Compliance with Ethical Standards Disclosure of potential conflicts of interest : The author(s) declared no potential conflicts of interest concerning this article's research, authorship, or publication. Informed consent : Informed consent was obtained from all participants in the study. Funding: The author(s) received no financial support for this article's research, authorship, and/or publication. Ethical approval: All procedures performed in the study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee at which the study was conducted (Institutional Ethics Committee, Post Graduate Institute of Medical Education and Research, Chandigarh, India, IEC approval number: No. INT/IEC/2021/1308, dated: 14.09.2021) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. References Geylis M, Coreanu T, Novack V, Landau D. 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Fry AC, Stratton J, Farrington K, Mahna K, Selvakumar S, Thompson H, et al. Factors affecting long-term survival of tunnelled haemodialysis catheters--a prospective audit of 812 tunnelled catheters. Nephrol Dial Transplant Off Publ Eur Dial Transpl Assoc - Eur Ren Assoc. 2008 Jan;23(1):275–81. Sulek CA, Gravenstein N, Blackshear RH, Weiss L. Head rotation during internal jugular vein cannulation and the risk of carotid artery puncture. Anesth Analg. 1996 Jan;82(1):125–8. Weijmer MC, Vervloet MG, ter Wee PM. Compared to tunnelled cuffed haemodialysis catheters, temporary untunnelled catheters are associated with more complications already within 2 weeks of use. Nephrol Dial Transplant Off Publ Eur Dial Transpl Assoc - Eur Ren Assoc. 2004 Mar;19(3):670–7. Kumar G. Catheter-related blood stream infections among children on hemodialysis over 7 years: A single-center experience. Asian J Pediatr Nephrol. 2021;4(1):22. Onder AM, Chandar J, Billings A, Diaz R, Francoeur D, Abitbol C, et al. Chlorhexidine-based antiseptic solutions effectively reduce catheter-related bacteremia. Pediatr Nephrol Berl Ger. 2009 Sep;24(9):1741–7. Shimon O, Green H, Eliakim-Raz N, Rozen-Zvi B, Ben-Zvi H, Zohar I, et al. Gram-negative bloodstream infections in hemodialysis patients: A retrospective study. Clin Nephrol. 2018 Aug 1;90(2):117–24. Peynircioglu B, Ozkan F, Canyigit M, Pamuk GA, Geyik S, Cil BE, et al. Radiologically placed tunneled internal jugular catheters in the management of chronic hemodialysis and long-term infusion therapies in the pediatric population. J Vasc Interv Radiol JVIR. 2007 Jul;18(7):875–81. Tokars JI, Light P, Anderson J, Miller ER, Parrish J, Armistead N, et al. A prospective study of vascular access infections at seven outpatient hemodialysis centers. Am J Kidney Dis. 2001 Jun;37(6):1232–40. Napalkov P, Felici DM, Chu LK, Jacobs JR, Begelman SM. Incidence of catheter-related complications in patients with central venous or hemodialysis catheters: a health care claims database analysis. BMC Cardiovasc Disord. 2013 Dec;13(1):86. Boersma RS, Jie KSG, Verbon A, Van Pampus ECM, Schouten HC. Thrombotic and infectious complications of central venous catheters in patients with hematological malignancies. Ann Oncol. 2008 Mar;19(3):433–42. Wall C, Moore J, Thachil J. Catheter-related thrombosis: A practical approach. J Intensive Care Soc. 2016 May;17(2):160–7. Kander T, Frigyesi A, Kjeldsen‐Kragh J, Karlsson H, Rolander F, Schött U. Bleeding complications after central line insertions: relevance of pre‐procedure coagulation tests and institutional transfusion policy. Acta Anaesthesiol Scand. 2013 May;57(5):573–9. Kojima S, Marui Y, Shibagaki Y, Sakurada T. Accidental removal of dialysis central venous catheter inserted for blood purification therapy: a single-center study. Clin Exp Nephrol. 2022 Dec;26(12):1218–22. Levy I, Bendet M, Samra Z, Shalit I, Katz J. Infectious complications of peripherally inserted central venous catheters in children. Pediatr Infect Dis J. 2010 May;29(5):426–9. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7234349","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":500769988,"identity":"c807d45d-600b-41ad-be4b-a6180c6c4bc9","order_by":0,"name":"Shailza Mahajan","email":"","orcid":"","institution":"Post Graduate Institute of Medical Education and Research","correspondingAuthor":false,"prefix":"","firstName":"Shailza","middleName":"","lastName":"Mahajan","suffix":""},{"id":500769990,"identity":"406f2ccd-2a1d-4f0f-b809-2f0f1e8835a1","order_by":1,"name":"Lesa Dawman","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA3klEQVRIiWNgGAWjYBACPhDBA2YyHwASEjIEtbAhtLAlgLTwkKKFxwDBxquFvf3hhzc1h6P5Z/d8fnWjxoKHgf3w0Q14tfCcMZacc+xw7ow7Z7dZ5xwDOownLe0GXi0SOQzSPGy3cxtu5G4zzmEDapHgMcOvRf754988/27nzr+R88w45x8xWiQYzKR5227nbriRw/w4t40YLTw5ZpZz+/7nbryRZsac2yfBw0bIL/zsxx/fePMtLXfejeTHn3O+1cnxsx8+hlcLmiMZoDFFLGD+QIrqUTAKRsEoGDkAANiGR7SDkRpnAAAAAElFTkSuQmCC","orcid":"","institution":"Post Graduate Institute of Medical Education and Research","correspondingAuthor":true,"prefix":"","firstName":"Lesa","middleName":"","lastName":"Dawman","suffix":""},{"id":500769992,"identity":"54360aac-6195-4589-9a42-11e2d87b2fe4","order_by":2,"name":"Karalanglin Tiewsoh","email":"","orcid":"","institution":"Post Graduate Institute of Medical Education and Research","correspondingAuthor":false,"prefix":"","firstName":"Karalanglin","middleName":"","lastName":"Tiewsoh","suffix":""},{"id":500769993,"identity":"b5cf9074-6d8e-4dac-94f0-49cf938b70db","order_by":3,"name":"Thakurvir Singh","email":"","orcid":"","institution":"Post Graduate Institute of Medical Education and Research","correspondingAuthor":false,"prefix":"","firstName":"Thakurvir","middleName":"","lastName":"Singh","suffix":""},{"id":500769994,"identity":"0460a826-56b0-4f7a-865a-847aa801122a","order_by":4,"name":"Aarchie Gupta","email":"","orcid":"","institution":"Post Graduate Institute of Medical Education and Research","correspondingAuthor":false,"prefix":"","firstName":"Aarchie","middleName":"","lastName":"Gupta","suffix":""},{"id":500769996,"identity":"289bfe22-2b97-4f12-a890-8b018a5293ec","order_by":5,"name":"Manisha Biswal","email":"","orcid":"","institution":"Post Graduate Institute of Medical Education and Research","correspondingAuthor":false,"prefix":"","firstName":"Manisha","middleName":"","lastName":"Biswal","suffix":""}],"badges":[],"createdAt":"2025-07-28 13:23:21","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7234349/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7234349/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":89396546,"identity":"eb5d1842-d203-4f2b-900a-355aad68ad12","added_by":"auto","created_at":"2025-08-19 13:41:11","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":166713,"visible":true,"origin":"","legend":"\u003cp\u003eA – Presence of hematoma; B – Site of catheter insertion; C – Presence of thrombosis.\u003c/p\u003e","description":"","filename":"Figure1CVC.png","url":"https://assets-eu.researchsquare.com/files/rs-7234349/v1/2638c66a3c7fd9339f22fb28.png"},{"id":96603185,"identity":"51a06061-64d4-4a93-969f-b2a6b98e2262","added_by":"auto","created_at":"2025-11-24 09:07:22","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":846639,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7234349/v1/fbed91ed-1ed4-469b-967e-38d60620d8f5.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Catheter-related complications among children treated with hemodialysis","fulltext":[{"header":"Introduction","content":"\u003cp\u003eChronic kidney disease (CKD) affects 10% of the total population and has a prevalence of 1\u0026ndash;10 per 1000 children [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. End-stage kidney disease (ESKD), with an annual incidence of 5\u0026ndash;10 per million children, represents a significant burden on healthcare systems globally, often necessitating renal replacement therapy (RRT)[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Hemodialysis in these patients requires well-functioning access, such as an arteriovenous fistula (AVF), graft, or central venous catheter (CVC). Despite the preferential use of AVF, CVCs are still commonly used due to their relative ease of insertion and ability to initiate dialysis immediately [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eHowever, CVCs are associated with an increased risk of complications, morbidity, and mortality. Complications can arise during insertion, dwell time, and catheter removal. These include catheter-related bloodstream infections (CRBSI), bleeding and hematoma during placement, catheter misplacement, breakage, kinking, displacement, accidental removal, clot formation, and thrombosis. Larger trials have reported an overall complication rate of 25\u0026ndash;50% or 4.6 to 11 per 1000 catheter days [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eComplications include loss of access site, severe systemic infections, interruption of medical management, and the need for reinsertion. Therefore, identifying and preventing catheter-related complications are important for improving patient care [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThis study was conducted to address the lack of available information and reports, along with limited experience regarding the long-term use of CVC in pediatric hemodialysis, to investigate and define the current occurrence of both infectious and non-infectious complications related to CVC usage, and to identify the causative agents responsible for infectious complications.\u003c/p\u003e"},{"header":"Material and Methods","content":"\u003cp\u003e This prospective cohort study was conducted from July 2021 to December 2022 at our tertiary care hospital. The study was approved by the Institute's Ethics Committee (INT/IEC/2021-21-1308) and conducted according to Good Clinical Practice principles and the Helsinki Convention. Study participants were children aged 3\u0026ndash;14 years weighing over 15 kg who required hemodialysis. Patients were observed from catheter placement through hospitalization for catheter-related complications. Clinical, medical, and family history data were collected along with routine investigations. Hemodialysis duration was calculated. Data included catheter insertion date, size, type (tunnelled or non-tunnelled), insertion site, placement technique (ultrasound-guided or blind), and BSI prevention bundle compliance. Complications during insertion, such as bleeding, hematoma, and arterial puncture, were noted. CRBSI was suspected in patients who showed infection symptoms without alternate sources, and confirmed when identical organisms were cultured from the catheter hub and peripheral vein, with a differential time to positivity of 2 hours. For CRBSI, simultaneous peripheral venous and central-line blood cultures were used. If blood cultures were positive without other clinical reasons, bacteremia was considered catheter-related and managed per CRBSI guidelines[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Infection incidence was expressed as episodes per 1000 catheter days.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eThe study data were analyzed using IBM SPSS Statistics for Windows, version 26.0 (IBM Corp., Armonk, NY, USA). Descriptive statistics, including means, standard deviations, medians, and interquartile ranges, were used to summarize the continuous variables. Categorical variables were summarized as frequencies and percentages. Comparisons between the two groups were assessed using the Student\u0026rsquo;s unpaired t-test or Mann\u0026ndash;Whitney U test for continuous variables and the chi-square test for categorical variables. Pearson's correlation was used for linear relationships between two continuous variables with a normal distribution, while Spearman's correlation was used for non-normally distributed data. The study also examined the relationship between the time from catheter insertion to the first complication and catheter survival using Kaplan-Meier curves. Fisher's exact test was used to explore the association between CRBSI and catheter outcomes. Statistical significance was defined as a p-value less than 0.05.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cem\u003eBaseline demographic characteristics\u003c/em\u003e\u003c/p\u003e\u003cp\u003eCatheters were inserted in 97 children during the study. Mean age of patients was 103.48\u0026thinsp;\u0026plusmn;\u0026thinsp;34.98 months. There were 15 (15.5%) patients aged 2\u0026ndash;5 years, 48 (49.5%) aged 5\u0026ndash;10 years and 34 (35.1%) aged 10\u0026ndash;15 years. Of the total, 56 (57.7%) were male and 41(42.3%) were female (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eBaseline demographic characteristics\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD || Median (IQR) || Min-Max OR N (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge (Months)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e103.48\u0026thinsp;\u0026plusmn;\u0026thinsp;34.98 || 101.00 (84.00-132.00) || 26.00\u0026ndash;170.00\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge Group\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u0026ndash;5 Years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15 (15.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5\u0026ndash;10 Years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e48 (49.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e10\u0026ndash;15 Years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e34 (35.1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e56 (57.7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e41 (42.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDiagnosis\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCKD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e30 (30.9%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHUS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12 (12.4%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGBS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (1.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTLS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 (2.1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRPGN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13 (13.4%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNephrotic syndrome\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e22 (22.7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePSGN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 (2.1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMPGN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 (2.1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTransverse myelitis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 (2.1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMyasthenia gravis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (1.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTropical infection\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7 (7.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNephroblastoma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (1.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOptic neuritis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (1.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePIGN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (1.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePast History Of Haemodialysis (Present)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20 (20.6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAbbreviations:\u003cem\u003e\u0026nbsp;\u003c/em\u003eCKD:\u003cem\u003e\u0026nbsp;\u003c/em\u003eChronic Kidney Disease\u003cem\u003e\u0026nbsp;\u003c/em\u003eHUS:\u003cem\u003e\u0026nbsp;\u003c/em\u003eHemolytic Uremic Syndrome , GBS:\u003cem\u003e\u0026nbsp;\u003c/em\u003eGuillian\u003cem\u003e\u0026nbsp;\u003c/em\u003eBarre Syndrome, TLS:\u003cem\u003e\u0026nbsp;\u003c/em\u003eTumor Lysis Syndrome , RPGN: Rapidly\u003cem\u003e\u0026nbsp;\u003c/em\u003eProgressive Glomerulonephritis, PSGN: Post-streptococcal glomerulonephritis, MPGN:\u003cem\u003e\u0026nbsp;\u003c/em\u003eMesangio-proliferative Glomerulonephritis, PIGN: Post-infectious\u003cem\u003e\u0026nbsp;\u003c/em\u003eGlomerulonephritis.\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eIndications for hemodialysis\u003c/em\u003e\u003c/p\u003e\u003cp\u003eThe most prevalent underlying diagnosis was chronic kidney disease with 30 cases (30.9%), followed by nephrotic syndrome with 22 cases (22.7%), rapidly progressive glomerulonephritis (RPGN) with 13 cases (13%), and hemolytic uremic syndrome (HUS) with 12 cases (12%). Twenty patients (20.6%) were undergoing maintenance hemodialysis or had prior hemodialysis history.\u003c/p\u003e\u003cp\u003e\u003cem\u003eType of Catheter Inserted\u003c/em\u003e\u003c/p\u003e\u003cp\u003eNon-tunneled catheters were inserted in 91 cases (93.8%), while tunneled catheters were used in six cases (6.2%). Non-tunneled catheter duration ranged from 2 to 90 days, with a median of 13 days (7\u0026ndash;18 days). Tunneled catheter duration ranged from 4 to 120 days, with a median of 36.5 days (25.75\u0026ndash;48.75 days).\u003c/p\u003e\u003cp\u003e\u003cem\u003eSite of CVC insertion\u003c/em\u003e\u003c/p\u003e\u003cp\u003eThe right internal jugular vein (IJV) was the most frequent site for catheter insertion in 70 (72.2%) patients. The right femoral vein was the second most common site, used in 21 (21.6%) cases. The left IJV and left femoral vein were each used in 3 (3.1%) patients. The subclavian vein was not used as an access site for CVC insertion.\u003c/p\u003e\u003cp\u003e\u003cem\u003ePast history of hemodialysis\u003c/em\u003e\u003c/p\u003e\u003cp\u003eOf enrolled patients, 20 (20.6%) had hemodialysis history. Mean catheter survival was 52.56 days (95% CI: 29.46\u0026ndash;59.61) in patients with hemodialysis history, versus 72.23 days (95% CI: 59.61\u0026ndash;84.85) in those without (p\u0026thinsp;\u0026lt;\u0026thinsp;0.020).\u003c/p\u003e\u003cp\u003e\u003cb\u003eComplications\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003ePrimary outcome measure\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eCRBSI\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe incidence of CRBSI was 3.21/1000 catheter days. Of 97 patients, 21 (21.6%) developed CRBSI. Among these, 12 (12.4%) had possible CRBSI, 7 (7.2%) had culture-proven CRBSI, and 2 (2.1%) had probable CRBSI.\u003c/p\u003e\u003cp\u003e\u003cem\u003eSpecies isolated\u003c/em\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows bacterial isolates from blood cultures. Most isolates were gram-positive bacteria. Polymicrobial sepsis was uncommon, observed in one case showing growth of E. coli and Enterococcus faecalis.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eBacterial isolates from blood cultures\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSpecies Isolated\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFrequency\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePercentage\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e95% CI\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMRSA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c4\"\u003e\u003cp\u003e0.1% \u0026minus;\u0026thinsp;6.4%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMSSA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2.1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c4\"\u003e\u003cp\u003e0.4% \u0026minus;\u0026thinsp;8.0%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAcinetobacter baumanii\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c4\"\u003e\u003cp\u003e0.1% \u0026minus;\u0026thinsp;6.4%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOthers (Achromobacter xylosidans and Non lactose fermenting GNB)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2.1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c4\"\u003e\u003cp\u003e0.4% \u0026minus;\u0026thinsp;8.0%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEnterococcus faecalis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2.1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c4\"\u003e\u003cp\u003e0.4% \u0026minus;\u0026thinsp;8.0%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePseudomonas aeruginosa\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c4\"\u003e\u003cp\u003e0.1% \u0026minus;\u0026thinsp;6.4%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003eAbbreviations: MRSA: Methicillin resistant Staphylococcus aureus, MSSA: Methicillin sensitive Staphylococcus aureus, GNB: Gram Negative Bacilli\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003ePresence of CRBSI and catheter outcome\u003c/em\u003e\u003c/p\u003e\u003cp\u003eMean time to catheter outcome with and without CRBSI was 7(4\u0026ndash;14) days and 120(14\u0026ndash;120) days, respectively. A significant correlation existed between CRBSI and catheter outcome requiring reinsertion, seen in eight (38.1%) cases; dialysis continued in eight (38.1%) cases and catheter removal in five (23.8%), based on clinical condition.\u003c/p\u003e\u003cp\u003e\u003cb\u003eSecondary outcome measures\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eThrombosis\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThrombosis occurred in 9 (9.3%) cases, with an incidence of 1.38/1000 catheter days. The study showed thrombosis was associated with shorter survival of 31.56 (6.78\u0026ndash;56.34) days versus 72.14 (60.34\u0026ndash;83.94) in the thrombosis-absent group.\u003c/p\u003e\u003cp\u003e\u003cem\u003eCatheter outcome in thrombosis\u003c/em\u003e\u003c/p\u003e\u003cp\u003eA significant correlation existed between catheter outcome and thrombosis presence (χ2\u0026thinsp;=\u0026thinsp;17.830, p\u0026thinsp;=\u0026thinsp;0.002). In six (66.7%) thrombosis cases, catheter reinsertion was required, dialysis continued in one patient (11.1%) after heparin use, and in two (22.2%) cases, dialysis was discontinued.\u003c/p\u003e\u003cp\u003e\u003cb\u003eCatheter dysfunction\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe incidence of catheter dysfunction was 1.84/1000 catheter days. The main cause was nonfunctional catheters in 12 (12.4%) cases, mostly due to thrombosis or clots. In five (5.2%) cases, catheter dysfunction was from misplaced sutures, and in two (2.1%) cases, accidental removal occurred. No loss of catheter integrity was observed. No catheter dysfunction was observed in 78 (80.4%) cases.\u003c/p\u003e\u003cp\u003e\u003cb\u003eBleeding/ hematoma formation\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe incidence of bleeding and hematoma during insertion was 1.99/1000 catheter days, with hematoma in 13 (13.4%) cases. No complications related to sedation or embolism formation were observed.\u003c/p\u003e\u003cp\u003e\u003cb\u003eRisk factors associated with CVC-related complications\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eBleeding/ hematoma formation\u003c/em\u003e\u003c/p\u003e\u003cp\u003eThe absence of bleeding or hematoma during the procedure was linked to a reduced risk of complications (HR\u0026thinsp;=\u0026thinsp;0.00, 95% CI: 0.00\u0026ndash;0.00, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003cp\u003e\u003cem\u003eSite of catheter insertion\u003c/em\u003e\u003c/p\u003e\u003cp\u003eCatheter placement site was a significant factor. Catheters in the right IJV had mean survival of 77.91 (65.33\u0026ndash;90.49) days, followed by right femoral vein catheters with mean survival of 49.81 (25.6\u0026ndash;73.9) days. Catheters in the left IJV and left femoral had mean survival of 9 (4.02\u0026ndash;13.98) and 3.33 (2.7\u0026ndash;3.8) days, respectively (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Patients with right femoral catheters had increased hazard (HR: 1.98, 95% CI: 1.03\u0026ndash;3.80, p\u0026thinsp;=\u0026thinsp;0.040), while those with left femoral catheters faced higher hazard (HR: 9.71, 95% CI: 2.70-34.89, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) compared to right internal jugular vein.\u003c/p\u003e\u003cp\u003e\u003cem\u003eThrombosis\u003c/em\u003e\u003c/p\u003e\u003cp\u003eThe absence of thrombosis was associated with a lower risk of complications (HR\u0026thinsp;=\u0026thinsp;0.37, 95% CI: 0.11\u0026ndash;1.31, p\u0026thinsp;=\u0026thinsp;0.123).\u003c/p\u003e\u003cp\u003e\u003cem\u003eDwell time of the catheter in situ\u003c/em\u003e\u003c/p\u003e\u003cp\u003eThe mean (SD) duration of catheter in situ was 17.41 (17.27) days. The median (IQR) duration was 14 (7\u0026ndash;20) days. During the study, dwell time ranged from 2-120 days. A positive correlation existed between complication occurrence time and catheter duration (rho\u0026thinsp;=\u0026thinsp;0.34, p\u0026thinsp;=\u0026thinsp;0.018) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). For every 1 unit increase in catheter duration (days), complication occurrence time increased by 0.75 units.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003ePast history of hemodialysis\u003c/em\u003e\u003c/p\u003e\u003cp\u003ePatients without a history of hemodialysis experienced a significantly lower risk of complications than those with a previous history of hemodialysis (HR, 0.49; 95% CI: 0.27\u0026ndash;0.91, p\u0026thinsp;=\u0026thinsp;0.024).\u003c/p\u003e\u003cp\u003e\u003cem\u003eSerum albumin at insertion\u003c/em\u003e\u003c/p\u003e\u003cp\u003eSerum albumin levels at the time of catheter insertion proved to be a significant predictor, with patients having serum albumin levels above 3 g/dL exhibiting a lower hazard of complications (HR: 0.43, 95% CI: 0.18\u0026ndash;1.05, p\u0026thinsp;=\u0026thinsp;0.065)\u003c/p\u003e\u003cp\u003e\u003cb\u003eOutcome of catheter-related complications\u003c/b\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eElective removal of the CVC occurred in 47 (48.5%) cases when dialysis was no longer needed. Reinsertion was required in 16 (16.5%) cases \u0026minus;\u0026thinsp;5 due to infection, 5 to thrombosis, and 6 to catheter dysfunction. Resuturing was needed in 5 cases (5.2%) and guidewire exchange in 1 case (1%). A tunnelled catheter (Permcath) was inserted in eight patients (8.2%) requiring chronic dialysis. In seven (7.2%) cases, dialysis stopped due to hemodynamic instability, with patients either shifting to peritoneal dialysis or dying, and one left against medical advice. The remaining 13 patients (13.4%) continued dialysis during hospitalization without requiring catheter reinsertion or manipulations.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eSurvival analysis of catheter\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis study analyzed various factors affecting catheter survival (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eSite of catheter insertion\u003c/strong\u003e\u003cp\u003eIndividuals with right IJV catheters had mean survival of 77.91 (65.33\u0026ndash;90.49) days, followed by right femoral vein catheters with mean survival of 49.81 (25.6\u0026ndash;73.9) days. Left IJV and left femoral catheters had minimum mean survival of 9 (4.02\u0026ndash;13.98) and 3.33 (2.7\u0026ndash;3.8) days, respectively (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003ePresence of hematoma\u003c/strong\u003e\u003cp\u003eChildren with no history of bleeding/hematoma during catheter insertion showed significantly longer survival time of 78.37 (66.8\u0026ndash;89.5) days compared to those with bleeding and hematoma history of 3.62 (1.3\u0026ndash;5.9) days, as indicated by log rank test p-value (0.001).\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003ePresence of CRBSI\u003c/strong\u003e\u003cp\u003eChildren without CRBSI had significantly longer mean and median catheter survival than those with CRBSI (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003ePresence of thrombosis\u003c/strong\u003e\u003cp\u003eIndividuals with no history of thrombosis showed longer catheter survival time, 72.14 (60.34\u0026ndash;83.94) days versus those with positive thrombosis history, 31.56(6.78\u0026ndash;56.34) days, as indicated by p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.008.\u003c/p\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eDue to limited data on catheter-related complications in children, this study assessed their incidence and risk factors in 97 pediatric hemodialysis patients. Catheters inserted in the right IJV and femoral showed better survival and fewer complications compared to left IJV and femoral placements. These findings were similar to those reported by Fry et al.[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]and Sulek et al.[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], showing maximum catheter survival in IJV followed by femoral insertion. The lower survival of catheters in left IJV and femoral region is due to technical difficulty, more insertion attempts, and higher complications. Catheter survival is also influenced by tunneling, with 87.5% of complications occurring in non-tunneled catheters and 12.5% in tunneled ones. Our findings aligned with Weijmer et al.[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], showing non-tunneled CVCs have 2\u0026ndash;3 times greater complication risk than tunneled catheters. Tunneled catheter fixation using subcutaneous cuff reduces bacterial migration, improving survival. Non-tunneled catheter duration ranged from 2\u0026ndash;90 days with a median of 13 (7\u0026ndash;18) days. Our research shows uncuffed catheters can perform effectively for longer durations, with 50% of participants maintaining access for up to 30 days. These catheters remained functional until removal by choice in 46 cases (50.5%).\u003c/p\u003e\u003cp\u003eCRBSI was identified as the most prevalent CVC complication, occurring at 3.21episodes/1000 catheter days, mostly due to gram-positive organisms. Common gram-positive isolates were Enterococcus faecalis, MSSA, and MRSA. Gram-negative isolates included Acinetobacter baumannii, Acinetobacter xylosidans, Pseudomonas aeruginosa, and Escherichia coli. Only one patient had polymicrobial CRBSI with Enterococcus faecalis and Escherichia coli. The organism growth matched reports by Kumar et al. and Onder et al[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e][\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Kumar reported 1.72/1000 CVC days incidence with Staphylococcus aureus being most common, while Onder reported 1.6/1000 catheter-days with predominant gram-positive isolates. Their lower CRBSI rates were due to tunneled catheters, whereas our study included both types. Shimon et al.[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]found 51.8% gram-negative organisms, mainly Enterobacteriaceae and Pseudomonas, though their infections were mostly urinary or abdominal. Current CLABSI rates are lower than previous studies (25%-50%)[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], likely due to aggressive antibiotic use.\u003c/p\u003e\u003cp\u003eIn a study by Tokars et al. [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], hypoalbuminemia was identified as a risk factor for CRBSI, increased hospitalization, and changes in distribution volume. Our study showed reduced catheter-related complications and improved catheter survival in patients with albumin\u0026thinsp;\u0026gt;\u0026thinsp;3gm/dl at insertion. Good nutritional counselling, high protein diet, and increased dialysis frequency can reduce septicemia risk and improve catheter survival.\u003c/p\u003e\u003cp\u003eThrombosis had an incidence of 1.38 episodes per 1000 catheter days. In a study by Napalkov et al. [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], the incidence was 4.4% for catheters or 1.3/1000 catheter days, lower than previous studies (0.6%-33%) [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. This difference can be attributed to the study population having primarily hematological malignancies, increasing thrombosis incidence. Evidence shows an association between prolonged CVC placement, infections, and thrombosis, common reasons for CVC replacement [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. This association relates to fibrin sheath formation during infections and thrombotic events. However, our study found no significant correlation between these factors, possibly due to heparin locks, early thrombosis screening, and prompt antibiotic treatment in suspected CRBSI.\u003c/p\u003e\u003cp\u003eThe only peri-procedural complications were bleeding during CVC insertion, seen in 9 cases with 1.99 episodes/1000 catheter days, which responded to manual compression or stitching at catheter exit, as seen by Kander et al. [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Their study showed 0.9% of insertions caused bleeding requiring prolonged compression. No kinking or malpositioning occurred in our study, attributed to image-guided insertion, which reduces complications.\u003c/p\u003e\u003cp\u003eAccidental removal of catheters occurred in two cases (2%) in the right IJV, as reported by Kojima et al.[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. The neck region's easier accessibility compared to the inguinal area explains the higher incidence of accidental removal in IJV. This incidence was lower than the 9.3% reported by Levy et al. [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], who used tape instead of sutures to secure catheters.\u003c/p\u003e\u003cp\u003eThis single-center study may limit the generalizability of findings to other settings. The results may not fully capture the diversity of catheter-related complications across different healthcare environments.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eCRBSI was the most frequent complication, followed by mechanical dysfunction and thrombosis. Gram-positive organisms were predominant in CRBSI cases. Absence of CRBSI and thrombosis reduces complication risk, while CVC-related infections increase thrombosis risk. Femoral site catheters presented a higher risk than right internal jugular vein catheters.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eCompliance with Ethical Standards\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDisclosure of potential conflicts of interest\u003c/strong\u003e: The author(s) declared no potential conflicts of interest concerning this article\u0026apos;s research, authorship, or publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed consent\u003c/strong\u003e: Informed consent was obtained from all participants in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e The author(s) received no financial support for this article\u0026apos;s research, authorship, and/or publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval:\u003c/strong\u003e All procedures performed in the study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee at which the study was conducted (Institutional Ethics Committee, Post Graduate Institute of Medical Education and Research, Chandigarh, India, IEC approval number:\u0026nbsp;No. INT/IEC/2021/1308, dated: 14.09.2021)\u0026nbsp;and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.\u003c/p\u003e\n"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eGeylis M, Coreanu T, Novack V, Landau D. Risk factors for childhood chronic kidney disease: a population-based study. Pediatr Nephrol. 2023 May;38(5):1569\u0026ndash;76. \u003c/li\u003e\n\u003cli\u003eHarambat J, Madden I. What is the true burden of chronic kidney disease in children worldwide? Pediatr Nephrol. 2023 May;38(5):1389\u0026ndash;93. \u003c/li\u003e\n\u003cli\u003eWalters S, Porter C, Brophy PD. Dialysis and pediatric acute kidney injury: choice of renal support modality. Pediatr Nephrol. 2009 Jan;24(1):37\u0026ndash;48. \u003c/li\u003e\n\u003cli\u003eHemodialysis in infants and small children - PubMed [Internet]. [cited 2024 Jun 13]. Available from: https://pubmed.ncbi.nlm.nih.gov/8142206/\u003c/li\u003e\n\u003cli\u003ede Galasso L, Picca S, Guzzo I. Dialysis modalities for the management of pediatric acute kidney injury. Pediatr Nephrol Berl Ger. 2020 May;35(5):753\u0026ndash;65. \u003c/li\u003e\n\u003cli\u003eMermel LA, Allon M, Bouza E, Craven DE, Flynn P, O\u0026rsquo;Grady NP, et al. Clinical Practice Guidelines for the Diagnosis and Management of Intravascular Catheter-Related Infection: 2009 Update by the Infectious Diseases Society of America. Clin Infect Dis Off Publ Infect Dis Soc Am. 2009 Jul 1;49(1):1\u0026ndash;45. \u003c/li\u003e\n\u003cli\u003eFry AC, Stratton J, Farrington K, Mahna K, Selvakumar S, Thompson H, et al. Factors affecting long-term survival of tunnelled haemodialysis catheters--a prospective audit of 812 tunnelled catheters. Nephrol Dial Transplant Off Publ Eur Dial Transpl Assoc - Eur Ren Assoc. 2008 Jan;23(1):275\u0026ndash;81. \u003c/li\u003e\n\u003cli\u003eSulek CA, Gravenstein N, Blackshear RH, Weiss L. Head rotation during internal jugular vein cannulation and the risk of carotid artery puncture. Anesth Analg. 1996 Jan;82(1):125\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eWeijmer MC, Vervloet MG, ter Wee PM. Compared to tunnelled cuffed haemodialysis catheters, temporary untunnelled catheters are associated with more complications already within 2 weeks of use. Nephrol Dial Transplant Off Publ Eur Dial Transpl Assoc - Eur Ren Assoc. 2004 Mar;19(3):670\u0026ndash;7. \u003c/li\u003e\n\u003cli\u003eKumar G. Catheter-related blood stream infections among children on hemodialysis over 7 years: A single-center experience. Asian J Pediatr Nephrol. 2021;4(1):22. \u003c/li\u003e\n\u003cli\u003eOnder AM, Chandar J, Billings A, Diaz R, Francoeur D, Abitbol C, et al. Chlorhexidine-based antiseptic solutions effectively reduce catheter-related bacteremia. Pediatr Nephrol Berl Ger. 2009 Sep;24(9):1741\u0026ndash;7. \u003c/li\u003e\n\u003cli\u003eShimon O, Green H, Eliakim-Raz N, Rozen-Zvi B, Ben-Zvi H, Zohar I, et al. Gram-negative bloodstream infections in hemodialysis patients: A retrospective study. Clin Nephrol. 2018 Aug 1;90(2):117\u0026ndash;24. \u003c/li\u003e\n\u003cli\u003ePeynircioglu B, Ozkan F, Canyigit M, Pamuk GA, Geyik S, Cil BE, et al. Radiologically placed tunneled internal jugular catheters in the management of chronic hemodialysis and long-term infusion therapies in the pediatric population. J Vasc Interv Radiol JVIR. 2007 Jul;18(7):875\u0026ndash;81. \u003c/li\u003e\n\u003cli\u003eTokars JI, Light P, Anderson J, Miller ER, Parrish J, Armistead N, et al. A prospective study of vascular access infections at seven outpatient hemodialysis centers. Am J Kidney Dis. 2001 Jun;37(6):1232\u0026ndash;40. \u003c/li\u003e\n\u003cli\u003eNapalkov P, Felici DM, Chu LK, Jacobs JR, Begelman SM. Incidence of catheter-related complications in patients with central venous or hemodialysis catheters: a health care claims database analysis. BMC Cardiovasc Disord. 2013 Dec;13(1):86. \u003c/li\u003e\n\u003cli\u003eBoersma RS, Jie KSG, Verbon A, Van Pampus ECM, Schouten HC. Thrombotic and infectious complications of central venous catheters in patients with hematological malignancies. Ann Oncol. 2008 Mar;19(3):433\u0026ndash;42. \u003c/li\u003e\n\u003cli\u003eWall C, Moore J, Thachil J. Catheter-related thrombosis: A practical approach. J Intensive Care Soc. 2016 May;17(2):160\u0026ndash;7. \u003c/li\u003e\n\u003cli\u003eKander T, Frigyesi A, Kjeldsen‐Kragh J, Karlsson H, Rolander F, Sch\u0026ouml;tt U. Bleeding complications after central line insertions: relevance of pre‐procedure coagulation tests and institutional transfusion policy. Acta Anaesthesiol Scand. 2013 May;57(5):573\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eKojima S, Marui Y, Shibagaki Y, Sakurada T. Accidental removal of dialysis central venous catheter inserted for blood purification therapy: a single-center study. Clin Exp Nephrol. 2022 Dec;26(12):1218\u0026ndash;22. \u003c/li\u003e\n\u003cli\u003eLevy I, Bendet M, Samra Z, Shalit I, Katz J. Infectious complications of peripherally inserted central venous catheters in children. Pediatr Infect Dis J. 2010 May;29(5):426\u0026ndash;9. \u003c/li\u003e\n\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Children, Central venous catheters, CRBSI, Hemodialysis, Internal jugular vein","lastPublishedDoi":"10.21203/rs.3.rs-7234349/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7234349/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eObjectives\u003c/b\u003e\u003c/p\u003e\u003cp\u003eCentral venous catheters (CVCs) used for hemodialysis access are associated with various complications and pose significant risks of morbidity and mortality. Complications can occur during insertion, dwell time, and catheter removal. This study was conducted to identify the risk factors and estimate the incidence of catheter-related complications in children undergoing hemodialysis.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis prospective cohort study was conducted between July 2021 and December 2022. Incidence rates per 1000 catheter days were calculated for complications, including catheter-related bloodstream infection (CRBSI), mechanical complications, and thrombosis.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e\u003cp\u003eNinety-seven children were included in the study. The mean age was 103.48\u0026thinsp;\u0026plusmn;\u0026thinsp;34.98 months. The right internal jugular vein was the most common insertion site (72.2%). Non-tunneled catheters were used in 93.8% of the cases and tunneled in 6.2% of the total cases. Of the total complications observed, 87.5% were seen in the non-tunneled catheters and 12.5% in the tunneled catheters. CRBSI was the most common complication (3.21 episodes/1000 catheter days), followed by mechanical catheter dysfunction (1.84/1000 catheter days) and thrombosis (1.38 episodes/1000 catheter days). The mean duration of the catheter in situ was 17.41 days, with a moderate positive correlation between the occurrence of complications and the catheter duration (rho\u0026thinsp;=\u0026thinsp;0.34, p\u0026thinsp;=\u0026thinsp;0.018). Risk factors for complications included a history of hemodialysis, low serum albumin levels, tunneled catheters, and right femoral site placement.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion\u003c/b\u003e\u003c/p\u003e\u003cp\u003eIn children undergoing hemodialysis, the most common complications were CRBSI, mechanical catheter dysfunction, and thrombosis. An extended duration of CVC use is associated with a higher likelihood of complications.\u003c/p\u003e","manuscriptTitle":"Catheter-related complications among children treated with hemodialysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-19 13:41:07","doi":"10.21203/rs.3.rs-7234349/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"cdb792ea-2216-4311-9822-34bb16f64466","owner":[],"postedDate":"August 19th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-11-21T22:23:20+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-19 13:41:07","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7234349","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7234349","identity":"rs-7234349","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}