ESPN 50th Annual Meeting

ESPN 2017


 
Paediatric dialysis access complications in the UK
PATRICK WALSH 1 MANISH SINHA 2 AMRIT KAUR 3 KAY TYERMAN 4 HENRY MORGAN 5 RAJESH KRISHNAN 6 CAROL INWARD 7 DEEPA ATHAVALE 9 FARIDA HUSSAIN 8 HEATHER MAXWELL 9 YINCENT TSE 1

1- GREAT NORTH CHILDRENS HOSPITAL, NEWCASTLE UPON TYNE, UK
2- EVELINA CHILDRENS HOSPITAL, LONDON, UK
3- ROYAL MANCHESTER CHILDRENS HOSPITAL, MANCHESTER, UK
4- LEEDS CHILDRENS HOSPITAL, LEEDS, UK
5- ALDER HEY CHILDRENS HOSPITAL, LIVERPOOL, UK
6- UNIVERSITY HOSPITAL OF WALES, CARDIFF, UK
7- BRISTOL ROYAL HOSPITAL FOR CHILDREN, BRISTOL, UK
8- NOTTINGHAM CHILDRENS HOSPITAL, NOTTINGHAM, UK
9- ROYAL HOSPITAL FOR SICK CHILDREN, GLASGOW, UK
 
Introduction:

For children on dialysis, their access device is their lifeline. Existing data on complications are based on historical series or collaborative registries across different healthcare systems. We collated data across one healthcare system in the modern era.

Material and methods:

Between January and July 2016, we conducted a six month prospective monthly survey of children established (>3 months) on haemodialysis (HD) or peritoneal dialysis (PD). Data regarding infection and treatment of these events, need for revision of access, and outcomes were collected.  Data was collected on a monthly basis from participating centres

Results:

A total of 191 patients from 9 UK centres were included, equating to 787 person/months (HD = 382, PD=405). Infectious complications were recorded on 54 occasions (peritonitis n= 33, bacteraemia on HD n=21, 0.8 per patient/year). Peritonitis resulted in change of catheter in 6/33 (18%), causes included no organism identified (n=12) and coagulase negative staphylococcus (n=7). Staphylococcus aureus was the most common cause of HD bacteraemia (n=9). Haemodialysis lines were replaced on 21 occasions, the most common reasons was being dislodged (n=12) or infection (n=6). Alteplase for blocked or poorly flowing lines was used on 13 occasions and was successful on 11 occasions.

Conclusions:

 In our contemporary study, only a minority of infected dialysis lines resulted in replacement. Interestingly, over 50% of HD line changes were due to accidental displacement. These baseline data will form the basis of future quality improvement projects to minimise preventable loss of dialysis access in children