CKRT: Access

"The effect of vascular access location and size on circuit survival in pediatric continuous renal replacement therapy: a report from the PPCRRT registry."

7 Fr is generally minimum requred

Access location

• Internal jugular

  • Accessible

  • Large caliber, great flows

  • Lower infection risk

  • Allows more mobility

  • Risk for pneumo/hemothorax

• Femoral

  • Usually accessible

  • Smaller caliber

  • Higher infection risk

  • Flow hampered by:

    • Abdominal pressures

    • Patient movement

• Subclavian

  • Suboptimal choice

  • High risk of stenosis, loss of vascular access for future use

Order of vessel preference for catheter placement:

• Right IJ > Right EJ > Left IJ > Left EJ

• Do not place subclavian lines (80% risk of stenosis)

Who places acute dialysis catheters?

• Pediatric IR

• Critical care

Who places chronic dialysis catheters?

• Pediatric IR

• CT surgery after ECMO decannulation

• Transplant surgery