ABSTRACT
The aim of the study was to summarize the experience in the treatment of chronic renal failure due to secondary amyloidosis in the course of juvenile rheumatoid arthritis. Fourteen children aged 7.5-17.7 years were treated with dialysis; 12 with CAPD, 2 with HD. Our results indicate that CAPD is a proper dialysis technique for children with amyloidosis, despite a high rate of complications in early period of CAPD, such as: bleeding, leaks, hernias, and impaired wound healing.
Subject(s)
Amyloidosis/etiology , Amyloidosis/therapy , Kidney Failure, Chronic/complications , Peritoneal Dialysis, Continuous Ambulatory/methods , Adolescent , Child , Female , Humans , Male , Peritoneal Dialysis, Continuous Ambulatory/adverse effects , Retrospective StudiesABSTRACT
OBJECTIVES: To reduce the incidence of exit-site infection (ESI) a new peritoneal dialysis (PD) catheter, the Swan neck presternal catheter (SNPC), composed of abdominal and presternal parts joined by a titanium connector, with the exit site located on the chest wall, was designed. DESIGN: A prospective study was undertaken to estimate the usefulness of the SNPC for continuous ambulatory peritoneal dialysis (CAPD) in children. SETTING: University Children's Hospital, Medical Academy, Warsaw, Poland. PATIENTS: From December 1991 to June 1997, 11 SNPCs were implanted in 10 children for the following reasons: recurrent ESI in 3, the presence of ureterocutaneostomies in 3, obesity in 3, the use of diapers in 2, young age in 1, and fecal incontinence in 1. More than one indication was present in some patients. In 7 patients the SNPC was the first PD catheter inserted. INTERVENTION: In all children the presternal catheter was implanted surgically by the modification of the technique described by Twardowski et al. RESULTS: The observation period ranged from 1-60 months. The rate of ESI was 1/162 patient-months. The major complication was trauma of the exit site (4 times in 3 of 10 patients). In spite of leaving an extra length of the catheter in the entire subcutaneous tunnel at the time of implantation, the two parts of the SNPC became disconnected in 2 children (after 7 and 33 months respectively). CONCLUSION: Our results achieved with the SNPC in children are very good. The presternal catheter reduces the risk of ESI. However, the chest localization of the exit site does not help to prevent trauma in children. This type of PD catheter should be reserved for patients with specific indications.
Subject(s)
Catheters, Indwelling , Peritoneal Dialysis, Continuous Ambulatory/instrumentation , Adolescent , Child , Child, Preschool , Humans , Prospective StudiesSubject(s)
Candidiasis , Catheters, Indwelling/adverse effects , Peritoneal Dialysis, Continuous Ambulatory , Staphylococcal Infections , Surgical Wound Infection/microbiology , Child , Equipment Design , Equipment Failure , Humans , Kidney Failure, Chronic/surgery , Male , Peritoneal Dialysis, Continuous Ambulatory/methods , Staphylococcus aureus/growth & developmentABSTRACT
Since 15 December 1991 four swan neck presternal catheters (SNPC) have been implanted in four children aged 2-11 years. The observation period ranged from 4 to 10 months. The aim of this study was to evaluate the usefulness of a new peritoneal dialysis catheter implantation method in paediatric patients. The indications for insertion of the SNPC were: young age, use of nappies, obesity and recurrent exit site infection (ESI). The surgical technique of the SNPC implantation was similar to that used for adults. The chest location of the catheter exist site is advantageous for the following reasons: (1) easier care of a small child because of greater distance from nappies, (2) better healing and decreased risk of ESI in the area with less fat thickness and (3) less trauma. A larger number of children with a longer follow-up is necessary for better evaluation of the SNPC, as well as for estimation of frequency of ESI and peritonitis.
Subject(s)
Catheters, Indwelling , Kidney Failure, Chronic/therapy , Peritoneal Dialysis, Continuous Ambulatory/methods , Child , Child, Preschool , Equipment Design , Evaluation Studies as Topic , Female , Follow-Up Studies , Humans , MaleABSTRACT
Exit-site infection (ESI) in children on continuous ambulatory peritoneal dialysis (CAPD) is a complication observed mainly in obese patients and patients wearing diapers. From 15 December 1991 to 28 February 1993, five Swan neck presternal catheters (SNPCs) were implanted in 5 children aged 2-11 years. The criteria for insertion of a SNPC were the following: young age in 1 child, obesity in 2, recurrent ESI in 2, and the use of diapers in 2. In some patients there was more than one criterion. The observation period ranged from 1-10 months, and the time on CAPD with the SNPC was 1-9 months. During this period, we did not observe any catheter-related problems. The potential advantages of the chest location of the catheter exit site are the following: 1. easy exit-site care; 2. decreased risk of ESI in small children because of greater distance from wet diapers; 3. avoidance of trauma with crawling/creeping; and 4. better healing and decreased risk of ESI in the area with less fat thickness.
Subject(s)
Catheters, Indwelling , Peritoneal Dialysis, Continuous Ambulatory/methods , Catheters, Indwelling/adverse effects , Child , Child, Preschool , Humans , Male , Peritoneal Dialysis, Continuous Ambulatory/adverse effects , Peritoneal Dialysis, Continuous Ambulatory/instrumentationABSTRACT
In the paper 15 children are presented with terminal renal insufficiency in whom 17 arteriovenous fistulas were created between brachial artery and basilic vein displaced subcutaneously within the arm. Operational technique and obtained results are discussed with particular stress put on the usefulness of this type of fistula for children requiring treatment with haemodialysis.
