Use of the multipurpose drainage catheter for the provision of acute peritoneal dialysis in infants and children.

Background: Prior experience with the Cook (Cook Inc, Bloomington, IN) Teflon rigid catheter (CTC) showed it to be a suboptimal access for acute peritoneal dialysis (PD) treatment in infants and children because of the frequency of catheter-related complications associated with its use. The objective of this study is to report our experience with the bedside-placed flexible Cook Mac-Loc Multipurpose Drainage catheter (CMMDC) for acute PD in critically ill infants, comparing it with the historic Tenckhoff catheter (TC) and CTC use.

Study Design: Retrospective cohort study.

Setting & Participants: All patients with acute renal failure (ARF) seen in our institution between December 2003 and April 2005 who underwent CMMDC placement for acute PD are included.

Predictor: CTCs versus CMMDCs versus TCs.

Outcomes & Measurements: Catheter-related complications and catheter-free survival.

Results: 21 infants and children with ARF were treated with acute PD using a CMMDC; 16 patients were post-cardiac surgery and 5 had other diagnoses. Mean patient age was 6.9 +/- 14.4 (SD) months (range, 4 days to 5.2 years; median, 1.6 months). Of 21 catheters, 3 had complications, and in 2 patients, this precluded continuation of PD therapy. In the remaining 18 patients, catheter use continued until recovery from ARF or nonrenal death. All patients achieved target fluid and solute removal with no catheter-related infectious complications. Mean complication-free survival of CMMDCs was 10.5 +/- 7.9 days (range, 2 to 29 days), with the 90% probability of survival at 14 days. Although there was no significant difference between lengths of complication-free survival of CMMDCs and TCs (58 days; P = 0.57), the difference between CMMDCs and CTCs (6 days) was significant (P < 0.001). Likewise, incidences of catheter-related complications with TCs and CMMDCs were similar, and in both cases, significantly less than the incidence associated with CTCs (49%; P < 0.01).

Limitations: Small number of patients and comparison with historic experience.

Conclusions: Use of CMMDCs is associated with the provision of effective dialysis with a satisfactory complication-free survival and should be considered when bedside placement of an acute PD access in infants and children is desired.