Dialysis Catheter Size for Pediatric Hemodialysis
Catheter Selection Guidelines
- For children weighing 20 kg, a 9-10 Fr dual-lumen catheter is recommended by the American Journal of Kidney Diseases for hemodialysis access 1, 2, 3, 4
- Children as small as 4-5 kg can tolerate dual-lumen 8 Fr catheters, according to the American Journal of Kidney Diseases 3, 5
- As children grow larger, progressively larger volume access can be placed, as stated by the American Journal of Kidney Diseases 1
Important Considerations for Pediatric Dialysis Catheters
Placement Considerations
- The American Journal of Kidney Diseases recommends internal jugular vein placement over subclavian vein placement for pediatric dialysis catheters 3
- Right atrial placement helps prevent inlet/outlet hole occlusion by blood vessels, as noted by the American Journal of Kidney Diseases 5
- Subclavian vein placement should be avoided as it leads to stenosis in over 80% of pediatric patients, according to the American Journal of Kidney Diseases 3
- Femoral access should only be used when upper-anatomy venous access is no longer available, as stated by the American Journal of Kidney Diseases 5
Flow Rate Requirements
- Flow rates should be sufficient to achieve a Kt/V greater than 1.2, as recommended by the American Journal of Kidney Diseases 3
- The recommended flow rate for pediatric patients is 3-5 mL/kg/min, according to the American Journal of Kidney Diseases 5
- For a 20 kg child, this translates to flow rates of 60-100 mL/min, as noted by the American Journal of Kidney Diseases 3
Catheter Configuration Options
- Twin single-lumen catheters (Tesio System) may provide better performance than standard dual-lumen catheters in pediatric patients, as stated by the American Journal of Kidney Diseases 1, 3
- Longer and narrower catheters result in greater resistance to flow, which should be considered when selecting catheter length, according to the American Journal of Kidney Diseases 3