Table 1.

Methods of insertion of dialysis catheters

A. Peritoneal dialysis (PD) catheter insertion
	Infants/smaller children < 10 kg	Bigger children > 10 kg
Preparation of prior to PD catheter insertion	• Placed under strict aseptic technique • Full theatre conditions including gowns and gloves • Ensuring urinary catheter in bladder and patent by flushing to prevent bladder perforation • Use of bedside ultrasound to assess bladder distension and increasingly identifying best PD catheter position • Bowel perforation is prevented by initial instillation of 20 mL/kg fluid into the peritoneal cavity via a vascular cannula, thus creating artificial ascites, prior to placing a PD catheter
Specific PD catheter used	• Seldinger technique • Cook® PD (Straight 5Fr/8.5Fr) or Cook® Fuhrman drainage (pigtail 8.5Fr) • Uncuffed non-tunnelling	• Seldinger technique • “Peel-away” Tenckhoff catheters for bigger children • Uncuffed non-tunnelling
Operator medical	• Paediatric nephrologists/fellows/neonatologists
Operator surgeon	• Rarely • Bedside in ICU in complicated cases • Small number of cases surgeons place cuffed PD catheters in operating theatre during cardiac or abdominal surgery
At time of bedside PD catheter insertion	• Dose of vancomycin 10 mg/kg (or cefazolin 50 mg/kg) intravenously stat over 1 h slowly, unless already receiving antibiotics for their underlying condition • PD fluid is sent for microscopy and culture and, specifically, for a white cell count at the time of insertion and at any other time if concerns of peritonitis arise
Infection surveillance	• Urine dipstick testing on the PD fluid is performed daily at the bedside to detect leucocytes • In cases of suspected peritonitis, dialysis effluent is sent for microbiological examination, and empiric intraperitoneal antibiotics (ceftazidime and vancomycin) are added as per local protocol until microbiological identification and sensitivities are available
Trouble shooting tricks	• Flushing is attempted for blocked or poorly draining catheters • For leaking PD catheters, attempts are made to seal the leak with surgical glue or sutures • Pleural effusions related to PD are diagnosed on chest X-ray or on ultrasound. If identified, pleural fluid is aspirated and tested for glucose to confirm the presence of dialysis fluid. Treatment includes placing the patient head up at 30 degrees, reducing the fill volume of each dialysis cycle, and inserting an intercostal chest drain in cases where respiratory embarrassment occurs • In cases where PD fails or is not possible due to abdominal issues, it is changed to ECD either as HD or CKRT depending on stability of the patient
B. Haemodialysis/extracorporeal dialysis catheter insertion
	Infants/smaller children < 10 kg	Bigger children > 10 kg
Preparation of prior to PD catheter insertion	• Placed under strict aseptic technique • Use of ultrasound guided Seldinger technique • Dose of vancomycin 10 mg/kg (or cefazolin 50 mg/kg) intravenously stat over 1 h slowly, unless already receiving antibiotics for their underlying condition
Access vessel used	• Preferably neck vessels either internal jugular vein (avoid subclavian vein) • Femoral as second option
Specific HD catheter used	• Gamcath® 6.5Fr • Arrow® 5Fr (5 cm double lumen 18G and 20G (not a custom-made HD catheter) • For small infants—have used in less than 2 kg	Bigger children included sizes 7, 8, and 9 Fr (Medcomp® or Arrow®)
Operator medical	• Paediatric intensivists/anaesthetists/nephrologists • Neonatologists	• Paediatric intensivist/anaesthetists/nephrologists
Trouble shooting tricks	Heparin lock/other forms of locking, e.g. TPA