# Mini-sternotomy for direct right atrial dialysis catheter placement in a child with central venous occlusion

## TL;DR

A child with blocked central veins and kidney failure had a dialysis catheter placed directly into the heart through a small chest incision.

## Contribution

A novel surgical approach for dialysis access in children with exhausted venous pathways is presented.

## Key findings

- A mini-sternotomy allowed successful right atrial catheter placement in a child with central venous occlusion.
- A custom conduit facilitated extrathoracic tunnelling and protected the catheter postoperatively.
- The procedure provided a functional dialysis access when conventional methods were no longer possible.

## Abstract

We report the case of a pediatric patient with kidney failure and bilateral central venous occlusion, in whom conventional dialysis access was no longer feasible. Following multidisciplinary evaluation, a dialysis catheter was surgically inserted directly into the right atrium via a lower mini-sternotomy. A custom-made bovine pericardial conduit was used to facilitate extrathoracic tunnelling and protect the catheter. The procedure was technically successful, and the catheter remained functional postoperatively. This case highlights a viable salvage option for dialysis access in children with exhausted vascular access sites.

The online version contains supplementary material available at 10.1007/s00467-025-07104-6.