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

We report the case of a pediatric patient with end-stage renal disease 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.