We investigated the use of an indwelling right atrial (RA) catheter (Hickman catheter) for vascular access in small children and report our experience with 28 catheters in 26 small patients. The Hickman catheter afforded safe and reliable vascular access in infants and children up to 13 kg in weight. Adequate blood flow always required placement of the catheter tip in the RA or at the RA-SVC junction. We are now using this method preferentially to meet short-term dialysis needs in small patients with acute renal failure, before and after renal transplantation, and while awaiting maturation of A-V fistuale or grafts in larger children. A trial with a larger bore catheter in children weighing more than 12 kg is now underway in our institution to determine whether or not this technique may be useful for larger children in similar clinical settings.