Background:Despite peritoneal dialysis being the preferred mode of renal replacement therapy in neonates and infants, long-term haemodialysis may be necessary in a minority of patients with its attendant risks.Case Diagnosis/Treatment:This case identifies plastic bronchitis as a rare yet serious complication of long-term large bore vascular access when a vessel-sparing approach is not possible.Conclusions:An appropriately sized catheter should be used for the dialytic therapy required and to optimize access survival.