الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 145 |  |  |
| | | from | 145 | | |
Abstract
Recent data suggests that the incidence and prevalence of ESRD in pediatric population is increasing. Renal transplantation is the optimal therapy for pediatric patients, however it is not always feasible with a long waiting list due to shortage in the numbers of living donors moreover as pediatric patients survive longer some may return to dialysis after failed renal transplant.
Peritoneal dialysis is the second most preferred method for renal replacement therapy however many children are not suitable candidate due to peritoneal membrane failure. According to this, haemodialysis remains to be the most frequent modality of renal replacement therapy in pediatric population.
Construction and maintenance of vascular access is a cornerstone in the process of haemodialysis described by some as Achilles’ tendon of haemodialysis. This is more challenging and time consuming in pediatric population.
Selection of the best vascular access in pediatric haemodialysis patients mandates early planning and a multidisciplinary approach involving paediatric nephrologist, vascular surgeon, and interventional radiologist and dialysis nurse. Patient and family should be educated as regarding the available options of treatment and protection of non dominant arm (e.g.: against vein puncture and trauma).
The ideal vascular access delivers blood flow rate adequate for the dialysis prescription, survive for long duration and has a low rate of complication, the AVF best approximates these criteria, and guidelines recommended the use of AVF in the majority of pediatric patients however CVC and AVG are frequently used. Each type has its unique advantages.
CVC is the most commonly used vascular access in children who requires urgent hemodialysis also it can serve as a bridge for transplantation, peritoneal dialysis and while permanent accesses are maturing. Advantages of CVC include the ability to be used immediately and absences of needle cannulation. CVC are the only option in small children whose small vessel caliber is not accessible for placement of permanent access. Disadvantages include short life span and higher rates of complications (infection, thrombosis, interrupted flow poor position, and venous stenosis).
When choosing the access to place, particular importance should be placed on preoperative assessment to ensure that best access is placed. Although physical examination remains the mainstay of preoperative planning radiological tools may be used to assess vascular adequacy due to the small vessel size in pediatric patients. Duplex and venography can provide information about vessel size, venous stenosis or occlusion.
Continuous monitoring of vascular access should be performed to allow along life use. This must include clinical examination (inspection, palpation, auscultation) with special attention to prolonged bleeding, arm swelling, change in the thrill, and may include other parameters such as static venous pressure monitoring, dynamic venous pressure monitoring, assessment of access flow and recirculation).
Like access selection access monitoring also requires a multidisciplinary team involving the nephrologists, vascular surgeon, interventional radiologist, dialysis nurses with effective communication between team members.
Limited researches have described the clinical outcome associated with the types of vascular access in pediatric population.
This study was designed to reveal the different methods of vascular hemodialysis access in pediatric patient, how to select the most suitable access for pediatric patient and the outcome during the period of research.
Our study included 55 cases, 37 cases (67.3%) were done primarily in our institutions while 18 cases (32.7%) were referred patients (who already had one or more procedure done in another institution).