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Outcome of Vascular Access in Pediatric Haemodialysis of Baghdad Hospitals

Shatha Hussain Ali --- Ali Sadiq Hassan --- Alaa Kassar Salih

Medical Journal of Babylon مجلة بابل الطبية
ISSN: 1812156X 23126760 Year: 2016 Volume: 13 Issue: 2 Pages: 435 -444
Publisher: Babylon University جامعة بابل

Abstract

Vascular access is the ability to enter the vascular system. Three types of vascular access are used: arteriovenous fistula (AVF), arteriovenous grafts (AVG) and central venous catheters (CVC) as permanent or temporary. The Aims of this study are to study the number of each type of vascular accesses,correlationwith some demographic data,complications, survival time and correlation with dialysis adequacy.This is retrospective study based on 55 pediatric patients with CRF receiving maintenance HD in four pediatric HD centers in Baghdad from 1stMarch 2013 till end of March 2014. As for Central venous catheters (CVC), we investigated: number of catheters inserted, insertion site; survival time and; and complications.As for arteriovenous fistula (AVF), we investigated: the number of failed and patent AVF, survival time and the complications.Adequacy of dialysis (Kt/V and URR) was calculated.There was 172 HD vascular accesses in 55 patients; 38 (69.1%) were males and 17 (30.9%) were females. Mean age was 11.9 years.TDL was the commonest VA among patients below 20 Kg (40%), while PDL was commonest among patients with 20 – 30 Kg and above 30 Kg body weight (41.2%) and (47.8%) respectively. For 120 patients (69.8%) temporary dual lumen (TDL) were inserted, and for 27 patients (15.7%) AVF, and for 25 (14.5%) permanent tunneled dual lumen (PDL).Majority of TDL were inserted in right internal jugular veins in 42.98%, and left internal jugular veins in 35.54%. Infection and thrombosis are commonest complications observed in both dual lumen (41.9%, 27.9%),) and AVF (33.3%, 30.1%). Six out of 27 AVF failed to mature (22.2%), Survival time of AVF was 456.3±80.1 days which is more than that of PDL (187.2±36.3 days) and TDL (132.3±1.13 days).Adequate dialysis was seen in 50% of patients dialyzed by AVF, in 26.7% with PDL and in 23.3% with TDL.CVC are the main type of VA used. Infection and thrombosis are the most common complication. AVF provide longer survival time than CVC.

Keywords

Hemodialysis --- children --- vascular access .