Which kind of vascular access for hemodialysis in pediatric patients?

The choice of vascular access in hemodialysis pediatric patients can be challenging, due to the small diameter of vessels. In the last 19 years, 38 arteriovenous fistulas (AVF) for hemodialysis have been created on 21 patients; 25 of them were radio-cephalic AVF. The evaluation of the vessels was, in the majority of cases, done by clinical criteria. A local anesthesia was used in all surgical procedures. The percentage of early AVF failure was 24%. Long-term AVF survival was 97%, 65% and 55% at respectively 1, 3 and 5 years. Our data indicate that even in pediatric patients the radio-cephalic fistula is the first choice surgical procedure.

[Temporary vascular access for haemodialysis: is infection still the most important complication?]. / L'accesso vascolare temporaneo per emodialisi: e' ancora l'infezione la complicanza da temere maggiormente?

BACKGROUND: Aging in the dialitic population currently shows the problem of vascular access for haemodialysis. The use of temporary catheters for haemodialysis has increased the risk of infections. DOQI guidelines underline this problem. We think that the thrombosis of central veins is a problem as important as infection. METHODS: In the last two years we studied prospectively 310 patients. 686 catheters for haemodialysis were placed. Infection, malfunctioning of catheters and thrombosis of central veins were studied. We compared femoral catheters with jugular catheters. Finally we studied by ultrasound the jugular vessels diameter and thrombi of jugular vein. RESULTS. Fever was present in 5.55% of patients with femoral catheters and in 5.84% of the patients with jugular catheters. The malfunctioning incidence in patients with femoral catheters was 22.75% and 8.76% in patients with jugular catheters with statistic difference. Ultrasound study of jugular veins showed thrombotic incidence of internal jugular vein in 20,8% of patients. CONCLUSIONS: We think that with correct management of catheters there is no difference in the incidence of fever in patients with jugular catheters versus femoral catheters. Probably jugular catheters have better performance than femoral catheters. We need controlled studies to better understand the problem of central vein thrombosis.

Internal jugular vein thrombosis after positioning CVC in dialysis patients: The most common ultrasound patterns.

Frequently patients are started on hemodialysis after the placement of a central venous catheter (temporary or tunneled) in the internal jugular vein (IJV). Currenty this procedure is facilitated by ultrasound probes that improve the rate of success of catheter placement in vessels and diminishes the possible complications, minimizing the gap between nephrologists with wide surgical expertise and those with limited surgical experience. Stenosis and thrombosis of the subclavia vein are well documented complications derived from the placement of the venous catheter. Internal jugular vein thrombosis is not seen very often due to scarce clinical evidence. In our paper we have been able to systematically document various extrinsic thrombotic complications outside the central venous catheter, by use of ultrasound (periluminar or related to the vessel).

Acute renal failure after massive ingestion of gliclazide in a suicide attempt.

Gliclazide, a sulfonlyurea class molecule, is used to control glycaemic levels in non-insulin-dependent diabetes mellitus. Acute and chronic toxicity studies, conducted in various animal species, have demonstrated a very low toxicity. We report a patient who developed acute renal failure due to acute tubular necrosis following a massive ingestion of gliclazide in an suicide attempt. The patient ingested 28 grams of gliclazide; the normal dose of gliclazide is 80 mg one or twice a day. At admission the patient was hypoglycaemia and in a few days became oliguric with an increase in the serum creatinine concentration, but with a normal blood urea nitrogen level. He underwent dialysis and ten days after ingestion of gliclazide, his renal function improved rapidly.