Vascular access challenges in children with CRF

The incidence and prevalence of ESRD in pediatrics had increased. As we know, like adults Hemodialysis is the major first line of renal replacement therapy . So for almost all pediatrics with stage 4 CKD we need a vascular access. The ideal vascular access delivers an adequate flow rate in hemodialysis procedure, also has a long use-life with the lowest incidence of complications .We usually select one of these 3 types of vascular access: arteriovenous fistula (AVF) , arteriovenous graft (AVG) , central venous catheter (CVC) Selection the method depends on many factors such as patients age and their physical condition and distance to the start of the first dialysis session , parental cooperation and acceptance . In this article, we will compare different methods and express the advantages and disadvantages of each of them while pointing briefly to the prerequisite and efficiency of each method. We also express operational strategies (including all personal, family and nursing medical care’s) to increase their efficiency, reduce and delay complications