Comparison of the complications of central vein catheters and arterio-venous fistulae in children on chronic hemodialysis

Background: Complications related to vascular access are among the most important causes of morbidity in children chronically on hemodialysis. This study was designed to determine the prevalence of the central vein catheters (CVC) and arterio-venous fistulae (AVF) in children on chronic hemodialysis.
Methods: This study includes 68 children who have been treated with hemodialysis in Dr. Sheikh Hospital, Mashhad, Iran, during 2000-2005. Physical examination, clinical and paraclinical findings were recorded in special charts.
Findings: Out of 68 patients treated with hemodialysis 29 (42.6%) were female and 39 (57.3%) male. The average duration time of hemodialysis was 15.8 months. Before performing AVF, the central venous catheters were placed in subclavian vein in 28 patients (41.1%) and internal jugular vein in 26 patients (38.2%). The fistula placed was radio-cephalic in 29 (42.6%) and brachio-basilic in 33 children (48.5%). 48 patients (77.4%) underwent only one surgery for AVF. The most frequent complications of central venous catheters were: catheter infection (48.1%), inadvertent extraction of the catheters (7.4%), cardiac arrhythmia (1.8%) and hemothorax (1.8%). The most common complications of AVF in decreasing order of frequency were: non-functional fistula due to thrombosis or hematoma (20.9%), infection (12.9%), aneurysms (11.2%) and ischemia of the hand presenting as paresthesia, dysesthesia and pain (11.2%). Overall, 10 (18.5%) patients were hospitalized due to the complications of CVC and 20 (29.4%) for the complications of AVF.
Conclusion: The most frequently observed complications of CVC and AVF were catheter infection and non-functional fistula. The risk factors for AVF dysfunction were young age, hypotension and hemodialysis without administration of heparin.

Keywords
End stage renal disease , hemodialysis , arterio-venous fistulae , central venous catheters , aneurysms