소아 혈액투석(hemodialysis in children) 1. Indication 1) Chronic congenital anomalies of kidney and urinary tract (CAKUT),Glomerulonephritis/FSG Systemic Lupus erythematosus,cystic kidney diseases,Pyelonephritis or Other infection,Malignancy,Metabolic disorders,Congenital nephrotic syndrome,hemolytic uremic syndrome (HUS),Ischemic renal failure 2) Acute Hyperkalemia,hyperammonemia,severe fluid overload,severe lactic acidosis,inborn error of metabolism,tumor lysis syndrome,Intoxications 2. Access Native arteriovenous fistulas : Preferred chronic access if feasible Synthetic arteriovenous grafts : Used whenever other access have failed Central venous catheters (CVCs) : Used when temporary access is needed 3. Equipment 1) Dialysis machine 2)Dialyzer 3) Extracorporeal Circuit :available in infants/babies size, biocompatible material, tolerate up to a maximum of 10 percent of his or her total blood volume safe volume of the circuit is targeted at 8 percent of total blood volume of the child 4)Priming volume In infants, if the amount of extracorporeal blood volume exceeds 10% of the patient’s blood volume, there is a risk of complications, so red blood cells, or 5% albumin could be used to fill the line as priming 4. Prescription 1) Blood Flow rate :A blood flow rate of 35 ml/kg/min is adequate to achieve the proper solute removal with the hemodynamic stability 2)Dialysate flow :500 mL/min is sufficient for children, at least 1.5 x blood flow 3) Fluid removal : 10ml/kg/hr 4)Length of dialysis and frequency of sessions 5) anticoagulation 6) Hemodialysis Adequacy 5. Complications Catheter-related complications increased risk of central vein thrombosis and stenosis Central venous catheter infection Hypotension Muscle spasms Dialysis dysequilibrium syndrome Elimination of drugs and nutrients Disequilibrium symptoms Long-term complications Hypertension, neurocognitive/neurodevelopmental delay, psychological stress, Mineral and bone disorder, Cardiovascular disease 6. Nursing Execution of accurate Prescription Monitoring Safety Good vascular access Ethical issues during dialysis of infants Optimal care is provided by multidisciplinary team