Introduction: Reliable vascular access for hemodialysis is challenging in the pediatric population. The Venous Window Needle Guide (VWING; Vital Access Corp, Salt Lake City, Utah) is an implanted surgical device that allows for constant site access but has not been reported in pediatric patients.

Case description: Three patients under 18 years of had a brachiobasilic fistula created with a minimum of 6 weeks for fistula maturation prior to VWING placement. This paper describes the management of constant site dialysis using VWING as well as strategies used for successful long-term management. Patients include a 15-year-old male with end-stage renal disease (ESDR) secondary to hemolytic uremic syndrome (HUS), a 14-year-old female with ESRD secondary to systemic lupus, and a 17-year-old female with ESRD secondary to rapidly progressive glomerulonephritis. All three patients had successful placement of VWING allowing for improved AVF access for dialysis for several years.

Conclusion: In our limited experience with VWINGs in the pediatric population, we have demonstrated a successful method of long-term constant-site dialysis using VWING as an adequate alternative to other interventions for difficult-to-access arteriovenous fistulas (AVFs).