Catheter placement for hemodialysis in a patient in the prone position by anatomic reference, a case report

ABSTRACT

The use of renal replacement therapies in patients with SARS-COV2 infection accounts for up to 20% of patients admitted to the intensive care unit. Therefore, for an adequate dialysis therapy, the placement of an adequate catheter is imperative. In patients who develop a severe SIRA, the American and European guidelines recommend the prone position to improve pulmonary ventilation, so the placement of an catheter, becomes a great challenge, the use of technology such as ultrasound, helps reduce complications, however, when it is not available, the importance of an anatomical knowledge is vital for success. A 62-year-old male, with non-productive cough, asthenia, adynamia, adding, increasing dyspnea, even meriting ventilator mechanical support, with high ventilatory parameters, Therefore, as an added therapeutic measure, the patient was pronated, presenting ventilatory improvement. After 6 days of stay in the intensive care unit, renal compromise is added with evolution of oliguric AKIN 3 acute kidney injury, requiring initiate renal replacement therapy so it is decided to place a temporary catheter to start therapy. Because the patient's requirement to remain in pronation position, it is decided to place a temporary double- lumen catheter in that position, after not having an ultrasound available, the use of anatomical reference is chosen. The challenges that doctors have faced over the last few months, due to the recent coronavirus, have required new protocols and procedures to which techniques and procedures have had to be adapted to obtain better results, and improve the health status of each of the patients. A review of this case was carried out to refer the importance of anatomical knowledge, that the nephrologist, in the interventional area, is of utmost importance for reducing complications and increasing the success rate in each of their procedures.