Ultrasound-guided insertion of dialysis catheter in the prone position

• DOI: 10.1007/s00134-014-3229-4
• Publication Date: 2014-02-11T16:09:57Z
• Authors: Thomas Flament; Julie Mankikian; Emmanuelle Mercier
• Keywords: Prone position

A 66-year-old man was admitted to the intensive care unit for a septic shock with acute renal failure and acute respiratory distress syndrome (ARDS) with a PaO2/FiO2 ratio of 72 mmHg, an FiO2 of 90 %, a PEEP of 10 cmH2O, and a tidal volume of 6 ml/kg of predicted body weight ventilation. The patient was turned to the prone position (PP) on the first day of admission. During the PP period, he presented anuric renal failure. The first studies related to the potential use of PP in ARDS treatment were published in 2011. The Proning Severe ARDS Patients (PROSEVA) group demonstrated the beneficial effect of a prolonged PP session during mechanical ventilatory support in a recent study. Sepsis-associated acute kidney injury was associated with a poor prognosis, substantiated by mortality rates of up to 75 %. In this context, we decided to maintain the PP session and to insert the dialysis catheter under ultrasound guidance (Fig. 1) in the left jugular by the posterior approach (Supplemental Fig. 1). We controlled the catheter placement by chest X-ray in the PP (Supplemental Fig. 2), no complication was observed and haemodialysis was started during the PP session.