Ultrasound-Guided Placement of a Hemodialysis Catheter into the Distal Femoral Vein in a Patient with Multiple Catheters: A Case Report

Shuta Morishige,1 Yoshikazu Yamaguchi,1 Kei Nakajima,1 Sayaka Tsuboi,1 Yoh Sugawara,2 Hajime Hayami,1 Joseph D Tobias,3 Gaku Inagawa1 1Department of Anesthesiology, Yokohama Municipal Citizen’s Hospital, Yokohama, Japan; 2Department of Anesthesiology, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA; 3Department of Anesthesiology and Pain Medicine, Nationwide Children’s Hospital and The Ohio State University, Columbus, OH, USACorrespondence: Yoshikazu Yamaguchi, Department of Anesthesiology, Yokohama Municipal Citizen’s Hospital, 1-1 Mitsuzawanishimachi, Kanagawa-ku, Yokohama-shi, Kanagawa, 221-0855, Japan, Tel +81-45-316-4580, Fax +81-45-316-6580, Email yoshikaz@yokohama-cu.ac.jpAbstract: Cardiac surgery-associated acute kidney injury may require postoperative renal replacement therapy. Although the right internal jugular vein and femoral veins are generally the preferred insertion sites for the hemodialysis catheter for continuous renal replacement therapy, the presence of other indwelling catheters or prior thrombotic events from previous catheters may preclude use of these sites. We present a case in which the hemodialysis catheter was inserted into the distal femoral vein using point-of-care ultrasound in a patient with multiple catheter insertions after coronary artery bypass grafting. Although the tip of the dialysis catheter was more distal than the classic femoral approach, renal replacement therapy was performed without problems. Moreover, it was easier for the nurses to keep the insertion site clean and to change the patient’s position.Keywords: central venous catheter, renal replacement therapy, femoral vein