Renal replacement therapy by the popliteal vein in a critical patient with COVID-19 in the prone position

Guimarães, Rafael Gardone; Lacerda, Arthur Pires; de Carvalho, Gabriela Portilho de Castro Rodrigues; de Sales, Luiza Reis; Vásárhelyi, Marina Perim; Paixão, Matheus Pessanha

This patient was a 73-year-old man who initially came to our service with acute respiratory failure secondary to COVID-19. Soon after hospitalization, he was submitted to orotracheal intubation and placed in the prone position to improve hypoxia, due to severe acute respiratory syndrome (SARS). On the third day of hospitalization, he developed acute oliguric kidney injury and volume overload. The nephrology service was activated to obtain deep venous access for renal replacement therapy (RRT). The patient could not be placed in the supine position due to significant hypoxemia. A 50-cm Permcath (MAHURKARTM, Covidien, Massachusetts, USA) was inserted through the left popliteal vein. This case report describes a possible challenging scenario that the interventional nephrologist may encounter when dealing with patients with COVID-19 with respiratory impairment in the prone position.