Femoral Catheter Research Articles

Acute Renal Shutdown Following Femoral Central Venous Catheterization: Iatrogenic or Spontaneous Rupture of the Inferior Epigastric Artery

Acute Renal Shutdown Following Femoral Central Venous Catheterization: Iatrogenic or Spontaneous Rupture of the Inferior Epigastric Artery

Air embolism during unsuccessful transcatheter closure of secundum atrial septal defect in a patient with an undetected left-sided inferior vena cava.

A 46-year-old man with a history of secundum atrial septal defect and interstitial lung disease was admitted to the hospital for a planned transcatheter closure of the atrial septal defect. Following multiple failed attempts to place a right femoral vein catheter, the procedure was aborted. Another attempt was made to the left femoral vein, but that attempt was complicated by an unfamiliar resistance. Even though resistance was met during insertion, the catheter was further inserted until a position in the inferior vena cava above the liver was obtained at fluoroscopy. Simultaneously, the patient became unresponsive. The procedure was immediately aborted and the atrial septal defect closure was not completed. Air embolism to the heart and brain was detected using echocardiography and computed tomography. The patient died 15 days after the procedure. Death was attributed to severe cerebral edema due to air embolism. The autopsy revealed a left-sided inferior vena cava. This case report demonstrates that unexpected congenital vascular anomalies complicating a routine transcatheter closure of the atrial septal defect can result in a fatal outcome.

The effect of reiki and acupressure on pain, anxiety and vital signs during femoral sheath removal in patients undergoing percutaneous coronary intervention: A randomized controlled study

ObjectiveThis study was conducted to determine the effect of reiki and acupressure on pain, anxiety, and vital signs during femoral sheath removal in patients undergoing percutaneous coronary intervention. MethodsThe study, which was conducted as a prospective randomized controlled study, was carried out with 84 patients: reiki group (n = 28), acupressure group (n = 28), and control group (n = 28). Twenty minutes before the femoral catheter was extracted, 18 minutes of reiki was applied to the seven chakra regions in the reiki group, and 20 minutes of acupressure was applied to the LI4, HT7, and PC6 points in the acupressure group. The control group received standard care. All three groups were given the assessment with Visual Analog Scale, Spielberger State Anxiety Scale, and 5 minutes before & 5 minutes after sheath removal and vital sign data also collected at these time points. ResultsAfter the intervention, it was determined that the pain and anxiety scores of both the reiki and acupressure groups were significantly lower than the pain and anxiety scores of the control group (p < 0.05). In addition, heart rate and respiratory rates were significantly lower than the control groups in the measurements made after the intervention of both reiki and acupressure groups (p < 0.05). Systolic and diastolic blood pressures after acupressure, but not after reiki, were significantly lower compared to the control group. ConclusionsAccording to the results of the study, reiki and acupressure applied before the removal of the femoral sheath after percutaneous coronary intervention reduce pain and anxiety and improve vital signs to some extent.

Effect of Cryotherapy on Pain Intensity for Patients Undergoing Arterial Sheath Removal After Percutaneous Coronary Intervention: A Randomized Controlled Trial

Introduction: Coronary artery disease is the main cause of mortality globally, making up approximately 33% of all deaths Patients with coronary artery disease experience pain and discomfort post-percutaneous coronary intervention after the femoral catheter is removed, which might raise the patient's duration of hospitalisation and the hospital's costs. Aims: The purpose of the study is to evaluate the effect of cryotherapy on the degree of pain that patients who have had their arterial sheath removed after percutaneous coronary intervention felt. Methods: A test-and-retest design in a randomised controlled trial was conducted from January 7, 2024, to February 19, 2024, at Babylon Centre/Imam Al-Sadiq Hospital. A probability (simple random) sampling method was used in a two-group design, with 50 patients in each group as a control and cryotherapy group, and evaluating pain levels utilizing the visual analogue scale. Descriptive and inferential statistics were used in data analysis frequency, percentage, mean, paired sample t-test, standard deviation, and ANOVA. Results: This stated the mean pain level was similar before cryotherapy. However, after cryotherapy, the level of pain in the cryotherapy group was significantly less than that of the control group (2.38± 5.1 vs. 23.34± 11.5), respectively. P = 0.000 (&lt;0.05) demonstrating a statistically significant variation. Conclusions: According to the study, cryotherapy applied to the femoral sheath region assisted the percutaneous coronary intervention patients feel less pain when their femoral catheter was removed. In these situations, a local cold gel bag may be advised as a nursing intervention for pain management.

Transpulmonary cardiac output with room temperature saline is accurate and tracks directional changes in anesthetized dogs.

To assess the performance of transpulmonary thermodilution (TPTD) using room-temperature saline (CORT) and waveform-derived continuous CO (CCO) compared with TPTD using iced saline (COICED) as the indicator for measurements of CO in isoflurane-anesthetized dogs. 8 Beagles aged 1 to 2 years (7.4 to 11.2 kg) were enrolled in this experimental study from March 21 to 31, 2023. Dogs were anesthetized with 0.01 mg/kg acepromazine, 5 to 6 mg/kg propofol, and isoflurane and were mechanically ventilated. Dogs were instrumented with a central venous catheter and a femoral arterial catheter equipped with a thermistor. The COICED, CORT, and pulse wave-derived CCO values were obtained at baseline, during infusions of phenylephrine and norepinephrine, and during blood withdrawal and replacement. Data were analyzed with a mixed effect model, Bland-Altman plots, and concordance. Percent error was calculated. P < .05 was used for significance. Data were collected from 8 dogs. Significant effects of time and the interaction of time and method were found. Bland-Altman plots showed negligible bias with limits of agreement between -0.35 and 0.25 L/min for CORT versus COICED and -1.23 and 1.15 L/min for CCO versus COICED. Percent errors were 17.7% and 66.6%, respectively. In the 4-quadrant plots, the concordance rate was 95% and 68% for measurements obtained with CORT and for CCO, respectively. Transpulmonary thermodilution using room temperature saline was accurate and able to track changes in CO. Continuous CO had a large percent error and low tracking ability. Transpulmonary thermodilution using room temperature saline is reliable for monitoring CO and obviates the need for iced preparations in clinical scenarios.

Abstract P175: The Effect of TRF on Hypertension Development in Male Dahl Salt-Sensitive Rats

Time restricted feeding (TRF), or food consumption restricted to &lt;10 hrs/day, has been shown to improve blood pressure in various cardiometabolic diseases, yet there is limited data on the effect in SS hypertension. The goal of this study was to examine the effect of TRF on disease development in the Dahl SS rat. We hypothesized that implementing TRF during a critical timepoint in disease progression would reduce mean arterial blood pressure (MAP). To study this, femoral catheters were surgically implanted in male Dahl SS rats at 9±0.5 weeks of age (n=5-7/group), allowing for urine and arterial blood sample collection from conscious rats during continual blood pressure recording. After 1 week of recovery, rats either continued a low salt (LS;0.4% NaCl) diet or were switched to a high salt diet (HS;4% NaCl) with ad libitum (ad lib) access for 1 week. At the start of week 2, a subset of rats began TRF, in which food was provided for 8 hrs (10PM-6AM) during their active period for an additional week. Rats meeting the following criteria were included in analysis: pulse pressure &gt; 10 mmHg, baseline MAP of 115-130 mmHg, and a 10-20 mmHg increase in MAP after 1 week on HS. Differences in MAP were analyzed by 2-way ANOVA with Tukey multiple comparisons and data are reported as mean ± SEM. By the end of week 2, HS TRF rats trended toward lower average MAP compared to HS ad lib rats (141.51±3.41 vs 149.49±1.65 mmHg; p=0.07). However, we found that the HS TRF rats had reduced MAP during their active period (6PM-6AM), compared to the HS ad lib rats (142.60±2.99 vs 151.65±1.862 mmHg; p&lt;0.05), but no difference during the inactive period (6AM-6PM). At the end of the study, average MAP was calculated every 4 hrs to identify the timing at which TRF reduced MAP. We found that the HS TRF rats had lower MAP from 6PM to 10PM (134.61±2.34 vs 146.75±1.21 mmHg; p&lt;0.05) and 10PM to 2AM (144.58±2.79 vs 154.70±2.18 mmHg; p&lt;0.05) when compared to the HS ad lib rats. The LS TRF group also had lower pressure from 6PM-10PM compared to the LS ad lib group (124.93±1.19 vs 130.56±0.73 mmHg; p&lt;0.05), suggesting that this time-specific reduction in MAP may be due to fasting, as there were no other differences in MAP within the LS groups. This suggests that TRF may slow progression of hypertension development in the Dahl SS rat, primarily by affecting MAP during the active period. Future studies will examine how TRF affects Na + handling to further understand these time-dependent effects.

Performance of Risk Assessment Models for VTE in Patients Who Are Critically Ill Receiving Pharmacologic Thromboprophylaxis: A Post Hoc Analysis of the Pneumatic Compression for Preventing VTE Trial

BackgroundThe diagnostic performance of the available risk assessment models for venous thromboembolism in critically ill patients receiving pharmacologic thromboprophylaxis is unclear. Research QuestionFor critically ill patients receiving pharmacologic thromboprophylaxis, do risk assessment models predict who would develop venous thromboembolism or who could benefit from adjunctive pneumatic compression for thromboprophylaxis? Study Design and MethodsIn this post hoc analysis of the PREVENT trial, we evaluated different risk assessment models for venous thromboembolism (ICU-VTE, Kucher, Intermountain, Caprini, Padua, and IMPROVE models). We constructed receiving operator characteristic curves and calculated the sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios. Additionally, we conducted subgroup analyses evaluating the effect of adjunctive pneumatic compression versus none on the study primary outcome. ResultsAmong 2003 patients receiving pharmacologic thromboprophylaxis, 198 (9.9%) developed venous thromboembolism. With multivariable logistic regression analysis, the independent predictors of venous thromboembolism were APACHE II score, prior immobilization, femoral central venous catheter, and invasive mechanical ventilation. All risk assessment models had areas under the curve <0.60 except for the Caprini model (0.64, 95% confidence interval 0.60, 0.68). The Caprini, Padua and Intermountain models had high sensitivity (>85%) but low specificity (<20%) for predicting venous thromboembolism, whereas ICU-VTE, Kucher, and IMPROVE models had low sensitivities (<15%), but high specificities (>85%). The positive predictive value was low (<20%) for all studied cutoff scores, whereas the negative predictive value was mostly >90%. Using the risk assessment models to stratify patients into high- versus low-risk subgroups, the effect of adjunctive pneumatic compression versus pharmacologic prophylaxis alone was not different across the subgroups (p for interaction >0.05). InterpretationThe risk assessment models for venous thromboembolism performed poorly in critically ill patients receiving pharmacologic thromboprophylaxis. None of the models identified a subgroup of patients who might benefit from adjunctive pneumatic compression.

Optimizing central venous access devices insertion in thrombocytopenic patients: Balancing efficacy and safety.

Recently, the rising incidence of trauma, cancer, and critical illnesses has led to a growing necessity for Central Venous Access Devices (CVADs). Inserting CVADs in thrombocytopenic patients is still challenging. This study tries to shed light on the safety and associated risks of CVADs insertion in this high-risk group, with the ultimate goal of informing clinical practice and aiding in decision-making processes. This study was conducted as prospective cohort study from September 2020 to September 2023 in Mazandaran University of Medical Sciences, Iran. Individuals aged 18-80 years with a platelet count of less than 50,000/dL included and those designated for subcutaneous port procedures or on anticoagulant and antiplatelet therapy, excluded. Ultrasound-guided CVAD insertion using the Seldinger technique and SIC/FIC strategies performed for participants. Incidence of hemorrhagic complications post-CVAD insertion, requirement for blood product transfusions to amend platelet counts, frequency of non-bleeding complications, and complications related to blood product transfusions monitored. The study comprised 137 participants, 54% of whom were men, with an average age of 46.90 ± 15.70 years. No significant correlation was found between the site of CVAD placement (jugular vs femoral) and the incidence of major or minor bleeding. Femoral catheters were associated with a higher rate of infection. No complications related to transfusion of blood products or mortality seen, indicating that CVAD implantation can be safely performed in patients with thrombocytopenia or coagulation disorders. CVAD insertion in thrombocytopenic patients, even with platelet counts below 10 × 109/L, is safe and associated with minimal complications when performed under ultrasound guidance by experienced surgeons. This finding supports the use of a lower platelet count threshold for CVAD insertion than currently recommended in guidelines, potentially reducing the need for platelet transfusions prior to CVAD placement.

Local Infiltration Analgesia Is Superior to Regional Nerve Blocks for Total Hip Arthroplasty: Less Falls, Better Mobility, and Same-Day Discharge.

Background: Multimodal analgesia in total hip arthroplasty (THA) provides better pain control, mobility, and reduced side effects compared to monotherapies. Local infiltration analgesia (LIA) and regional nerve blocks (RNBs) are commonly used throughout these protocols. This study aimed to compare these procedures as part of a multimodal analgesia protocol for patients undergoing THA. Materials and Methods: A retrospective review of 1100 consecutive elective primary THAs was performed in 996 patients between June 2018 and December 2021. The RNB consisted of a preoperative continuous femoral nerve catheter and single-shot obturator nerve block, and LIA consisted of the intraoperative infiltration of weight-based bupivacaine. Results: A total of 579 (52.6%) patients received RNB, and 521 (47.4%) received LIA. Mean oral morphine equivalents (OMEs) during the first four hours postoperatively were significantly lower for LIA group (p < 0.001). However, the numeric pain rating scale in the post-anesthesia care unit (PACU) was similar between groups. Patients with LIA had significantly greater first ambulation distance in the PACU (p < 0.001), higher successful same-day discharge rate (p = 0.029), fewer falls (p = 0.041), and less refill OMEs post-discharge (p < 0.001) than RNB. Conclusions: In the setting of similar pain management between groups and better functional outcomes for LIA, the use of minimally invasive procedures like LIA for pain control following THA is favorable.

Identifying the Mechanisms of a Peripherally Limited Exercise Phenotype in Patients With Heart Failure With Preserved Ejection Fraction.

We identified peripherally limited patients using cardiopulmonary exercise testing and measured skeletal muscle oxygen transport and utilization during invasive single leg exercise testing to identify the mechanisms of the peripheral limitation. Forty-five patients with heart failure with preserved ejection fraction (70±7 years, 27 females) completed seated upright cardiopulmonary exercise testing and were defined as having a (1) peripheral limitation to exercise if cardiac output/oxygen consumption (VO2) was elevated (≥6) or 5 to 6 with a stroke volume reserve >50% (n=31) or (2) a central limitation to exercise if cardiac output/VO2 slope was ≤5 or 5 to 6 with stroke volume reserve <50% (n=14). Single leg knee extension exercise was used to quantify peak leg blood flow (Doppler ultrasound), arterial-to-venous oxygen content difference (femoral venous catheter), leg VO2, and muscle oxygen diffusive conductance. In a subset of participants (n=36), phosphocreatine recovery time was measured by magnetic resonance spectroscopy to determine skeletal muscle oxidative capacity. Peak VO2 during cardiopulmonary exercise testing was not different between groups (central: 13.9±5.7 versus peripheral: 12.0±3.1 mL/min per kg; P=0.135); however, the peripheral group had a lower peak arterial-to-venous oxygen content difference (central: 13.5±2.0 versus peripheral: 11.1±1.6 mLO2/dL blood; P<0.001). During single leg knee extension, there was no difference in peak leg VO2 (P=0.306), but the peripherally limited group had greater blood flow/VO2 ratio (P=0.024), lower arterial-to-venous oxygen content difference (central: 12.3±2.5 versus peripheral: 10.3±2.2 mLO2/dL blood; P=0.013), and lower muscle oxygen diffusive conductance (P=0.021). A difference in magnetic resonance spectroscopy-derived phosphocreatine recovery time was not detected (P=0.199). Peripherally limited patients with heart failure with preserved ejection fraction identified by cardiopulmonary exercise testing have impairments in oxygen transport and utilization at the level of the skeletal muscle quantified by invasive knee extension exercise testing, which includes an increased blood flow/V̇O2 ratio and poor muscle diffusive capacity. URL: https://www.clinicaltrials.gov; Unique identifier: NCT04068844.

Gestationally administered RAS modulators reprogram endotoxic cardiovascular and inflammatory profiles in adult male offspring of preeclamptic rats.

Previous studies showed that preeclampsia (PE) amplifies cardiovascular dysfunction induced by endotoxemia in adult male, but not female, offspring. Here, we asked if such aggravated endotoxic insult could be nullified by modulators of the renin-angiotensin system (RAS). PE was induced by gestational administration of Nω-nitro-L-arginine methyl ester(L-NAME, a nitric oxide synthase inhibitor). Adult male offspring of PE mothers treated gestationally with angiotensin 1-7 (Ang1-7, angiotensin II-derived vasodilator), losartan (AT1 receptor antagonist), pioglitazone (peroxisome proliferator-activated receptor gamma, PPARγ, agonist), or combined losartan/pioglitazone were instrumented with femoral indwelling catheters and challenged intravenously with a 5-mg/kg dose of lipopolysaccharides (LPS, 5mg/kg). LPS caused significant decreases in blood pressure (BP) and spectral index of overall heart rate variability and increases in heart rate and left ventricular contractility (dP/dtmax). These effects were mostly reduced to similar magnitudes by individual drug therapies. In offspring born to Ang1-7-treated dams, the spectral index of cardiac sympathovagal balance showed elevated sympathetic dominance in response to LPS. Immunohistochemistry revealed that Ang1-7, but not losartan/pioglitazone, abolished the exaggerated increases in toll-like receptor 4 (TLR-4) expression caused by PE/LPS in heart tissues and neuronal circuits of brainstem rostral ventrolateral medulla (RVLM). By contrast, the losartan/pioglitazone regimen, but not Ang1-7, decreased and increased angiotensin converting enzyme (ACE) and ACE2 expression, respectively. Together, gestational fetal reprogramming of Ang II (depression) and Ang1-7 (activation) arms of RAS effectively counterbalance worsened endotoxic cardiovascular and inflammatory profiles in adult male offspring of PE rats.

The Scrotal Displacement of the Catheter After Femoral Venous Cutdown: A Neonatal Case Report from Iran

Introduction: One of the most preferred cutdown access sites in neonates is the femoral vein; however, the medical staff should be aware of the associated complications. In this study, we present a case where the displacement of the catheter tip after femoral vein cutdown resulted in a scrotal hematoma. Case Presentation: A neonate with a gestational age of 39 weeks and a birth weight of 3740 grams was born in an academic hospital in Tehran, Iran, in 2022. The newborn gradually showed symptoms of respiratory distress and was immediately transferred to the neonatal intensive care unit (NICU). Within the first minutes of NICU admission, the newborn developed acute respiratory distress, and a chest X-ray revealed congenital pneumonia. The patient was promptly intubated, and endotracheal surfactant was administered. Simultaneously, peripheral vascular access was established. On day 3, the vascular access failed, and multiple attempts at percutaneous venipuncture were unsuccessful. A consultation with an expert pediatric surgeon led to the decision to perform a surgical venous cutdown. A 22-gauge catheter was inserted into the external iliac vein through the right femoral access to initiate intravenous fluid and antibiotics. Within the next four hours, the neonate developed right scrotal edema, discoloration, localized erythema, and clear fluid leakage from the right scrotum. Intravenous infusion was urgently clamped. The pediatric surgeon recommended catheter removal, suspecting displacement of the catheter. A sonography examination revealed a hypoechoic 11 × 10 × 4 mm region, indicating a hematoma at the inferior pole of the right testis. The neonate was placed under serial follow-up to monitor vital signs and local manifestations. The patient was managed with conservative treatment and discharged in good condition on the 10th day of NICU admission. Conclusions: The presented case demonstrated scrotal damage following femoral cutdown catheterization. This unexpected complication was effectively managed by the immediate removal of the catheter, close monitoring, conservative therapy, and serial follow-ups, which prevented the progression of local signs. NICU staff should be aware of the potential for testicular injuries in such cases.

Incidental Discovery of Migrated Guidewire from Right Femoral Vein Catheterization: A Case Report

Background: Catheterization of central veins can be life-saving for gravely ill patients and remains the mainstay of vascular access for haemodialysis patients especially in the absence of arterovenous fistula. Femoral vein catheterization often comes in handy especially in emergency situations. This is nevertheless fraught with complications including: hemorrhage, femoral artery puncture, femoral nerve injury, pseudoaneurysm, fistula formation, thrombophlebitis, retroperitoneal hemorrhage, bowel perforation, urinary bladder puncture, and guidewire migration. However, guidewire migration has been considered a rare but serious and preventable complication. Case presentation: We report a case of a 64 year old end stage kidney disease patient who was on maintenance haemodialysis using femoral vein catheters as access. Patient was unaware he had a migrated guidewire in situ following femoral vein cannulation by unqualified health professionals. He remained asymptomatic until the migrated guidewire was incidentally discovered during an attempt at right internal jugular vein cannulation for placement of tunneled catheter for haemodialysis. Guidewire extraction was subsequently done through a right neck open surgery. Conclusion: Migrated guidewire is a rare complication of central vein cannulation. It is potentially preventable but prompt extraction should be done immediately if it occurs.

Pulmonary Arterial Hypertension as a Predictor of Severity of Chronic Kidney Disease and Correlation with Its Various Stages

Abstract Background: Pulmonary arterial hypertension (PAH) pulmonary hypertension (PH) presents a complex pathobiology. Individuals with end-stage kidney disease, particularly those undergoing hemodialysis (HD), face an elevated risk of PH development. Early identification of PH severity in chronic kidney disease (CKD) can facilitate timely interventions to mitigate cardiovascular mortality. Our study aimed to determine the prevalence of PAH in CKD patients and explored its association with different CKD stages. Materials and Methods: A hospital-based cross-sectional study involving 60 CKD patients was conducted. Pulmonary arterial pressures were assessed using Doppler echocardiography, and patients were stratified into groups based on PH severity. Results: In our study, 86.7% of CKD patients had PAH, and their mean pulmonary arterial systolic pressure (PASP) was 50.83 ± 9.779 mmHg. There was a significant increase in PH prevalence with advancing CKD stages (P &lt; 0.001). Patients undergoing HD exhibited a substantial PH prevalence (63.5%) (P &lt; 0.001) as compared to those receiving conservative treatment. Furthermore, pulmonary arterial pressures were greater in HD patients with an arteriovenous fistula (AVF) (44.2%) (P &lt; 0.001) than in individuals with a femoral or jugular vein HD catheter. Conclusion: Nearly four-fifth of CKD patients had PAH. In addition, individuals undergoing dialysis with an AVF demonstrated significantly elevated pulmonary arterial pressures compared to those using a femoral or jugular vein HD catheter.

#2923 Intracardiac vascular access as a last resort for hemodialysis in patients with exhausted traditional vascular access: a case report

Abstract Introduction The dysfunction of vascular access (VA) constitutes one of the main problems faced by nephrologists and patients in chronic hemodialysis (HD). This challenge becomes particularly worrying in patients who have depleted their upper extremity venous resources and have no longer arteriovenous fistula available, requiring the placement of a central venous catheters. It leads to an increase in morbidity and mortality and a higher of infections, thrombosis and exhaustion of access points. In such cases, alternatives to conventional VA are limited, with intracardiac access being an emerging option, albeit with very limited documented experience. Case Report We describe the case of a 68-year-old male with a history of hypertension, nasopharyngeal carcinoma in 2012 treated with chemotherapy and radiotherapy. In 2018 he was diagnosed with low-grade urothelial bladder carcinoma (PT1G1) that infiltrated the subepithelial corion while sparing the muscular layer. He also had severe hydronephrosis with impaired renal function, requiring radical cystoprostatectomy with Bricker bladder reconstruction and subsequent bilateral nephrostomy due to persistent dilatation and progressive deterioration of renal function. He began chronic HD in June 2020 through a left femoral catheter due to the inability to access the upper thoracic vascular tree due to stenosing fibrosis from previous radiotherapy. He was placed on the waiting list for a kidney transplant (KT) in the right iliac fossa but experienced multiple catheter dysfunction episodes, requiring the placement of a right femoral venous catheter to continue with his HD sessions. Additionally, peritoneal dialysis was not considered due to previous urological surgery. Considering the limitation of VA and the possibility of KT as its best alternative, we opted for the insertion of a tunnelled intracardiac catheter at the right atrium. This procedure was conducted by the Cardiac Surgery Department on 03/12/2021 through a median sternotomy in the 4th intercostal space. A permanent hemodialysis catheter was inserted in the right atrium through the 3rd intercostal space and fixed with a purse-string suture. It was then tunnelled under the breast to the 2nd intercostal space through a counter-incision. The cuff was appropriately placed in the subcutaneous tissue (Figs 1 and 2). The intervention proceeded without any complication and the catheter exhibited normal functionality. After that, the patient received anticoagulation with enoxaparin the days between dialysis sessions. Consequently, the right femoral catheter was safely removed. Two weeks later, the patient successfully received a KT from a deceased donor. He was discharged on the day 11st post-KT with any complication and maintains a good renal function after 2 years of follow-up with a serum creatinine 1.7 mg/dL (eGFR: 39 ml/min). The intracardiac catheter was removed one month later through a mini-thoracotomy. Conclusions Intracardiac VA is an unusual and high-risk resource that seems an alternative in patients with exhausted VA with no alternative emergency renal replacement therapy, so it should be considered as the last resort. In the case of our patient, the implantation of this catheter allowed for the continuation of dialysis and access to KT.

#1217 Reinsertion of peritoneal dialysis catheter in a patient with Nocardial peritonitis: a case report

Abstract Background and Aims Peritonitis is a major drawback in patients on PD leading to technique failure, change in modality to hemodialysis, mortality. Nocardia infections are rare and occur mainly in immunocompromised individuals. Eleven cases of Nocardial peritonitis only have been reported. Given the rarity of the condition, duration of medical treatment, time at which catheter reinsertion can be done after treatment are not clear. We describe a case of nocardial peritonitis which presented with tunnel abscess and septic shock. Method Our patient is a 65 yr/M, DM &amp; HT, initiated on CAPD due to multiple access failure elsewhere. He was also on treatment with directly acting antiviral for HCV infection. He presented with fever, abdominal pain and cloudy peritoneal fluid. Vitals were HR 98/min, BP 90/ 60 mmHg, temperature 100 F. Abdominal examination showed insertion and exit site pus with tenderness (Fig. 1a,b). USG screening showed tunnel abscess. Labs showed hemoglobin 7.2 g/dL, white blood cell count 6200 cells/cu mm, platelet count 1.4 lakh/cu mm, SGOT 23 U/L, SGPT 15 U/L and peritoneal dialysis fluid count 1570. CT abdomen showed no intraabdominal abscess. He was started on intravenous antibiotic and ionotropic support. Emergent PD catheter removal was done in view of septic shock &amp; was dialysed via femoral tunneled catheter. Pus and peritoneal fluid culture grew Nocardia spp after six days of incubation. Intravenous cotrimoxazole was given for 2 weeks and intravenous ceftriaxone was given for 4 weeks followed by oral cotrimoxazole 960 mg thrice weekly. Results Following 7 months of treatment with cotrimoxazole, PD catheter was inserted laparoscopically after omentectomy and adhesiolysis. Peritoneal biopsy was taken at the time of catheter insertion, histopathology showed fragments of peritoneal tissue with scattered chronic inflammatory cells, culture was negative for Nocardia. PD catheter outflow dysfunction was noted after initiation of exchanges. CT abdomen showed migration of PD catheter tip following which catheter tip repositioning was done laparoscopically. During procedure, nodules were noted over peritoneum and bowel. Biopsy of the nodules were revealed foreign body granuloma and culture did not grow Nocardia (Fig. 2). Patient was initiated on three exchanges with 2.5% dextrose per day after a break-in period of 14 days. He continues to be on PD with good ultrafiltration. Conclusion There is not much data on reinsertion of PD catheter after nocardial peritonitis. One case of Nocardial peritonitis reported in literature, in which PD catheter was reinserted. Jamie Kendrick-Jones et al. [1] reported a case of Nocardial peritonitis in which catheter was reinserted after 1 year. To our knowledge this is the first case of Nocardial peritonitis which presented with tunnel abscess. Catheter was removed due to septic shock. Patient was treated with cotrimoxazole for seven months after which PD catheter insertion was done. Return to PD is feasible if Nocardial infection is identified and treated appropriately.

#2391 Changes of medical costs and number of uses for continuous renal replacement therapy until recent six years in South Korea

Abstract Background and Aims Continuous renal replacement therapy (CRRT) is a necessary dialysis treatment method applied to patients with acute renal injury at intensive care unit. In South Korea, the use of such CRRT is increasing, and the cost of health insurance used for CRRT is also increasing. In this study, the pattern and medical costs increase of CRRT usage until recent 6 years were investigated. Method From 2016 to 2021, the number of CRRT claims was investigated using data from the National Health Insurance Review and Assessment Service. CRRT costs is applied by a resource-based relative value score in Korea. CRRT can be charged as continuous venovenous hemodialysis, continuous venovenous hemofiltration, and continuous venovenous hemodiafiltration depending on the treatment mode. The CRRT cost differs from the very day and the next day's cost, and the cost of the very day includes the femoral hemodialysis catheter insertion cost, which is higher than the next day's cost. Results CRRT medical practice is gradually increasing. The number of CRRT the very day increased from 15,640 cases in 2016 to 20,883 cases in 2021, and it continues to increase from 81,649 cases CRRT the next day in 2016 to 121,376 cases CRRT the next day in 2021. The CRRT relative value score is higher than the conventional hemodialysis(HD) and the CRRT relative value score is 9715 points higher than the conventional HD 1065 points. The total cost of CRRT increased by about KRW 52.5 billion (approximately 38,363,171 dollars) in 2021 from about KRW 17.3 billion (approximately 12,641,578 dollars) in 2016. In addition to CRRT medical practice costs, dialysis fluid, anticoagulant costs, and material costs are added, and so actual CRRT-related costs are more expensive. Conclusion CRRT medical practice is gradually increasing. The number of CRRT the very day increased from 15,640 cases in 2016 to 20,883 cases in 2021, and it continues to increase from 81,649 cases CRRT the next day in 2016 to 121,376 cases CRRT the next day in 2021. The CRRT relative value score is higher than the conventional hemodialysis (HD) and the CRRT relative value score is 9715 points higher than the conventional HD 1065 points. The total cost of CRRT increased by about KRW 52.5 billion (approximately 38,363,171 dollars) in 2021 from about KRW 17.3 billion (approximately 12,641,578 dollars) in 2016. In addition to CRRT medical practice costs, dialysis fluid, anticoagulant costs, and material costs are added, and so actual CRRT-related costs are more expensive.

Tunneled Hemodialysis Catheter Making Its Way into the Spinal Canal: An Unusual Complication

The procedure of tunnelled hemodialysis catheter insertion is generally considered safe. We report the case of a lady who had a malpositioned femoral tunneled hemodialysis catheter that entered into the spinal canal causing neurological weakness. The catheter was later safely removed leading to partial neurological recovery.

Mobilization With Femoral Catheters in the Burn ICU: A Retrospective Review Following Change in Practice Guidelines.

Femoral catheters are commonly viewed as a barrier to Burn ICU mobility progression due to anatomical location and potential risk of complications. The purpose of this review was to examine outcomes and complication rates following implementation of femoral catheter mobilization guidelines, as well as determine safety and feasibility of mobilization with femoral catheters in place within the burn population. A retrospective review was completed on 17 patients prior to and following the implementation of new femoral catheter mobility guidelines, 34 patients total. Burn therapy notes were reviewed for burn admissions with at least 1 femoral catheter in place, including arterial, central, and dialysis catheters. Demographic data, admission statistics, line placement timelines, and active mobility achieved during therapy sessions were recorded for both the nonmobilization group (NMG) and mobilization group (MG). The 34 patients reviewed had 99 total lines placed (30 NMG, 69 MG). Change in mobility protocols for the MG resulted in more therapy sessions (n = 516 vs 281) and a significant increase in active mobility sessions (n = 83 vs 5, P < .001), including 146 total mobility activities such as transitions to chairs, tilt table, sitting edge of bed, standing, active chair transfers, ambulation, and cycle ergometry. No catheter-associated adverse events occurred during active mobility sessions and no complications were associated with participation in mobility. This review supports that the presence of femoral catheters alone should not limit the progression of mobility interventions with the use of clinical judgment in specialty-trained burn therapists.

Unraveling a Novel Mechanism of Altered Glomerular Hemodynamics in Pre-diabetic Obesity

Background: In pre-diabetic obesity, disrupted glomerular autoregulation leads to increased glomerular capillary pressure and renal blood flow, causing potential barotrauma-induced glomerular damage. A decrease in Afferent arteriole ( Af-Art) resistance causes higher glomerular capillary pressure but the underlying mechanism behind this, specifically in pre-diabetic obesity, remains unclear. Hyperinsulinemia is common in pre-diabetic obesity, but its role in reducing Af-Art resistance in the kidneys is unknown. Kidney blood flow is auto-regulated by vasoconstriction via tubuloglomerular feedback (TGF) and vasodilation through the Distal convoluted tubule-2/connecting tubule (DCT-2/CNT) mechanism. Our earlier studies indicate increased Af-Art dilation in pre-diabetic obese rats through the DCT-2/CNT mechanism without affecting TGF. This DCT-2/CNT induced Af-Art dilation requires initiation from epithelial sodium channels (ENaC) present at this tubular segment and interestingly insulin is a known ENaC activator. Hypothesis: We hypothesize that in the context of pre-diabetic obesity, hyperinsulinemia contributes to an increase in renal cortical blood flow (CBF) by increasing DCT-2/CNT-induced Af-Art dilation, subsequently leading to glomerular injury. Methods: We assessed the effects of insulin on Af-Art dilation by perfusing juxtaposed DCT-2/CNT segments with insulin in normal rabbits. Contribution of DCT-2/CNT induced Af-Art dilation was measured by co-administration of the ENaC blocker benzamil. To study hyperinsulinemia's role in an in-vivo setting without altering blood glucose levels, we used a hyperinsulinemic-euglycemic (HI-EUG) clamp in obese rats with intravenous (IV) glucose and insulin infusions. Renal CBF and blood pressure were monitored using a laser Doppler probe and femoral artery catheter, respectively, both with and without benzamil administration (400 μg/kg, IV). To evaluate insulin's potential role in causation of renal damage, we infused insulin directly into one kidney of lean rats for 6 weeks via a renal sub-capsular catheter, with the contralateral kidney serving as control. Glomerular basement membrane (GBM) thickness, a marker of renal damage, was measured via electron microscopy. Untargeted lipidomic analysis of the renal cortex was performed to identify potential renal damage pathways in insulin infused kidneys. Results: Insulin perfusion in rabbits' DCT-2/CNT potentiated the dilation of adherent Af-Art compared to control infusions with artificial tubular fluid. ENaC inhibition reversed the insulin-induced Af-Art dilation, confirming that insulin increases Af-Art dilation through the ENaC-initiated DCT-2/CNT mechanism. In obese rats, insulin delivery using a HI-EUG clamp resulted in a significant 20.8±4.9% increase in CBF, which was negated by the administration of the ENaC blocker benzamil, indicating the potential involvement of DCT-2/CNT-mediated vasodilation. Neither the HI-EUG clamp nor benzamil infusion affected blood pressure. Additionally, continuous direct insulin infusion into the kidneys of lean rats led to an increase in glomerular basement membrane (GBM) thickness and ceramide accumulation in the renal cortex, both indicative of renal damage. Conclusion: Our study demonstrates that insulin directly augments DCT-2/CNT-mediated Af-Art dilation and increases renal cortical blood flow in obese rats. Chronic renal insulin infusion led to structural changes and damage markers in the kidney, independent of blood glucose and blood pressure levels. Henry Ford Health System Internal Funding. Pilot and Feasibility grant from southeast center for integrated metabolomics. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.