Emergency ultrasound-guided percutaneous PD catheter insertion in an orthopneic, dyspneic, and hemodynamically unstable patient (on norepinephrine, vasopressin, and dobutamine), performed under local anesthesia. This was my first time performing the procedure on an ORTHOPNEIC patient -- a scenario often not feasible with an open surgical technique. One of the best clinical situations where the percutaneous approach truly shines. Grateful to be saving lives on Maundy Thursday. #InterventionalNephrology #MaundyThursdayGrind – at Taytay, Calabarzon

Interventional Nephrology Workshop, World Congress of Nephrology (WCN), Yokohama, Japan. POCUS and dialysis access. Lead by my mentor Dr. @bernardo_moguel & POCUS master, Dr. @ArgaizR #WCN – at Yokohama-shi Nishi, Kanagawa

Sharing an interesting case I encountered today—one that may actually be worthy of a formal case report. A 26-year-old female underwent insertion of a tunneled left internal jugular hemodialysis catheter (Permcath). The left side was chosen because the right IJ was no longer patent from multiple prior cannulations. The procedure itself was uneventful. Ultrasound guidance confirmed that I had cannulated the left internal jugular vein properly, and the catheter advanced smoothly without resistance. However, the post-procedure chest X-ray gave me an immediate scare. The catheter appeared malpositioned, raising concern for a serious complication. To clarify the anatomy, we requested a CT angiography—which fortunately brought relief. The patient turned out to have a congenital anomaly: a duplicated, left-sided superior vena cava (persistent left SVC). A rare but important anatomical variant that explained the unusual catheter trajectory on X-ray. #InterventionalNephrology – at Taytay, Calabarzon

Fluid management in the critically ill — a lecture today at the American Society of Nephrology convention. So many slides on fluid responsiveness… yet not a single mention of fluid tolerance. And the most concerning part? “Cessation of fluid responsiveness” presented as a marker of adequate resuscitation. What do you think, @ThinkingCC? – at Houston, TX

Congratulations, @brendacfl, on your excellent poster presentation at the @ASNKidney #ASN2025 #interventionalnephrology

LVIII Congreso Nacional de Nefrología — Monterrey, Mexico. Delivered a lecture and hands-on workshop on Image-Guided Percutaneous Peritoneal Dialysis Catheter Insertion under both ultrasound and fluoroscopic guidance. I am deeply grateful to be back in Mexico — a country very close to my heart. This visit is not only an opportunity to teach and share knowledge, but also to reconnect with friends and colleagues, experience the beauty of this nation once again, and to proudly raise the flag of the Philippines and @psnmanila on the global stage. #InterventionalNephrology – at Monterrey, Nuevo León

🔍 POCUS Serye: When Traditional Exam Fails 🧓 Case: A 76-year-old female was referred due to dyspnea on exertion (DOB), hypotension, and azotemia. 🩺 Initial Clinical Impression: Physical exam: Clear breath sounds, no bipedal edema Urine output: Dark and concentrated (initially presumed to be dehydration) ➡️ Based on these findings, IV hydration was initiated — a reasonable approach by most standards. --- 🧠 But POCUS changed everything: 🔹 Cardiac: Severely depressed ejection fraction (EF) Global hypokinesis with multi-wall motion abnormalities 🔹 Lungs: B-lines across all lung zones Shred sign on R1 (suggestive of pneumonia) Pleural effusions seen on R4 and L4 ➡️ Pulmonary congestion + effusion + pneumonia 🔹 Abdomen: Moderate ascites 🔹 IVC: Plethoric and non-collapsing, max diameter: 2.5 cm 🔹 Doppler Findings (VeXUS): Hepatic vein: S-wave reversal Portal vein: Pulsatile flow ➡️ VeXUS Grade 3 = Severe venous congestion --- ❌ No need to assess fluid responsiveness (e.g., LVOT-VTI) This patient was clearly not fluid-tolerant. --- ✅ Revised Management: Stopped IV hydration Norepinephrine uptitrated Furosemide carefully administered (with BP monitoring) Emergency IJ catheter insertion Initiated SLED --- 📌 Key Takeaways: Traditional physical exam and basic volume indicators (e.g., urine color, edema, breath sounds) can be misleading. This patient appeared “dry” on exam but was in severe volume overload on ultrasound. Point-of-Care Ultrasound (POCUS) provided a 180-degree shift in management, likely preventing further harm. 👉 Every critically ill patient deserves bedside ultrasound evaluation. Don’t rely solely on clinical gestalt — let the probe guide your care. #pocusforthewin

Late post: April 2025: delivered a lecture during the Philippine Society of Nephrology Annual Convention (PSN) about POCUS and the VExUS score. Introduced the VExUS score and explained why we have to give more attention to the venous side, and not just the forward flow. And that Fluid tolerance is more important than Fluid responsiveness. Clinicians here are still too forward flow-centric, and most of them are not even aware of the VExUS score. #POCUS #VExUS – at Montréal, Québec

H&R 2025 Beyond gratetul to have attended this conference. Learning from the legends and trailblazers of #POCUS @ThinkingCC @NephroP – at Montréal, Québec