Ultrasound-guided internal jugular vein cannulation in the obese patient in a forced semi-sitting position

Central venous cannulation may be difficult in morbidly obese patients. We present a case of successful right internal jugular vein catheterization under real-time ultrasound guidance in an obese patient in a forced semi-sitting position.

A 43-year-old male patient with body mass of 182 kg (body mass index, 52.2 kg/m²) was admitted to the clinic 48 h after the trauma. The patient was in a forced semi-sitting position (37° head elevation). The patient was not able to perform the Valsalva maneuver. In the reported case, the lateral access for right internal jugular vein catheterization was chosen. We selected a lateral-oblique probe position for the ultrasound-guided internal jugular vein cannulation. Internal jugular vein catheterization was successful at the first attempt.

Ultrasound imaging enables us to choose a desirable access for successful internal jugular vein cannulation in the obese patient without head-down tilt position. The lateral-oblique probe position for internal jugular vein cannulation may have advantages in certain clinical situations.