Kasatkin Anton A, Urakov Aleksandr L, Nigmatullina Anna R
1 Izhevsk State Medical Academy, Izhevsk, Russia.
2 Department of Anesthesiology and Intensive Care, Clinical Hospital, Izhevsk, Russia.
J Vasc Access. 2018 Jul;19(4):398-400. doi: 10.1177/1129729817752635. Epub 2018 Mar 12.
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/m) 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.
病态肥胖患者的中心静脉置管可能具有挑战性。我们报告一例在实时超声引导下，成功为一名处于强迫半坐位的肥胖患者进行右颈内静脉置管的病例。
一名体重182千克（体重指数52.2千克/平方米）的43岁男性患者在创伤后48小时入院。患者处于强迫半坐位（头部抬高37°），无法进行瓦尔萨尔瓦动作。在本病例中，选择右侧颈内静脉外侧入路进行置管。超声引导下颈内静脉置管时，我们选择了外侧斜位探头位置。首次尝试颈内静脉置管即获成功。
超声成像使我们能够在不采用头低位的情况下，为肥胖患者成功进行颈内静脉置管选择理想的入路。颈内静脉置管的外侧斜位探头位置在某些临床情况下可能具有优势。
