Abstract
A patient with angina pectoris suffered an acute renal failure that was induced by a contrast medium used for coronary angiography. The patient had orthopnea, but he could not be placed in the supine or head-down tilt position because of congestive heart failure. Using ultrasound guidance, we safely performed internal jugular venipuncture and achieved venous access for continuous hemodiafiltration in the 45° head-up tilt position, which was employed considering the risk of air embolism.
Ultrasound guidance may be useful for internal jugular venipuncture in patients who cannot be placed in a head-down tilt position. For patient safety, ultrasound-guided central venipuncture should be considered when the puncture is challenging.
