[Successful internal jugular vein puncture with ultrasound guidance for a terminal life stage patient in sitting position].

We experienced an internal jugular vein cannulation of a terminal life stage patient suffering from serious peritonitis carcinomatosa with severely edematous limbs. He could not lie down on a bed because of dyspnea due to high abdominal pressure caused by massive ascites. We examined his internal jugular vein with ultrasound device, and found that it kept high venous pressure even in his inspiratory phase, although in sitting position. Internal jugular vein cannulation was successfully performed at first attempt by using ultrasound guide with no complications including air embolism, pneumothorax and bleeding. We considered that positive pressure of jugular vein during a respiratory cycle of the patient was obtained from his unconscious Valsalva's maneuver by increasing intrathoracic pressure following high abdominal pressure. Ultrasound-guided vascular access technique is useful and safe even in terminal life stage patients under palliative care.