Beware Trendelenburg Positioning in the Critically Ill Obese Patient

• When inserting a central venous catheter (CVC) into the internal jugular or subclavian vein, clinicians often place patients in the Trendelenburg position to increase the size of the vein.
• When possible, avoid Trendelenburg position for CVC placement in the morbidly obese patient.
• These patients can quickly deteriorate in this position due to reduced lung volumes, increased right heart pressures, decreased cardiopulmonary reserve, and the effects in intra-abdominal pressure.

References

Rahman O, Willis L. Vascular procedures in the critically ill obese patient. Crit Care Clin 2010;26:647-60.