Determination of Absence of Right Internal Jugular Vein During Ultrasonographic Guided Central Venous Cannulation.

Written informed consent was obtained from the patient for sharing his clinical condition in a scientific journal. The 53-year-old male patient (weight 78 kg) was going to undergo liver transplantation from a living donor because of end-stage liver failure. His history revealed that he had cirrhosis for 1 year and had thrombus in his portal vein. He was admitted into the operating room and underwent induction after standard monitoring. A cannula was inserted into the left radial artery, and invasive arterial pressure was monitored. A central catheter was planned to be inserted into the right IJV under USG guidance. The table was set in the Trendelenburg position and the patients head was slightly turned to the left side. The patient was covered in a sterile way and 9-L linear probe of USG (5.0–13.0 MHz, multi-frequency, boardband) was sterilised and placed in the right neck region, but the right IJV was not visible. While the right carotid artery could be clearly observed using colour Doppler, the right IJV was not detected (Figure 1). Although the right neck was thoroughly examined via USG, the right IJV was absent. The left IJV was evaluated through USG and it was easily viewed (Figure 2). A central venous catheter was inserted into the left IJV without any problem.