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.
