Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 3 3 2019 04 27 e32 e32 Mehran Sotoodehnia Department of Emergency Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran Atefeh Abdollahi Department of Emergency Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran Maryam Khodayar Imam Hossein Center for Education, Research and Treatment, Shahroud University of Medical Sciences, Shahroud, Iran 2019 04 27 An 85-year-old female patient was brought to emergency department (ED) from a nursing home with altered mental status (GCS: 12/15) and hypotension (90/60 mmHg). Bilateral fine crackles in lungs and severe cachexia were obvious in her physical examination. The ECG showed only sinus tachycardia. Several attempts at peripheral vein cannulation failed due to poor visualization of severely atrophied and contracted subcutaneous veins. Therefore, on two attempts, a central venous catheter (CVC) was inserted into the right internal jugular vein (IJV) using the Seldinger technique. After securing and taping the central line, fluid infusion started with no difficulty and a portable chest x-ray was ordered. https://fem.tums.ac.ir/index.php/fem/article/view/144 https://fem.tums.ac.ir/index.php/fem/article/download/144/173