Distal femoral central venous catheterization in a semi-sitting position for a patient with lung cancer and superior vena cava syndrome: A case report

• Superior vena cava (SVC) syndrome in lung cancer is an oncological emergency. • Supine positioning worsens symptoms, which makes venous access difficult. • Distal femoral central venous catheterization (CVC) is technically feasible. • CVC is safely carried-out in a semi-sitting position. • Distal femoral CVC is a safe, practical alternative for patients with SVC syndrome. Superior vena cava (SVC) syndrome is an oncological emergency characterized by venous obstruction, most commonly due to malignancy, that leads to facial and upper extremity edema and dyspnea that worsen in the supine position. A 70-year-old man with SVC syndrome secondary to lung adenocarcinoma presented with severe orthopnea, generalized edema, and inability to tolerate the supine position. Because the peripheral and inguinal venous accesses were not feasible, distal femoral central venous catheterization (CVC) was performed under ultrasound guidance in a semi-sitting position, without complications. This facilitated the prompt initiation of chemotherapy, which stabilized the patient’s condition. This case demonstrates that in oncological emergencies, semi-sitting distal femoral CVC is a safe and practical alternative for patients with SVC obstruction who cannot tolerate the supine position.