Yesterday, I intubated the patient Lao Mao to prepare for hemodialysis. Lao Mao had undergone emergency hemodialysis treatment six months ago, and I remember that it was a Saturday night when I arrived at the hospital from home. This time, Old Mao was temporarily changed to hemodialysis due to poor ultrafiltration of peritoneal dialysis. Because of his repeated internal jugular vein placement, he was worried about proximal thrombosis or stenosis, which I observed is common in diabetic patients. I found that the internal jugular vein was very small and could not be penetrated repeatedly, while the superficial external jugular vein was also very small but superficial, so I tried to penetrate it and the result was very smooth and the dialysis flow was very good. This patient is very fat, and for patients who are thin or have obvious external jugular veins, it is relatively easy to puncture them, so for patients who do not have easy access to the internal jugular vein, don’t forget that there is an external jugular vein available.