Background <p>Central vein cannulation is a common invasive procedure performed in critically ill patients and during major surgeries. This study compares the right internal jugular vein’s diameters and cross-sectional area after passive legs elevation and hepatic compression, analyzing these based on age, gender, body mass index and fasting duration.</p> Methods <p>A cross-sectional study of 184 elective surgery patients (84 males, 84 females) at B.P. Koirala Institute of Health Sciences, Nepal, included 18–75 years. Exclusions: patients on mechanical ventilation, history of right jugular cannulation, neck/abdominal swelling, raised intracranial pressure, lower extremity fracture and refusal of consent. Age, gender, fasting duration and body mass index were recorded. The 6–13&#xa0;MHz linear probe identified the internal jugular vein by its compressibility and anechoic appearance. Short axis view of transverse and anteroposterior diameters and cross-sectional area were measured in short axis view at the cricoid level using electronic calipers. Maximum diameter and average cross-sectional area were measured in supine with the head rotated 15°- 30° left, after one minute of passive legs elevation at 45° and after hepatic compression for one minute with a 19.6&#xa0;N force.</p> Results <p>Hepatic compression increased transverse diameter by 1.64 (0.40) cm, <i>p</i> = 0.035 and cross-sectional area by 1.28 (0.54) cm², <i>p</i> = 0.047. No gender differences were noted. The transverse diameter increased in underweight (<i>p</i> = 0.02) and overweight (<i>p</i> = 0.01) patients. The cross-sectional area increased in overweight (<i>p</i> = 0.03). Passive legs elevation matched hepatic compression for the fasting durations.</p> Conclusion <p>Hepatic compression better optimizes transverse diameter and cross-sectional area of right internal jugular vein than passive legs elevation.</p>