Yup you have to wait for him to attempt to pip or for the veining to go away enough that you can try and turn him in the egg to get his head towards the top. Sometimes their feet are over their head too so don't count out the head being at the top he may surprise you.
Since you brought this up, I hope you don't mind if I pick your brain about malpositions as well. One of the chicks that I lost in my last hatch had very full blood vessels, was malpositioned, and from what I could tell wasn't in a position that it could pip anywhere. I typically would make a small hole between vessels as close to the beak as I can get once the vessels are a bit thinner but it just wasn't happening with that one and in my hesitation, I lost it. Do you never assist malpositions that haven't attempted pipping or have you just not encountered that yet?