External Jugular IV Lines (updated)
External jugular vein cannulation gives you a quick and easy “almost central” line. Our protocol allows paramedic level personnel to use the “EJ” IV access in critically ill or injured patients 8 years of age and older when a peripheral site is not immediately available or very difficult to access. Intermediate level personnel may access the External Jugular on patients in cardiac arrest who are 8 years of age or older.
Some of the patient scenarios where an EJ might be beneficial are…
- Cardiac arrest; gives you a direct line to cardiac circulation
- MVA where you need volume replacement but can’t get to an extremity
- Multi-system trauma where you need a big line, smartly
- Other situations where a large diameter line is needed quickly
What you will need:
- IV start kit plus a betadine prep
- 14 gauge IV cath
- INT hub and saline flush
- Torn tape for the typical chevron or your usual taping method
How you do it:
1.
Place the patient supine and head down if possible.
2.
Turn the patient’s head away from the side of the neck you intend to use. (Don’t do this if you suspect a cervical spine injury, duh!)
3.
Prep with alcohol prep and Betadine prep
4.
Tourniquete the vein lightly with one finger just above the clavicle; this might help distend the vein for a better view and puncture. Remember that blood is flowing from the head into the chest in the external jugular.
5.
Cannulate the EJ by holding the needle over the patient’s lower jaw vicinity and aiming toward the same side shoulder. In other words; stick the vein from the medial side instead of trying to go in right on top of it.
6.
Maintain a tourniquet effect with a finger to prevent air from entering the vein until you can attach and INT hub.
7.
Tape and secure as usual with a Tegaderm
8.
Flush with a saline flush or attach an IV set.
Special Thanks to Pat Clontz for serving as our victim! “Anything for a little recognition.”