Are any of you out there doing external jugular PIV insertions in difficult sticks? Sometimes we have people who come into the ER and just need a blood draw and fluids for a couple of hours. We can't often get them even with ultrasound because their veins are too deep or they are too dehydrated. A central line is really overkill. Thoughts/suggestions?
Too deep for ultrasound? That is odd because US is designed specifically for use with deep veins. You may need a longer catheter to increase your success. EJ can be done, but I have serious reservations about this site due to it tortuous pathway and neck movement. If you insert an EJ just for a blood draw and a few hours of fluid, what is to stop someone from using it for other procedures such as a power injection for CT or a vesicant infusion on a pump? That would be an extravasation injury just waiting to happen. I would keep trying with US and a longer, 2 inch peripheral catheter before use of the EJ. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
We do place PIV's in EJ's using ultrasound. I have had good success with a long 20g (1.75 inch).
Regards
Judy
Lynn, I agree with you. Ironically I had this conversation with a nurse in the ER when I was finishing up a midline on a patient. I explained and expressed to her the high risk of the procedure verses the purpose of the procedure. Blood Draws in my mind don't justify the risk. U/S guided insertions should prevent this type/sort of iv access from occuring. Finally, I don't remember EJ access being covered in any IV access class I've ever attended and I've attended quite a few.
Where does a RN get the training to perform this procedure? What type of instruction did the nurse receive in order to ensure s/he has the necessary skill set to perform this procedure safely? Establishing IV access in the EJ...Is that a peripheral IV? ( I know, I know, ICU, and ER nurses are biting my head off...lol). Still doesn't make this a safe practice for though.
Alfonza J. Riley, RN,RVS
Registered Nursing and Vascular Ultrasound Services,LLC
8162 Fenwick Court
Laurel. Maryland 20707
Alfonza J. Riley, RN,RVS
EJ is a superficial peripheral vein that becomes a deep vein where it joins the axillary vein in the inferior and middle area of the clavicule on most patients. There can be lots of variations in the pathway of the EJ though.
IJ is a deep peripheral vein. It passes into the thorax near the head of the clavicle where it joins the innominate or brachiocephalic vein and becomes an intrathoracic vein.
tip location would dictate what type of catheter it is. If either vein is used for a PICC insertion with the tip at the CAJ, this would be a central venous catheter. If shorter than this, it would not be considered a central catheter. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861