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EJ's and IO's

Another topic that we are trying to get changed in policy is placement of external jugular (EJ) and intraosseous (IO) lines by nursing. Currently, nurses cannot place or remove EJ's, and can only remove IO's. Placement of both can only be done by an APP or doctor. Our proposal would be to train ED and ICU nurses to place these. Push back from the care and practice council (our policy makers) is that an ED physician is "always available" and they don't see the need for nursing to start them. Our rebuttal being that an ED doc is not "always available" and we don't always have time to wait for one to become available. 

Of note, we do not have an IV team here. Several ICU and ED RN's are trained in US guided midlines and PIV's. We also do not have 24/7 intensivist coverage, and our nocturnist is usually a family medicine doc that is not credentialed. 

So on to my question - are any of you placing these at your facilities? If so, what does your policy, competency process, etc. look like? Also, if this is a new thing for our facility, was there anything that helped you to get the policy changed? 





Why EJ's? Tortuouse pathway

Why EJ's? Tortuouse pathway and neck motion lends to complications from a PIVC. IO for emergent need to dwell for less than 24 h. USGPIVC for difficult venous access and avoid the EJ totally except for very short need. 

Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

The thought behind the EJ was

The thought behind the EJ was quick, and usually fairly easy access to bridge to more definitive access. I understand that it is not for longer term use, but it is a tool in the tool box. Currently it is a tool we can't even weigh as an option. I for one would like to have the option to make the choice as to what access is best for the situation at hand. 


ICU Nurse


IO Placement

Our ED and MICU nurses place IO's during a cardiopulmonary arrest.  They are part of the Rapid Response and Code Blue teams.  We had initial training and competency and provide ongoing competency.  We use the EZ-IO at our facility and Arrow/Teleflex sent clinicians in for initial training, then the CNS and Nurse Educator for the units carries on with the ongoing competency. 




Thank you for the reply. This is exactly where my thinking lies. We are primary responders for all codes and rapid responses within the facility and are the "team leader" in absence of a physician. It seems elementary to give the nurses the tools that we need for the job, but many seem more than happy to relinquish a part of their practice to physicians still. 

And might I add - the physicians don't necessarily want the chunk of practice nursing is trying to force to remain in their lap. 




ICU Nurse


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