Forum topic

Our Board of Nursing considers jugular venipuncture to be beyond the scope of basic nursing education and therefore it requires additional instruction via an approved course and clinical demonstration before the nurse can do it.

When a peripheral IV is placed in a jugular the same damage results as when it's placed in an extremity--you can lose the patency of that vein.  A patient that needs an EJ IV really needs a more appropriate device--to me that is an indication that there is a serious access problem that needs to be addressed.  Exceptions might be a hypovolemic or septic patient but an IO might be considered emergently to improve their status immediately if the LOC is poor and a code is imminent or occurring until other access can be established.

As the Vascular Access Nurse , I am qualified to place both PIVs and PICCs in the external jugular.   I place more PICCs in the EJ than PIVs and I place more EJ PICCs in the neonate than older patients.  I do this when there is no other available access.  In addition to established risks of PICC placement I have seen little additional problems.  There can be more bleeding form the site due to increased venous pressure when the patient cries or strains within the first 24 hours and it is more difficult to maintain an occlusive dressing therefore increasing the risk of catheter malposition and infection.  The PICC hub is secured on the upper chest, therefore easy to access without disturbing the integrity of the dressing at the insertion site.  This gives the advantage of having almost everything under gown or clothing and out of reach for the patient.  I have placed EJ PICCs in the older child maybe two or three times in over 15 years--I try to avoid it as much as possible.

I am in Alabama and in a pediatric facility.