I ask about this last summer and someone responded about a course. I would like to know if a course is offered in the future too. I agree that the only time to use this vessel would be if there are no other options. But I have seen the need on occasion.
Hi everyone. I do offer this course. I haven't put one together yet, but I am looking at putting one together this summer. It would be out here in Phoenix, AZ. I agree, EJ's aren't for everyone, but there are times when that is all there is. I teach peripheral EJ and PICC EJ. You can contact me at [email protected] and I'll put you on my mailing list for the next EJ class. I also teach Radiographic tip placement once or twice a year. Let me know if you are interesting in that as well.
for what patients would an EJ placed PICC be a good choice? Do you think that it would be an alternative for testicular cancer patients, who in my experience tend to get a lot of upper arm thrombosis with regular PICC placement
This is where nursing and vascular assessments are key. History of DVT in arms, bilateral mastectomies, fistulas, bilateral stenosis. Truly, these are referrals to IR for tunneled catheters or ports. Unfortunately, there are times when IR can't get to these patients, or they are not a candidate for tunneled catheter due to their medical condition or labs, so this makes them a candidate for an EJ PICC. The second part of this to consider is the location of the PICC; it's now in the neck. Most patients don't like their catheters in the IJ or the EJ due to the dangling catheter, and it's an insertion site that tends to be more prone to infection. In summary, EJ PICC not my favorite catheter or site, but when you can't get that PICC in either arm, and no one around for triple lumen, and specials can't get to them, and that patient needs a line.....it gives us as the vascular access team, one more option.
So this is actually done! I have thought of it as an option for testicular cancer patients, as we have had so much trouble with upper arm thrombisis with these patients, and thus stopped placing piccs in them. They don't seem to have the same problem with thrombosis from ports
In response to your question about a course. Picc Advantage, LLC provides this course. You can reach Ann Earhart at PiccAdvantage.msn.
I have placed 1 EJ PICC, and if I never have to place another that would be ok with me. I do agree they serve a purpose, however, It was difficult. You first need to have another picc nurse with you ( it takes 2 sets of hands), it is a very bloody procedure, difficult to insert the introducer, and difficult to pass the catheter.....However, it did work well for the patient who went home with it.
we have had a lot of difficulty with thrombosis in testis cancer patients with 4 FR groshong PICCs placed by US in the upper arm. Would an EJ PICC be an option for this patient group?
EJ and IJ PICC'S ( We refer to them as Small Bore Central Catheters) should only be reserved for those patients where a PICC line in the arm is not an option. I currently to do not place EJ catherters only IJ catheters and PICC's. Primarily due to the fact that the EJ is usually much smaller, much more tortuous, and mobile. It should also be noted that Ultrasound placement is always preferred and the patient continuously monitored (EKG, O2 Sat, BP) during the procedure, due to the added procedural risk involved in placing these lines. Those patients in our facility are candidates for SBCC include, acute and chronic renal failure, patients s/p renal transplant, bilat mastectomy with lymph node dissection, severe bilat upper extemity trauma/burns.
Once again the first thing you need to know is that using a PICC line in this manner IJ/EJ is off label.
I suggest using a VAD or sometype of catheter that is labeled for IJ placement. However you cannot put those in the EJ as well. You are RN's off label usage better be well sanctioned by your medical board as well as doing this procedure (EJ) as you are on your own!
Secondly I would never use the EJ if at all possible. Why is it doctors do not use it if it is so good for any dwell over 24 hours? It is small, not a straight pathway, high risk of complications like thrombosis.
Lastly AVA position paper which you will be held to in court of law recommends against using the EJ for a PICC type catheter
BE SAFE!!!! Practice safety!!!! Stay out of the EJ for anything over 24 hour dwell time.
I just printed out an INS position paper on this subject. We are NOT doing this but I was reading to investigate as a possibility of something we may someday need to learn to do. Have you read the INS position paper on this and what are you thoughts if so?
Thanks,
Beth
Beth George, CRNI, VA-BC
Nurse Clinician/Vascular Access
UAB Medicine
Birmingham, AL
I read back several posts ago and found the information with both position papers. I have saved a copy and read both. Didn't realize it had been discussed before. Thanks for your input on the situation.
Beth
Beth George, CRNI, VA-BC
Nurse Clinician/Vascular Access
UAB Medicine
Birmingham, AL
David Longseth,RN Trauma Life Center University of Wisconsin Hospital
Two recent relevant publications:
External jugular venous catheterization with a Groshong catheter for central venous access. Ishizuka,et al in Journal of Surgical Oncolgy,2008 July 1:98(1) 67-9.
Usefulness of Groshong catheters for central venous access via the external jugular vein. Ishuzaki,et al in Journal of Investigative Surgery,2008 Jan-Feb;21(1):9-14.
This author has also published data showing EJ PICC's to have better outcomes than subclavian lines. He found that contrary to what is believed or previously published,the EJ placement of a PICC had relatively few complications,even those with extended dwell times.
Hallene E Utter, RN, BSN Intravenous Care, INC
Ann,
for what patients would an EJ placed PICC be a good choice? Do you think that it would be an alternative for testicular cancer patients, who in my experience tend to get a lot of upper arm thrombosis with regular PICC placement
Mats
This is where nursing and vascular assessments are key. History of DVT in arms, bilateral mastectomies, fistulas, bilateral stenosis. Truly, these are referrals to IR for tunneled catheters or ports. Unfortunately, there are times when IR can't get to these patients, or they are not a candidate for tunneled catheter due to their medical condition or labs, so this makes them a candidate for an EJ PICC. The second part of this to consider is the location of the PICC; it's now in the neck. Most patients don't like their catheters in the IJ or the EJ due to the dangling catheter, and it's an insertion site that tends to be more prone to infection. In summary, EJ PICC not my favorite catheter or site, but when you can't get that PICC in either arm, and no one around for triple lumen, and specials can't get to them, and that patient needs a line.....it gives us as the vascular access team, one more option.
So this is actually done! I have thought of it as an option for testicular cancer patients, as we have had so much trouble with upper arm thrombisis with these patients, and thus stopped placing piccs in them. They don't seem to have the same problem with thrombosis from ports
Anyone tried it? Any views on it?
Mats in Stockholm
Pam,
In response to your question about a course. Picc Advantage, LLC provides this course. You can reach Ann Earhart at PiccAdvantage.msn.
I have placed 1 EJ PICC, and if I never have to place another that would be ok with me. I do agree they serve a purpose, however, It was difficult. You first need to have another picc nurse with you ( it takes 2 sets of hands), it is a very bloody procedure, difficult to insert the introducer, and difficult to pass the catheter.....However, it did work well for the patient who went home with it.
Thanks Ann,
we have had a lot of difficulty with thrombosis in testis cancer patients with 4 FR groshong PICCs placed by US in the upper arm. Would an EJ PICC be an option for this patient group?
Mats
EJ and IJ PICC'S ( We refer to them as Small Bore Central Catheters) should only be reserved for those patients where a PICC line in the arm is not an option. I currently to do not place EJ catherters only IJ catheters and PICC's. Primarily due to the fact that the EJ is usually much smaller, much more tortuous, and mobile. It should also be noted that Ultrasound placement is always preferred and the patient continuously monitored (EKG, O2 Sat, BP) during the procedure, due to the added procedural risk involved in placing these lines. Those patients in our facility are candidates for SBCC include, acute and chronic renal failure, patients s/p renal transplant, bilat mastectomy with lymph node dissection, severe bilat upper extemity trauma/burns.
Jeffery Fizer RN, BSN
Kathy Kokotis
Bard Access Systems
Once again the first thing you need to know is that using a PICC line in this manner IJ/EJ is off label.
I suggest using a VAD or sometype of catheter that is labeled for IJ placement. However you cannot put those in the EJ as well. You are RN's off label usage better be well sanctioned by your medical board as well as doing this procedure (EJ) as you are on your own!
Secondly I would never use the EJ if at all possible. Why is it doctors do not use it if it is so good for any dwell over 24 hours? It is small, not a straight pathway, high risk of complications like thrombosis.
Lastly AVA position paper which you will be held to in court of law recommends against using the EJ for a PICC type catheter
BE SAFE!!!! Practice safety!!!! Stay out of the EJ for anything over 24 hour dwell time.
Kathy
Kathy Kokotis
Bard Access Systems
Hi Kathy,
I just printed out an INS position paper on this subject. We are NOT doing this but I was reading to investigate as a possibility of something we may someday need to learn to do. Have you read the INS position paper on this and what are you thoughts if so?
Thanks,
Beth
Beth George, CRNI, VA-BC
Nurse Clinician/Vascular Access
UAB Medicine
Birmingham, AL
Kathy,
I read back several posts ago and found the information with both position papers. I have saved a copy and read both. Didn't realize it had been discussed before. Thanks for your input on the situation.
Beth
Beth George, CRNI, VA-BC
Nurse Clinician/Vascular Access
UAB Medicine
Birmingham, AL
I am not sure if anyone has noticed this particular thread is over a year old.
Pam Michael
Pam Michael, RN
David Longseth,RN Trauma Life Center University of Wisconsin Hospital
Two recent relevant publications:
External jugular venous catheterization with a Groshong catheter for central venous access. Ishizuka,et al in Journal of Surgical Oncolgy,2008 July 1:98(1) 67-9.
Usefulness of Groshong catheters for central venous access via the external jugular vein. Ishuzaki,et al in Journal of Investigative Surgery,2008 Jan-Feb;21(1):9-14.
This author has also published data showing EJ PICC's to have better outcomes than subclavian lines. He found that contrary to what is believed or previously published,the EJ placement of a PICC had relatively few complications,even those with extended dwell times.