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Gilda Taylor
External Jugular Vein
References needed to state IV nurses should not use external juguar vein for vascular access.
Angela Lee
I am not aware of any
I am not aware of any references that state the EJ should not be used.  Our board of Nursing has indicated that it is beyond the scope of basic education and therefore requires specific education and demonstration.  However, it's my thinking that as specialized vascular access nurses we should be doing a complete assessment on each patient and making decisions based on that assessment that best serve the patient.  That will occasionally include the decision to use the external jugular.  So while the bedside nurse probably should not use this site, the vascular access nurse by virtue of the specialized knowledge and experience can consider it.
Kathy Kokotis Bard Access

Kathy Kokotis

Bard Access Systems

Make sure the instructions on this catheter are labeled for this vessel.  If it is not you need to know you are off label.


Kathy Kokotis

Bard Access Systems

Eve Agarvan
I see it used all the time

I see it used all the time for difficult PIV's in the ER. Wouldn't it be too tortureous for puttimg in PICC's? Wouldn't the IJ be a straighter vessel to hit the SVC? AVA has a position paper on IJ use that says that the EJ is only to be used if the IJs aren't available. In my state (KY) there is  a practice advisory that says we can put PICCs in the IJ as RNs, so its' not a scope of practice issue.

Eve - KY

Laura M.
L. McRae,RN,BSN,CRNI I just


I just recently came back from INS in St. Louis and there was a speaker that talked about the need to preserve vessels for the chronic renal patient.  This is a hot topic among a few renal doctors at the facility I work at.  I am coming around to the fact that there is a need to cautiously place picc lines when the patient has the potential to need a fistula or graft some time down the road, thus  prolonging their quality of life. 

I placed EJ piccs for many years at a teaching facility in Florida and saw minimal complications with this type of alternative access.  We stopped practicing this when we came upon our Board of nursing stance that it was a beyond basic practice technique and only Nurse practioners, PA's or physicians could access this vessel.  Our board of nursing was never petitioned at the time due to a change of management and lack of knowledge or understanding for the need to pursue this avenue on managements end.

There is a great need to consider this alternative access in certain rare situations.  The vessel was almost always a large vessel, much larger than some of the vessels we place picc's in these days and not tortureous in my experience.  The clavicle area was a problem at times when advancing the catheter, but with arm manipulation, it would pass most of the time.

I agree with Angela, that every situation is different and in the case of the renal patient, would be a great way to avoid the arm vessels if the EJ vessels are of adequate size and no contraindications.  I can see where placing an IJ picc w/ ultra sound guidance would be beneficial as well for this patient population.

I have recently been told that AVA does not advise the EJ access placement and would like to know why if someone could explain.


Laura McRae, RN, BSN, CRNI

Randy McCown
To L. McRae, I would like to

To L. McRae, I would like to talk to you about your experiences with EJ PICC. Would you mind contacting me personally at [email protected]?

Thank you,


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