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Tara Dennis
IJ's & EJ's


I am currious to see what other hospitals are doing as far as Ij's & Ej's? Do you have nurses running meds through them or drawing labs off of them? If so in what departments? How long are your facilities keeping them in? Who's D/Cing them?

What I'm speaking about is an IJ or EJ that's tip termination is not in the SVC.

Obviosly I am asking because I am looking to solidify this area of practice & there is not a lot of guidance or INS standards that pertain to these types of VAD's.

My personal opinion is that they should only be accessed in an emergency & or for testing proceedures & they should come out as soon as possible.

Your input/ experiences positive & or negative would be greatly appreciated.



Darlene Kaminski
Hi Tara.....At our facility,

Hi Tara.....At our facility, physician's only place IJ lines and all RN's can pull them.  EJ peripherals are placed by RN's that have completed our EJ insertion course. All RN's can also pull them.  They are only placed when no other IV access is attainable and only one side of the neck is used. We (the picc team) will replace these as quickly as possible with an ultrasound guided peripheral or a PICC line if ordered. 

I have also placed one EJ PICC.  The patient was totally occluded in both arms, and came up from the ED with a EJ PIV.  It took 2 PICC nurses to accomplish the procedure, it was extremely bloody, very hard to insert the introducer and difficult to thread the catheter.  Not really an experience I would like to repeat.  However, the picc worked beautifully for a couple of months.

 On a side note, this patient was a frequent flyer and well known to me from previous PICCs (successful and unsuccessful).  We gave her, her family, and the physician other options prior to offering her the EJ PICC.  She chose to have us try that first d/t unpleasant IR experiences. So after actually doing an EJ PICC, I think all other options need to be considered first, and thoroughly discussed with the patient and physician.

Tara Dennis
Would you be willing to

Would you be willing to share your policy on this subject? As well as what departments are the nurses inserting the EJ's? Dose your policy actualy set a time frame on the length it can stay in, as well as what can be done throgh it? i.e. labs? & How is your facility keeping up with assessing competency if at all?

As an FYI, I was told that INS is currently working on a position paper for EJ's.

Tara Dennis, RN,BSN,CRNI

we are using IJ/EJ in most
we are using IJ/EJ in most of the critical care units.  many of the patients are admittied from the ED with the lines in, inserted emergently.  the critical care intensivists are pretty diligent about the lines coming out and PICC lines being placed.  we follow the 7-10day rule for removal. my understanding is because of the proximity to the oropharyngeal airway, being in a warm dark, moist environment in the neck.  that is the best answer that anyone has come up with.  the nurses do draw bloods off the lines,infuse meds through them, physicians place them and nurses/doctors can pull them.   i am not sure why else a patient would have these lines if not for access and blood draws. 
The ecology of human skin is
The ecology of human skin is the reason for avoiding the IJ/EJ sites if possible. Skin in the neck, chest and upper back is oily; the groin and axilla have wet skin; and the extremities have dry skin. Each skin type has a different profile of number and types of organisms. Dry skin has the fewest, oily skin has more, and wet skin has the greatest number. This is one of the primary reasons for a lower risk of infection from PICCs that IJ/subclavian CVCs. Of course, the risk of introduction from the hub must be considered but skin is the greatest source within the first week of dwell. Lynn

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

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

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