     External Jugular vein access is a peripheral IV Cannulation should not exceed 24-48 hours Only 1 attempt on each side of the.

Report
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External Jugular vein access is a peripheral IV
Cannulation should not exceed 24-48 hours
Only 1 attempt on each side of the neck is
permitted due to possible airway compromise from
infiltration or hematoma formation at the site if the
vessel is missed
DO NOT use a pressure infuser on an EJ site
Irritant solutions (pH<5. pH> or osmolarity >600
mOsm/L, chemotherapeutic agents &
vasopressors) are more safely infused into a central
vein
IV fluid administration
 IV medication administration
 IV blood or blood product administration
 IV nutritional support
 NOTE: Many institutions will not allow
administration of a high pressure IV
contrast agent into an EJ
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Gloves
 IV start pack
 J-loop (optional)
 14, 16, 18 gauge angiocath
 2x2s
 Sterile occlusive dressing
 Tape
 IV solution and primed IV tubing
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Explain the procedure to the patient &/or
family
Make sure the room/ambulance/helicopter
is adequately lit and warm to assist with
vasodilatation
Raise the litter
HOB is to be put in the Trendelenburg
position
Instruct the patient to turn his/her head to
the opposite shoulder (if c-spine is cleared).
Look at both sides of the neck to find the
largest external jugular vein
Place the patient in the supine, head
down position with his/her head turned
to the opposite side of where initiation is
intended
 This position will help distend the vessel
and may prevent an air embolism
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The EJ vein runs downward & backward
obliquely (at an angle) behind the angle
of the mandible & across the
sternomastoid muscle. The EJ then
courses deeply into the neck above the
midclavicular area and enters the
subclavian vein
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Wash your hands
Don non-sterile gloves & eye protection
If the patient’s skin is visibly dirty, wash with
soap & water first
Ask the patient to bear down (if awake & able
to do so)-this helps to assist with vasodilatation
Note: Make the puncture on expiration
because the EJ tends to collapse on inspiration
especially in volume depleted patients
Note: A warm towel &/or hot pack can be
utilized to help distend the vein
Cleanse the site with an approved antimicrobial for 30-60 seconds and allow
area to air dry up to 1 minute
 Once the skin is cleansed, do not touch
or re-palpate it
 Lightly place a finger of your nondominate hand just above the clavicle
to produce a tourniqueting effect
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Use the thumb of that same hand to pull traction
above the puncture site
Anchor the vein and align the cannula with the vein
The bevel of the needle should be pointing toward
the clavicle. Insert the angio at a 10-30 degree with
the bevel up
Perform the venipuncture between the angle of the
jaw & the clavicle. The site should be as proximal as
far above the clavicle to avoid accidental lung
puncture
Cannulate the vein in a shallow superficial manner
When blood is returned, advance the catheter off
the needle until the hub is securely against the skin
Remove the IV catheter needle & discard
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If drawing bloods due so prior to attaching
transparent dressing
Attach the IV tubing
Apply the transparent dressing
Secure the tubing with additional tape
(may loop the tubing up around the ear)
Label the dressing with “EJ”, date & time of
insertion, size of catheter & your initials
Avoid circumferential dressing or taping
Raise HOB and lower the litter
Frequently evaluate the EJ site for signs
of infiltration (monitor per hospital policy)
 Discontinue fluid/medications
immediately if signs of infiltration are
present
 Extravasations of fluids &/or vasoactive
medications into the neck is a serious
complication thus diligent monitoring of
the site & documentation of patency is
required
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Pulmonary Embolism
Hematoma (patients receiving anticoagulation
therapy are at increased risk for h
Hematomas at the insertion site
Accidental arterial puncture
Catheter shear (which may place the patient at risk
for embolus formation
Air embolism
Bleeding
Infiltration/Extravasation
Infection
Phlebitis
Date
 Time
 Site of insertion
 Catheter size
 Patient response to procedure
 Complications encountered such as
hematoma, signs of PE or air embolism,
signs of infiltration &/or extravasation
 Remedies for the complications
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Educate the patient/family regarding
excessive head movement & to report
any pain, shortness of breath, bleeding,
burning or dampness at the insertion site
immediately
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Cervical spinal injury
Penetrating injury to the neck
Significant blunt trauma to the neck
Soft tissue injury to the neck
VP shunt on the side of intended insertion
Neck mass
Circumferential burns of the neck
Infection at or near intended insertion site
Agitated patient (excess moving of head)
Clinical &/or physical limitations that would not allow
proper securing of the EJ access such as a large
neck, no neck, diaphoresis etc
Campbell, J. (2012). International
Trauma Life Support for Emergency Care
Providers. Pearson Education Inc.
 Holleran, R. (2010). ASTNA Patient
Transport Principles & Practice. Mosby. St.
Louis, Missouri
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