External jugular vein cannulation: Difference between revisions
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==Procedure== | ==Procedure== | ||
[[File:PMC3270925 rmhp-4-027f6.png| | [[File:PMC3270925 rmhp-4-027f6.png|thumb|Veiw of right side of anterior neck. External jugular vein is crossing the posterior border of sternocleidomastoid (arrow), Sedillot’s triangle (red star), and sternal notch (black star).]] | ||
[[File:EJV.png|thumb|EJV cannulation technique. Operator here is using index finger to tamponade the vein superior to the clavicle and thumb to provide counter traction]] | [[File:EJV.png|thumb|EJV cannulation technique. Operator here is using index finger to tamponade the vein superior to the clavicle and thumb to provide counter traction]] | ||
* Place patient in Trendelenburg position and rotate head to opposite side of cannulation | * Place patient in Trendelenburg position and rotate head to opposite side of cannulation | ||
Latest revision as of 03:30, 8 May 2021
Overview
- Alternative to ultrasound-guided PIV or CVC placement
Indications
- Patients with difficult vascular access (DVA)
- May be particularly useful in patients with jugular venous distention/volume overload
Contraindications
- Thrombosis of EJV
- Overlying infection
Equipment Needed
- 16-20 gauge angiocatheter
- Chlorhexidine or alcohol wipe
- Disposable gloves
Procedure
- Place patient in Trendelenburg position and rotate head to opposite side of cannulation
- Position yourself at the head of the bed facing the patient
- Clean skin with appropriate antiseptic
- Use non-dominant thumb to provide counter-traction and index finger to tamponade EJV just superior to clavicle
- Cannulate vessel midway between angle of mandible and clavicle
- When "flash" seen, advance catheter over needle
- Attach pre-flushed IV tubing and apply dressing
- Having patient perform Valsalva maneuver can dilate vein and aid in cannulation
- Same effect can be achieved by having the patient hum[1]
- Can also use stethoscope to act as "tourniquet"
Complications
- Typical risks associated with PIV cannulation
See Also
Vascular access types
- Central venous catheterization
- Rapid infusion catheter
- Intraosseous access
- Venous cutdown
- Umbilical vein catheterization
- Ultrasound assisted peripheral line placement
- External jugular vein cannulation
- The "Easy IJ"
- Midlines
External Links
- emDOCs: Approach to the Patient with Difficult Vascular Access
- https://www.youtube.com/watch?v=BoLgMnDOBpY
- https://www.aliem.com/trick-of-trade-external-jugular/
References
- ↑ Lewin M, Stein J, Wang R, et al. Humming Is as Effective as Valsalva’s Maneuver and Trendelenburg’s Position for Ultrasonographic Visualization of the Jugular Venous System and Common Femoral Veins. Ann Emerg Med. 2007; 50(1): 73-7.