External jugular vein cannulation

Overview

Veins of the neck (anterior view).

• 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

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).

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
• 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
  • Can also use stethoscope to act as "tourniquet"

Complications

• Typical risks associated with PIV cannulation

See Also

Vascular access types

• Central venous catheterization
  • Central line: internal jugular
  • Central line: subclavian
  • Central line: supraclavicular
  • Central line: femoral
  • Pediatric central line
  • Sheath introducer
• 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/