External jugular vein cannulation

Overview

• Alternative to ultrasound-guided PIV or CVC placement

Indications

• Patients with difficult vascular access (DVA)

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
• 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

Complications

• Typical risks associated with PIV cannulation

External Links

https://www.youtube.com/watch?v=BoLgMnDOBpY