Procedure 39 —Venous Access: External Jugular Access

What age is required for external jugular vein cannulation?

Greater than 8 years of age.

What patient condition indicates external jugular vein cannulation?

A critically ill patient who requires intravenous access for fluid or medication administration and an extremity vein is not obtainable.

What alternative access should be considered in addition to or instead of an EJ attempt?

IO access.

When may external jugular cannulation be attempted initially?

In life threatening events where no obvious peripheral site is noted.

What position should the patient be placed in for external jugular access?

Supine, head-down position.

What two effects does the head-down position have for external jugular access?

It helps distend the vein and prevents air embolism.

Which direction is the patient's head turned for external jugular access, if no cervical injury risk exists?

Toward the opposite side.

How is the external jugular access site prepared?

Cleansing with an alcohol or iodine swab.

Toward what landmark is the catheter aimed during external jugular access insertion?

The same side shoulder.

How is the external jugular vein compressed before puncture?

Lightly with one finger above the clavicle.

Where is the vein punctured during external jugular access?

Midway between the angle of the jaw and the clavicle.

Why can external jugular venipuncture attempts only be made on one side of the neck?

Due to possibility of airway compromise from infiltration or hematoma formation at the site.

What type of dressing should be avoided when securing an external jugular catheter?

A circumferential dressing or taping.

What must be documented after external jugular access?

The procedure, time, and result on the patient care report.

What provider levels can perform external jugular access?

EMT-A and EMT-P.