Procedure 39 - Venous Access: External Jugular Access

What age and condition indicate external jugular vein cannulation?

A critically ill patient greater than 8 years of age who requires IV access 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 is the patient placed in for external jugular access?

Supine, head down position.

Why is the patient placed in a supine, head down position for EJ access?

This helps distend the vein and prevents air embolism.

How is the patient's head positioned for EJ access if no cervical injury risk exists?

Turned toward the opposite side.

What is used to prep the site for EJ access?

An alcohol or iodine swab.

How is the catheter aligned for EJ access?

Aligned with the vein and aimed toward the same side shoulder.

How is the vein compressed before EJ puncture?

Lightly with one finger above the clavicle.

Where is the vein punctured for EJ access?

Midway between the angle of the jaw and the clavicle.

How many sides of the neck can be attempted for EJ venipuncture?

Only one side.

Why can EJ venipuncture only be attempted on one side of the neck?

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

What should be avoided when securing the EJ catheter?

Circumferential dressing or taping.

What should be documented after EJ access?

The procedure, time, and result on the PCR.

What provider levels can perform external jugular access per CFD protocol?

EMT-A and EMT-P.