EJ question.

  1. Hi all,

    Quick general question:

    Do you guys consider the external jugular a central vein or a peripheral vein and why? I was looking online and am getting a lot of conflicting information, with some states' BON stating that it's a peripheral vein (with more risks involved in cannulation, but peripheral nonetheless) and others placing it in the central vein category. Hopefully someone has a more definitive answer, or at least a place to find it.

    Thank you for any responses.
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  2. 15 Comments

  3. by   TazziRN
    I'd say central, since most nurses can't access it.
  4. by   Altra
    The EJ is a peripheral vein, although one that poses more risks w/cannulation as the OP stated. At my facility we nurses cannot start lines in the EJ, the docs must, but we otherwise use them as we would any other peripheral line.

    A line placed in the interior jugular is a central line.
  5. by   CritterLover
    Quote from mlos
    the ej is a peripheral vein, although one that poses more risks w/cannulation as the op stated. at my facility we nurses cannot start lines in the ej, the docs must, but we otherwise use them as we would any other peripheral line.

    a line placed in the interior jugular is a central line.



    at our facility, the medics can place them too. (ejs, that is)

    [color=#a0522d]a central line is defined by where the tip of the iv ends, not where it starts. for a line to be central, the tip must be in the superior vena cava (or inferior vena cava for fem lines)

    [color=#a0522d]even if it looks like a central line, if the tip isn't in the svc/ivc, then it isn't truley a central line. it is long, multi-lumen peripheral line.

    [color=#a0522d]jugular central lines are almost always placed in the ij, though the ej can be used if the ij is occluded and the ej patent/large enough. if the central line is placed via the ej route, the facility may consider it a picc, though that is really splitting hairs.
  6. by   Altra
    Quote from critterlover
    [color=#a0522d]a central line is defined by where the tip of the iv ends, not where it starts. for a line to be central, the tip must be in the superior vena cava (or inferior vena cava for fem lines)

    [color=#a0522d]even if it looks like a central line, if the tip isn't in the svc/ivc, then it isn't truley a central line. it is long, multi-lumen peripheral line.
    you're correct of course ... i was trying to say that at my facility we frequently use the ej for placement of a peripheral line but not the ij - if someone's putting a line in an ij, it's going to be a multi-lumen central line.

    we have the docs place or attempt to place ejs frequently, as we serve a large urban population w/many long-term ivda patients. when there is just nothing in their arms or feet, even using ultrasound guidance, and the choice is between a 30 minute wait for iv team or doing an ej, we usually go for the ej.

    in my dept. this is an issue that sometimes gets feathers ruffled - all of our techs are medics, and several of our rns are also medics and/or flight nurses with experience placing lines in the ej ... but our hospital's practice is that they cannot perform that procedure in the hospital. :stone
  7. by   CritterLover
    Quote from mlos
    you're correct of course ... i was trying to say that at my facility we frequently use the ej for placement of a peripheral line but not the ij - if someone's putting a line in an ij, it's going to be a multi-lumen central line.

    we have the docs place or attempt to place ejs frequently, as we serve a large urban population w/many long-term ivda patients. when there is just nothing in their arms or feet, even using ultrasound guidance, and the choice is between a 30 minute wait for iv team or doing an ej, we usually go for the ej.

    in my dept. this is an issue that sometimes gets feathers ruffled - all of our techs are medics, and several of our rns are also medics and/or flight nurses with experience placing lines in the ej ... but our hospital's practice is that they cannot perform that procedure in the hospital. :stone

    at one of the hospitals in our city, rns (even without medic training) can place ejs with an additional check-off. not allowed at our hospital system, which really irritates some, especially those who used to work at that hospital. (not a skill i ever learned, so it doesn't bother me ) but at least our medics can do them. some of our docs do the ejs quite a bit, but others won't put them in at all. they'd rather put in a fem line.

    by the way, the only time i ever saw the ej route used for cvl placement was for a vascath in a patient with an occluded ij. they tried it in interventional radiology, and it didn't work.
  8. by   Lacie
    Things have changed alot but back in the late 80's we as RN's in the hospital I was at did EJ's when needed in the ER and the ICU. We also did the art. lines as needed particularly in codes or when placing someone on a vent. Respiratory did the intubations but there were times we did also. Only one ER doc on evenings and nights so if he was tied up then no one else to do it unless you waited for the attending to get there from home. Most the time it took some of the docs mulitiple sticks when the RN could hit it much quicker. Those of us that did have to previously demonstate though with a checklist that we knew what we were doing. Later I ended up in places where they didnt even let us start an IV unless it was on the iv team lol. I did less when I went to a large teaching hospital over that little 90 bed one.
  9. by   meownsmile
    We treat jugular access as if it is central. It is important that it has close monitoring due to bleeding factors and problems if it becomes infiltrated and its undetected. Only RN's hang or give meds through a jugular, just like a PICC, infusaport or central line. Our LPN's dont even replace a empty bag of fluids if infusing into a jugular.
  10. by   absolut
    Hi all,

    Do you guys consider the external jugular a central vein or a peripheral vein and why? I was looking online and am getting a lot of conflicting information, with some states' BON stating that it's a peripheral vein (with more risks involved in cannulation, but peripheral nonetheless) and others placing it in the central vein category. Hopefully someone has a more definitive answer, or at least a place to find it.

    P.S. At your facility, is it part of your scope practice?

    Thank you for any responses.
  11. by   berry
    If you can palpate a vein, it is not central. If you have to use blind stick based on landmarks it is central kind of the rule I go by. When I worked in the ER we could stick EJs (Alabama BON scope of practice allows if you have had instruction and has a length limit if I remember correctly) later hospital policy was changed and RN were no longer allowed to stick EJs.

    Just my 2 cents
  12. by   Altra
    Mods ... this question was asked by the same poster in the General Nursing forum and received several replies.

    Merge the threads?
  13. by   jayne109
    We had this question rise earlier this year. Management (who doesn't work the floor, much less start IV's) said that and EJ was central. We nurses FOUGHT HARD and won that it is a peripheral IV and we can start them. We had to be inserviced and everything because of a policy thing but I have no problem with them unless someone has no neck, then I won't stick for fear of a pneumo.

    just my 2 cents.
  14. by   Medic/Nurse
    Absolutely a PERIPHERAL line. (even per ACLS standards)

    I have seen varying policies on their placement (who/why/how). I am comfortable and quite competent in their placement/monitoring so I have fewer issues than some nurses - but I think it depends on your background.

    If there is not a specific policy I will generally only place with WRITTEN MD order unless it is a critical access and then I will place with VERBAL order and good documentation.

    Practice SAFE!

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