External Jugular vein question

  1. 0
    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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  3. 13 Comments...

  4. 0
    hi absolut....it all depends on where the tip of the line resides. If you only insert a typical 18g or 20g angiocath (being 1-1.5 inches long), then it would be considered a peripheral iv. If a doctor inserted a central line with the tip residing in the SVC (central lines are typicall 10 - 15cm long),being centrally located would classify it as a "central line".
    Hope this info helps you out......
  5. 0
    EJ is a peripheral vein. Can use it for a PIV or central line in unusual circumstances. Can't recall if the INS standards mention this vein. Pretty sure ACLS training says it's a peripheral.
  6. 1
    per the INS July/August 2008 V 31, n 4 edition of Journal of Infusion Nursing, the external jugular vein has been deemed "peripheral" as it does not break the intrathoracic cavity at the point of entry. Even better yet, as I am sure you are already aware of, AVA published their position paper re: the internal jugular vein and is appropriatness in certain situaitions (i.e. vessel preservation in patient with chronic kidkey disease, etc) and too being a peripheral approach at a central catheter. A small LTACH I work at I have implemented this program and it truly has been awesome to be able to place what is BEST for the patient. Educating them about their poor renal function and that I have no business traumatizing the upper arms veins (no matter how good you are...it's is still damage) because they may be needed for an AVF someday. It has been much more fluent of a transition than I thought,
    Nurse Wendy likes this.
  7. 0
    I want to initiate this in our hospital...now we send our renals to radiology and ask them to place via the EJ to preserve the peripheral vasculature.....we are in Ca...and have a very experienced PICC team...just worried about an increased work load...we are so so busy now...can you tell me more about your process of implementation....anyone in California placing CVCs via the EJ as a nurse-led team???
    Last edit by sirI on Oct 7, '09
  8. 0
    The LTACH I work at is great because of it being so small change can occur quickly. My other place of work, the University of Michigan Health System is HUGE and it takes almost 2 years just to get a policy read by the appropriate committee. So I truly value the intimacy of a small institution and being able to provide evidenced-based best practice shortly after it has been deemed to be best practice. So, when the position papers came out I brought everything to the medical director and she saw how this absolutely was best practice especially for our patient population and she told me to come back after the policies and procedures were written. I did that, revised our forms to include the EJ and IJ as vessel options as well as education materials, etc. She serves as my champion physician. After reviewing everything and making sure I was knowledgeable re: A & P, complications and interventions, etc (everything that was already laid out in the very long policies and procedures with numerous references) I was off to place my first EJ PICC. It went well but I definitely felt the valves! Then AVA's statement came out and it was like DUH! THIS is definitely best practice! So instead of the tortuous and valved EJ, PICCs were to be placed in the IJ for patients with chronic kidney disease or impending (i.e. verified by BUN, Creat, GFR, etc). I have now placed 8 of these and I have followed every single one like they were my own child. I am the only one who changes the dressings and if there are any issues I am immediately paged and notified so I can troubleshoot or do what I have to do. They have been a huge success! Patient's state they can't even really feel that anything is there except for right after the dressing change it can sometimes be tight. Each one has been treated as a "case study" for me as I have someone photograph the insertion and then I take pre/post PICCs with dressing changes and upon removal of the IJ PICC. Again, they have been exceptional for those patients requiring vessel preservation in the upper extremities and it feels great to be truly practicing cutting-edge evidence-based practice which more important than anything is best for the patient. As for the external jugular, it's an option for peripheral access in the right circumstances. After reviewing much literature it was made obvious that the IJ is by far preferred for PICCs over the EJ but that the EJ is an excellent option for peripheral access, again in the right circumstance and in the right patient. I give IJ PICCs a thumbs up.
  9. 0
    Thank you soooo much! My hospital is looking into the nursing placed EJ access, that we currently place in ED and always have after certification and education... the argument was central vs. peripheral-- thanks for the reference
  10. 0
    Did you ever recieve adequate responses to this question? I am currently looking into the same topic of nurse-placed EJ's in ED... education, certification, evidence-based practice. I have several nurse who've done this routinely in other facilities; I don't have education to sustain it, or bring it out to other nursing staff--- suggestions?
  11. 0
    If anyone wants further info on how I made this work for an LTACH, both EJ peripherals & IJ PICCs, feel free to contact me Thanks.
    Last edit by jb2u on Oct 7, '09 : Reason: Email address removed - TOS Violation
  12. 0
    Tx RN I think I will do that....I think that is what we should be doing.....I have to beg IR right now to do that..and many times it is not pleasant

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