Emergency meds through IJ

[Kaysmom8]

Hello,

I responded to to a code yesterday at my facility and while doing chest compressions I noticed the patient had a IJ I the right side of their chest. I later learned the patient was a diabetic with a blood glucose of below 30 and I remember seeing D50 and IV supplies unused at the bedside, the nurse gave IM glucagon. I feel stupid asking fellow co workers with more experience this question. In an emergent situation such as this could the D50 be given through the IJ when no other access is available? I know it's not ideal and generally nobody is to be playing with a dialysis patients lifeline but when the patient was being rushed out things didn't look so good...

[Guttercat, ASN, RN]

As far as I am aware, nationally the right IJ is still the preferred site. I would have to check with the docs for a definitive answer. I have been told a number of things...placing a temp catheter in the ED, the femoral is an easier access point in an emergent situation and doesn't require xray confirmation to use. We most often place them in patients with pulmonary edema or hyperkalemia and I have been told the femoral is preferred in those patients. I will have to ask one of the ultrasound fellows for the real rationale next time I see them.

If a patient is really...really crumping, meaning there are multiple people working around the patient's head to insert things like ET tubes, central lines (including SWANZ-type lines), I can see why the femoral would be the first access of choice. (Or if their IJ is simply crap to access in the first place.)

The hyperkalemia or pulm edema angle, as rationale for choosing a femoral dialysis line placement over an IJ, is something I am not aware of.

Hmmm. I will have to look into this.