External Jugular Cannulation Procedure

Published

I'm currently trying to piece together didactic and a skills lab for my ED staff to FINALLY begin allowing RNs to place EJs in the department. Does anyone know of any good resources to utilize to develop the didactic, P&P, etc? I am really looking for help with the P&P portion and would greatly appreciate any examples (if you have them) from other facilities on what the P&P entails.

Up Vote Up Vote ×

What does 'P&P' mean?

Up Vote Up Vote ×
Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.

I am guessing P&P is policy & procedure.

OP, I would suggest checking with your local EMS — odds are good that EJs are within their scope. :)

Up Vote Up Vote ×
Specializes in Med-Surg, Emergency, CEN.

Do NOT use a tourniquet!!!!

:woot: :wacky: :yes:

Up Vote Up Vote ×
Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.
Do NOT use a tourniquet!!!!

:woot: :wacky: :yes:

That was a running joke with some patients.... Lol

Up Vote Up Vote ×
Do NOT use a tourniquet!!!!

:woot: :wacky: :yes:

That's what I've been doing wrong...

Up Vote Up Vote ×
Specializes in Float Pool - A Little Bit of Everything.
Do NOT use a tourniquet!!!!

:woot: :wacky: :yes:

I bet there is a P&P somewhere out there, that says just that!

Up Vote Up Vote ×
Specializes in Emergency.

Avoid anything that's pulsing.

Up Vote Up Vote ×
Specializes in ER.
Do NOT use a tourniquet!!!!

:woot: :wacky: :yes:

Sorry to derail the thread, but I have seen an instance where EMS brought a guy in with a tourniquet around his neck. They didn't put it on, of course. The Nurse at the jail did, after a guy's cellie gave him a nice 8cm superficial lac.

OP, if you find anything let me know. I'm trying to get our policy changed at my facility to make so we can do EJs as well. I doubt it'll happen with us being able to do U/S guided & IOs though.

Up Vote Up Vote ×
Specializes in Emergency Department.
I'm currently trying to piece together didactic and a skills lab for my ED staff to FINALLY begin allowing RNs to place EJs in the department. Does anyone know of any good resources to utilize to develop the didactic, P&P, etc? I am really looking for help with the P&P portion and would greatly appreciate any examples (if you have them) from other facilities on what the P&P entails.

While I do not have EJ P&P's available at hand (my facility prohibits EJ cannulation without physician order), it's not that difficult. As a Paramedic, it's within my scope of practice and EMS usually considers the EJ as a peripheral site, we usually don't have a policy allowing it. Most facilities that I'm aware of consider the EJ as basically a central line so they avoid sticking the neck unless absolutely necessary. Basically we have to get a physician order to start an EJ and once that's obtained, we do it basically like any other PIV line. If the EJ isn't visible, consider placing the patient supine or mild Trendelenburg, or even simply have them do a very mild valsalva. This increases intrathoracic pressure and the EJ should just pop up without difficulty. Then all you need is mild finger pressure to occlude the EJ and help anchor it. It "rolls" very easily. You may not get a flash. It's a very low pressure vein. Once you're in, just cannulate as usual. Just remember that there's a slightly higher risk of gas embolism than with other PIV sites.

Coming from my background, it's not that big of a deal. No arm or leg sites? I'd go for the EJ... normal course of business. Where I'm working now? Must get that order... and the MD may just want to put in an IJ...

Up Vote Up Vote ×

Coming from my background, it's not that big of a deal. No arm or leg sites? I'd go for the EJ... normal course of business. Where I'm working now? Must get that order... and the MD may just want to put in an IJ...

Same here, there is some big stigma about EJ's. When I was in the ICU, I did them a lot, and every times somebody would come talk to me about it, I would ask:

"Is there any specific P&P against it". No.

"Are we allowed to start peripheral IV's", they would say yes.

"Is the EJ a peripheral site" a blank start usually, but then I would answer "yes, it is a peripheral site".

The patient has no other venous access that we can get, we needed a line, so I got a line. It is not like I did an IV in the foot or leg of a diabetic (made that mistake once in the ICU, but is a common site in EMS).

In the ER, the physician does EJ's, and I can't stand watching them screw it up. I end up "assisting" them with it.

Up Vote Up Vote ×
+ Join the Discussion