Internal jugular IV

You keep saying IJ and peripheral, which is confusing. Was this a central line (IJ) or a peripheral IV (EJ)?

With central lines I suppose you could trend them and remove according to patients breathing. Refer to your hospital policy as to who can remove central lines.

If this is a peripheral EJ, I see no reason to trend the patient or involve the DOC. But maybe there is something I dont understand and I've missed the boat entirely... hopefully someone else can come along and shed some light.

Also if you think the line is a source of infection, I hope it was cultured.

Apparently there are peripheral IJs. I've never seen such a thing, I'll be following the post.

Emergency Medicine Literature of Note: The "Peripheral" IJ

Thank you for comments, ArmaniX. Yes, you can have EJ or IJ cannulation. Basically, when protocols are not in place, we want to ensure best practice. Because the 16 gauge periph IV was used, and not a tunneled cath or central line, which we sometimes see on the wards, we want to make sure the IV is flushed to maintain patency. I'm just wondering what everyone is doing in terms of catheter care. Thank you!

having worked ER decades, sometimes a perpheral length iv cath had to access IJ, totally different from ij central, sometimes multiluminal lines.....i have a little problem with the line you described not being flushed.....if there were other established IV in place, why would it still be there?......the practice of flat or trendelenberg aids in prevention of potential air emboli at discontinue of ij.....i always apply pressure and never have experienced a problem...

Hi Sallyrnrrt, thank you for your thoughtful feedback. Do you trendelenburg the pt when d/c'ing the IJ or EJ IV, you mean? How does this prevent air embolus? Thank you for helping me learn!

Removal of IV catheters, especially Central lines, should be done with the insertion site BELOW the level of the heart. Therefore, I would NOT remove it while the patient is sitting up in the chair. You should have documentation of how long this IV catheter is. 16 gauge peripheral IV catheters can be 1-1.5 inches in length. Therefore, they are NOT central lines. Central lines are IV catheters whose tip teminiates in the Superior Vena Cava (SVC).

A venous air embolism (VAE) can occur anytime when the vein opening is 5cm or greater above the level of the heart. The pressure gradient can cause air to enter into the vascular system. The patient should be lying in supine position. Also, use of a petroleum based product to occlude the vein/vessel track is another important safety feature to prevent VAE. And have the patient lay flat for 30 minutes post removal. Over Central line site = Petroleum ointment followed by two by two, tape and an occlusive dressing which should remain intact x 24 hours post removal.

thanks ivru,

when intravascular pressure is increased as the jugular vein distribution would be in tredelenburg reduces chance of air imbolism

Thank you for the very helpful feedback and information. We know the 16 gauge is not a central line, in this case, but there was no consistent documentation on when it was inserted, nor on its care. Again, thank you for your help!

Although it's just semantics...an IJ catheter is, by definition, a central venous catheter, whether it's with a 3 inch 18ga catheter or a 9FR introducer and everything in between. Treat it as such.

Also, it makes no sense to leave a catheter in the IJ (or other orifice for that matter) for four days if it's not being used or cared for appropriately. There's no reason an RN can't take it out using appropriate technique.

A venous air embolism (VAE) can occur anytime when the vein opening is 5cm or greater above the level of the heart. The pressure gradient can cause air to enter into the vascular system. The patient should be lying in supine position. Also, use of a petroleum based product to occlude the vein/vessel track is another important safety feature to prevent VAE. And have the patient lay flat for 30 minutes post removal. Over Central line site = Petroleum ointment followed by two by two, tape and an occlusive dressing which should remain intact x 24 hours post removal.

At peripheral sites there actually isn't much if any risk of an air embolism due to the number of valves between the site and the source of intermittent negative pressure, which is why the use of trendelenberg in removing PICC's is controversial. The risk of VAE when pulling true central lines is well established, and can occur even with trendelenburg positioning, which is why the patient should also be instructed to vagal while pulling the line.

The use of petrolatum directly on the site is not well established. I've worked in two facilities where it is strictly forbidden, and for good reason. When applying petrolatum directly to the puncture, as opposed to applying a pre-saturated petrolatum gauze or gauze with petrolatum already applied, there is a risk that the petrolatum will enter the puncture and potentially the vein, which is extremely dangerous. Venous petrolatum embolus has been documented to cause death, and for those fortunate enough not to die from it the result is likely long term or even permanent injury to whatever vasculature the petrolatum ends up getting stuck in.

It sounds like it was just an EJ placed as a peripheral IV, which we do on the ambulance, although not as much now that we have IO. You can removed it just like any other IV there is no special considerations, it is like any other peripheral IV, may just need to hold pressure a bit longer since it is a big catheter and a big vessel.

Annie

Although it's just semantics...an IJ catheter is, by definition, a central venous catheter, whether it's with a 3 inch 18ga catheter or a 9FR introducer and everything in between. Treat it as such.

Also, it makes no sense to leave a catheter in the IJ (or other orifice for that matter) for four days if it's not being used or cared for appropriately. There's no reason an RN can't take it out using appropriate technique.

Sorry, but this is just not true. A catheter placed in the jugular vein is ONLY a central line if its tip terminates in the superior vena cava (SVC) !! A 3 inch 18 gauge IV catheter is a peripheral IV! Also, Muno, it is a standard to use a petroleum based ointment on all sites over three inches. The case you refer to was an abstract, and it appears to be related to something that occurred upon insertion. Share the entire study if you have it. And, using a petroleum product at the site is important and is in the standards, whether you choose to acknowledge them or not, is you choice and your liability, should an AE occur.