Internal jugular IV

[maloneys]

Hi everyone! I could really use some help here. Pt had a 16 gauge, jugular IV that was heplocked. In for 4 days, never flushed, nor verified if still venous return. Pt was febrile, and I wanted to d/c it (he had other access). Staff told me I cannot, only the doc can do it, and in trendelenburg. That doesn't make sense to me. I would have the pt in a semi or high fowler's when d/c'ing any IJ access. Can anyone tell me what the best practice guidelines are for care of a peripheral IV put into a jugular be, aside from monitoring the site? thank you for any advice!

[IVRUS, BSN, RN]

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.

[VANurse2010]

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.

The petroleum ointment hasn't been a standard any place I've ever worked.

[IVRUS, BSN, RN]

The petroleum ointment hasn't been a standard any place I've ever worked.

I do believe that is because many hospitals have NO clue about INS, much less their standards.

[scuba-girl, BSN]

The INS Standard #44 states that the removal of a non-tunnelled CVAD should include cautions to avoid air embolism. Digital pressure should be applied until hemostatsis is achieved by using manual compression and/or other adjunct approaches such as hemostatic pads, patches, or powders that are designed to potentiate clot formation. The nurse should apply petroleum-based ointment... to seal the skin catheter track.

[offlabel]

Just a couple of points. Any occlusive dressing over an IJ site (tegaderm etc.) is sufficient to prevent the theoretic entrainment of air. Vaseline, if used, needs to not interfere with the tape that also becomes a requirement if tegaderm isn't used. Also, it's easier to see an intact

occlusive dressing than it is to confirm the Vaseline is sufficiently covering the hole in the skin, IME.

It isn't the amount of air that may theoretically be entrained in the 1/4 second it takes to remove the line. Unless there is an ASD or PFO, a little air into the heart and lungs is negligible. The concern is an ongoing "trickle" of air that might occur should there be a patent tract between the vein and skin, which in most patients, is pretty unlikely.

There are no valves in veins above the SVC.