The external jugular vein is a superficial vein situated on the lateral portion of the neck. Central venous catheterization is a procedure that is commonly performed, with an estimated 15 million centrallinedays per year in the intensive care units in u. Common iv sites for pediatric patients peripheral extremities hand, wrist, dorsal foot, antecubital peripheral other external jugular, scalp, intraosseous neonate umbilical vein any drug or fluid that can be given iv may be given by the io route little interference during resuscitation. Alabama board of nursing approved standardized procedures the following list reflects abn approved procedures since implementation of the standardized procedure process located in administrative code chapter 610x6. Certification by the vascular access certification corporation references 1. Finally close clinical followup for several hours is essential for all patients in whom extravasation occur. Intravenous iv catheter access is of vital importance in emergency medical care. The lpns education, training and competency validation of skills must be specific to the types of access devices and medications used in the facility.
Oct 05, 2009 jugular venous pulse jvp explained clearly evaluation, waveforms, interpretation duration. Adult, child infant 30 nasogastric tube medication administration 31. Appropriate sites for iv placement include the scalp, hands, feet and forearms. External jugular cannulation for peripheral iv andor peripherally. Either the external or internal jugular veins may be used to estimate pressure because measurements in both are similar. A small incision was made at the jugular vein puncture site and a peelaway sheath was placed in the jugular vein. Jul 08, 2019 external jugular vein cannulation is an integral part of modern medicine and is practiced in virtually every health care setting. Observation of clients responses to iv therapy, therapeutic nursing interventions, and identifying and reporting adverse reactions. Standardized procedure manual sp 304 external jugular vein cannulation. Since it is a peripheral line, it should only dwell for 96 hours. This guide outlines the steps necessary for the licensed practical nurse lpn to achieve competency in the. There should be documented evidence of educational preparation and clinical competence. Its diameter is roughly 510mm, but varies widely from one side to the other, between.
Ccs and has their competency validated through the charlotte ke1. Vascular access and use of central lines and ports in. Attach the iv and secure the catheter avoiding circumferential dressing or taping. Drip 27 supraglotic airway king tube insertion 28 metered dose inhaler administration adult, child infant 29 nasogastric tube insertion. Knowledge of complications associated with jugular venous cannulation. The external jugular vein receives the greater part of the blood from the exterior of the cranium and the deep parts of the face, being formed by the junction of the posterior division of the retromandibular vein with the posterior auricular vein. Competency and training required pursuant to nur 405. Excludes peripheral external jugular catheters and peripherally inserted central catheters.
Alabama board of nursing approved standardized procedures. Her collar and cuff had been applied very tightly and it was felt by the. Umhs department of radiology, ct section iv injection. Competency in the technical skills specific to cannulation of the jugular veins. Delays in iv access lead to delays in patient care and expose. The management of most medical emergencies involves an iv line for the administration of medications. The following are best intravenous or iv therapy tips and tricks for nurses who would want to master this essential nursing skill. This procedurette features tips and tricks for placing peripheral ivs in the external jugular vein a key skill that can save your patients the time, expense, and. The new advanced arm has a greater degree of rotation and extension than our. Palpates to identify the external jugular 1 occludes the vein both distally and proximally to stabilize 1 cleanses site appropriately 1 perform venipuncture with point aimed ipsilateraly inserts needle 1 notes or verbalizes flash back 1 occludes vein proximal to catheter 1 3 attaches fluid delivery system prn, or fluid 1.
Steven mcgee md, in evidencebased physical diagnosis fourth edition, 2018. External jugular cannulation procedure emergency nursing. It is easily identified visually, and runs obliquely from the angle of the mandible down to the middle of the clavicle. Ultrasound guided peripheral iv insertion authors kevin arnold, rn, bsn is a clinical specialist in the. The role of the registered nurse in the insertion of. The facilityagencycompany chief nursing administrator, chief medical officer, and chief executive officer. The external jugular vein is slightly raised with an opening for you to attach. Short peripheral catheter spc insertion via the external jugular ej vein 79 79 ultrasoundguided midline catheter insertion 84 84 ultrasoundguided peripherally inserted central catheter picc insertion using modified seldinger technique mst 93 93. External jugular vein cannulation is indicated in a critically ill patient 12 years of age who requires intravenous access for fluid or medication administration and in whom an extremity vein was not attainable. Identify the point of insertion for the introducer needle along the posterior edge of the sternocleidomastoid muscle at the level just superior to where the external jugular vein crosses the muscle. Nontunneled catheters should be used only when the patient is hospitalized. The conversion of an external peripheral jugular line to a central jugular line is complicated and should be fully documented.
It can be identified when the child cries or by temporarily occluding the vein just above the clavicle with the tip of the long finger of the nondominate hand. Some patients have large, distended, and superficial external jugular veins, which can be encountered in normal dissection or from novice surgeons entering too deep of a plane. Facilities shall submit a standardized procedure application to abn for approval. The role of the registered nurse in the insertion of external jugular peripherally inserted central catheters and external jugular peripheral intravenous catheters. External jugular peripheral intravenous catheters ej pivs are peripheral.
Because training using simulation has been previously shown to be associated with improved performance outcomes as well as clinical outcomes ma et al. Use of the right external jugular vein as the preferred access site when the right internal jugular vein is not usable. Vascular access fact sheet american nephrology nurses. Policies and procedures addressing iv therapymedication administration must be. Venous access allows sampling of blood, as well as administration of fluids, medications, parenteral nutrition, chemotherapy, and blood products. Measuring competence in central venous catheterization. I know external jugulars are considered peripheral ivs. Would nursing staff in medsurg require a competency for removal of an ej. Prediction of a small internal jugular vein by external jugular vein diameter. Questions regarding the content of this presentation should be addressed to 1 retromandibular vein, 2 external carotid artery, 3 facial artery and vein, 4 lingual artery and vein, 5 external carotid artery, 6 internal jugular vein, 7 external jugular vein. Intravenous iv insertion may be one of the basics skills a nurse would learn, but it could be one of the most difficult to master if you lack the practice and the confidence to do it. No authors listed as a leader in infusion therapy, the infusion nurses society convened a national task force of experts to examine the practice of registered nurses placing. For an external jugular line to be a central line, the physician must use a jwire insertion to jump between the external and internal jugular vein.
Governor executive director arizona state board of nursing. External jugular vein is not recommended for power injection of contrast media and contrast media should not be administrated by power injector through small bore, peripheral access central venous catheters. The institution or practice setting has in place an educationcompetency validation mechanism that includes a process for evaluating and documenting the rnsaprns demonstration of the knowledge, skills, and abilities related to site selection and the placement of central lines. External jugular line secondary to risk of neck hematoma from extravasation. Other less desirable sites are the antecubital space, palmer aspect of the wrist, external jugular and trunk. The external jugular vein can be cannulated for both peripheral and central venous access.
The jugular venous pressure jvp is the indirectly observed pressure over the venous system via visualization of the internal jugular vein. External jugular vein cannulation is an integral part of modern medicine and is practiced in virtually every health care setting. When a peripheral iv is placed in a jugular the same damage results as when its placed in an extremityyou can lose the patency of that vein. Ol competency guide provides the background theory to safely apply best practice guidelines and processes in order to provide high quality care for the individual requiring iv medication administration. Document the procedure, time, and result success onwith the patient care report pcr. A peripheral iv catheter inserted into the external jugular vein is considered a peripheral iv, often referred to as ej piv. Ultrasound first, second, and last for vascular access. Vascular access and use of central lines and ports in adults. Ultrasoundguided peripheral intravenous access ugpiv. Clinical practice advisory summary intravenous therapy faq. External jugular peripheral intravenous catheters ej pivs infusion nurses.
The insertion of an external jugular peripheral intravenous catheter is within the scope of registered nursing rn practice for the rn who is educationally prepared and clinically competent. Competency in the modified seldinger technique for insertion of central venous catheters. Cvcs should be placed as a bridge access to dialysis while an avf is maturing or an avg is healing. Usefulness of the external jugular vein examination in. Intravenous therapy iv the following grid contains responses to specific frequently asked questions pertaining to this topic. Currently, insertion of an external jugular intravenous line. Once the registered nurse has validated initial competency, there must be a. Sites preferred for tunneled catheter insertion are the right internal jugular or the right external jugular.
Evaluation and documentation of competence occurs on a. As for the external jugular, its an option for peripheral access in the right circumstances. Using ultrasound guidance the internal jugular vein was punctured with a 21gauge needle. The role of the registered nurse in the insertion of external jugular.
External jugular vein an overview sciencedirect topics. We report the case of an 87yearold woman who developed a thrombosis of her external jugular vein after sustaining a proximal humerus fracture managed nonoperatively with a collar and cuff. All of this program content policy, competency, and. External jugular cannulation can be attempted initially in life threatening events where no obvious peripheral site is noted. Iv start on an ej of one of our friends while we shout encouragements. Warmth is essential for successful iv insertion and will make it easier to distend and visualize available veins. Cuttingedge discussions of management, policy, and program. Umhs department of radiology, ct section iv injection guidelines for ct contrast the type of iv access required for ct examinations varies by the ratevolume of contrast required for specific protocols. Medcram medical lectures explained clearly 162,904 views 12. Short iv cannulas placed in the jugular vein should not be power injected by the technologist or rn because of the dangers of extravasation in the neck. Although the external jugular vein ejv is present on both sides of every facelift it is only occasionally encountered during dissection. Maintain knowledge of the indications, contraindications, technique, and possible complications of the procedure. In accordance with abn administrative code, section 610x6.
Catheter picc insertions to access the external jugular vein for a picc line. The external jugular module may be attached to an adult manikin and is designed for teaching and practicing palpation of the jugular vein and iv catheter insertion. Scope of practice of the registered nurse in the insertion of. Central venous access via tunneled central vascular access devices cvads and implanted ports s55 vi. However, when the landmark technique fails ultrasound guidance used by emergency physicians for peripheral intravenous iv access has been shown to improve the success rate, decrease the time required to obtain access, and increase patient satisfaction with the procedure. During hospitalization, patient 501 had an ej catheter placed by an rn without demonstrated competencies in the procedure. Patient should be in trendelenberg for insertion and removal. Instructions given for the external jugular vein ejv examination an online evideo is available.
External jugular vein question infusion intravenous. Central venous access via nontunneled central vascular access devices cvads s55 v. If that procedure is not noted, then the line is a peripheral line. Diagram of external jugular line going up over the edge of the sternocleidomastoid muscle, the main landmark for the posterior approach. Palpates to identify the external jugular 1 occludes the vein both distally and proximally to stabilize 1 cleanses site appropriately 1 perform venipuncture with point aimed ipsilateraly inserts needle 1 notes or verbalizes flash back 1 occludes vein proximal to catheter 1 3. Students must show proficiency in all of the skills listed below either in competency andor theory.
Patient 501 developed an air embolism during the course of the. In many cases, ugpiv is a logical alternative to more invasive vascular access procedures because it avoids more significant complications. A peripheral iv catheter inserted into the external jugular vein is considered a peripheral iv, often referred to as. A patient that needs an ej iv really needs a more appropriate deviceto me that is an indication that there is a serious access problem that needs to be addressed. Pdf isolated thrombosis of the external jugular vein. Ejs are considered peripheral lines but must be inserted by md, pa or nurse practitioner. The preference is to attempt a peripheral iv in the patient for contrast administration. The external jugular vein crosses the sternocleidomastoid muscle b.