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Central Venous Access Via External Jugular Vein Periprocedural Care

  • Author: Rick McPheeters, DO, FAAEM; Chief Editor: Vincent Lopez Rowe, MD  more...
 
Updated: Feb 26, 2015
 

Equipment

The equipment needed for central venous cannulation is widely available as a prepackaged kit (see the image below).

Central venous access kit. Central venous access kit.

The basic materials include the following:

  • Povidone or chlorhexidine solutions to swab and prepare the venipuncture site
  • Sterile drapes and towels
  • Sterile gloves
  • Gown, mask, and cap
  • Lidocaine 1%
  • 27-gauge needle with 2- to 5-mL syringe for injecting local anesthetic
  • 20- to 22-gauge needle with 10-mL syringe to access the external jugular vein (EJV)
  • 16-gauge Angiocath to cannulate the EJV
  • Flexible guide wire with a maximum diameter of max 0.35 mm and with a 3 mm or less radius J-tip
  • No. 11 scalpel
  • Dilator device for the skin and soft tissue overlying the vein
  • Single or multilumen catheterization
  • Silk or nylon sutures
  • Needle holder
  • Suture scissors
  • Dressings to include plastic tape, antibiotic patch, gauze pads
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Patient Preparation

Anesthesia

Because this is initially peripheral venous access, local anesthesia by infiltration is generally unnecessary and is not recommended, because it can obscure the surface anatomy and thereby render the venipuncture more difficult. If time permits, a topical anesthetic can be applied prior to puncturing the skin. However, local anesthetic should be used prior to use of incision and dilator.

Sedation or analgesia may be necessary for certain patients, such as those with procedural anxiety or differing levels of anxiolysis. Of note, 10-20 mg of preservative free lidocaine can be slowly infused to diminish discomfort associated with passing the guide wire and catheter.

Positioning

The patient should be positioned so as to optimize venous distention and thus allow easier cannulation.[5] Have the patient lay supine, with 10-30° of Trendelenburg. Tilt the head contralaterally from the vein being cannulated. Stand at the head of the bed.

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Monitoring and Follow-up

A cardiac monitor should be used to observe for cardiac dysrhythmia that could arise if catheter enters the right atrium.

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Contributor Information and Disclosures
Author

Rick McPheeters, DO, FAAEM Chair, Department of Emergency Medicine, Kern Medical Center; Associate Clinical Professor of Medicine, University of California, Los Angeles, David Geffen School of Medicine; Associate Editor, Western Journal of Emergency Medicine

Rick McPheeters, DO, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American Osteopathic Association, Council of Emergency Medicine Residency Directors, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Ireneo H Catoera, III, MD Resident Physician, Department of Emergency Medicine, Kern Medical Center

Ireneo H Catoera, III, MD is a member of the following medical societies: American College of Emergency Physicians, Society for Academic Emergency Medicine, Emergency Medicine Residents' Association

Disclosure: Nothing to disclose.

Chief Editor

Vincent Lopez Rowe, MD Professor of Surgery, Program Director, Vascular Surgery Residency, Department of Surgery, Division of Vascular Surgery, Keck School of Medicine of the University of Southern California

Vincent Lopez Rowe, MD is a member of the following medical societies: American College of Surgeons, American Heart Association, Society for Vascular Surgery, Vascular and Endovascular Surgery Society, Society for Clinical Vascular Surgery, Pacific Coast Surgical Association, Western Vascular Society

Disclosure: Nothing to disclose.

Acknowledgements

Special thanks to Doctors Adria Winter and Anh Nguyen for videotaping the procedure.

References
  1. Byth PL. Evaluation of the technique of central venous catheterisation via the external jugular vein using the J-wire. Anaesth Intensive Care. 1985 May. 13(2):131-3. [Medline].

  2. Uvelin A, Kolak R, Putnik D. External jugular cannulation is irreplaceable in many situations. Resuscitation. 2010 Jun. 81(6):773; author reply 774. [Medline].

  3. Cho SK, Shin SW, Do YS, Park KB, Choo SW, Choo IW. Use of the right external jugular vein as the preferred access site when the right internal jugular vein is not usable. J Vasc Interv Radiol. 2006 May. 17(5):823-9. [Medline].

  4. Blitt CD, Wright WA, Petty WC, Webster TA. Central venous catheterization via the external jugular vein. A technique employing the J-WIRE. JAMA. 1974 Aug 12. 229(7):817-8. [Medline].

  5. Dailey RH. External jugular vein cannulation and its use for CVP monitoring. J Emerg Med. 1988 Mar-Apr. 6(2):133-5. [Medline].

  6. Segura-Vasi AM, Suelto MD, Boudreaux AM. External jugular vein cannulation for central venous access. Anesth Analg. 1999 Mar. 88(3):692-3. [Medline].

  7. Sparks CJ, McSkimming I, George L. Shoulder manipulation to facilitate central vein catheterization from the external jugular vein. Anaesth Intensive Care. 1991 Nov. 19(4):567-8. [Medline].

  8. Mitre CI, Golea A, Acalovschi I, Mocan T, Caea AM, Ruta C, et al. Ultrasound-guided external jugular vein cannulation for central venous access by inexperienced trainees. Eur J Anaesthesiol. 2010 Mar. 27(3):300-3. [Medline].

  9. Karaaslan D, Altinisik U, Peker TT, Nayir E, Ozmen S. External jugular vein catheterization using 'intra-atrial electrocardiogram'. Yonsei Med J. 2009 Apr 30. 50(2):222-6. [Medline]. [Full Text].

  10. Nishihara J, Takeuchi Y, Miyake M, Nagahata S. Distribution and morphology of valves in the human external jugular vein: indications for utilization in microvascular anastomosis. J Oral Maxillofac Surg. 1996 Jul. 54(7):879-82. [Medline].

  11. Jaroch M, Steiger E. Rapid identification of the external jugular vein. Cleve Clin J Med. 1990 Jan-Feb. 57(1):95-6. [Medline].

  12. Kato K, Taniguchi M, Iwasaki Y, Sasahara K, Nagase A, Onodera K, et al. Central venous access via external jugular vein with CT-venography using a multidetector helical 16-section CT. J Invest Surg. 2014 Jun. 27(3):176-82. [Medline].

  13. Chakravarthy M, Krishnamoorthy J, Nallam S, Kolur N, Faris A, Reddy K, et al. External jugular venous route for central venous access: our experience in 563 surgical patients. J Anesth Clin Res. 2011. 2(6):1-5. [Full Text].

 
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External jugular venous anatomy.
Neck anatomy.
Surface anatomy of neck. Large arrows point to external jugular vein.
Central venous access kit.
Central venous access via external jugular vein.
 
 
 
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