Central Venous Access Via External Jugular Vein Periprocedural Care

Updated: Mar 26, 2021
  • Author: Rick A McPheeters, DO, FAAEM; Chief Editor: Vincent Lopez Rowe, MD  more...
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Periprocedural Care

Equipment

The equipment needed for central venous cannulation via the external jugular vein (EJV) 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-iodine 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 EJV
  • 16-gauge Angiocath (BD, Franklin Lakes, NJ) to cannulate the EJV
  • Flexible guide wire with a maximum diameter of 0.35 mm and with a J tip 3 mm or less in radius 
  • No. 11 scalpel
  • Dilator device for the skin and soft tissue overlying the vein
  • Single-lumen or multilumen catheter
  • Silk or nylon sutures
  • Needle holder
  • Suture scissors
  • Dressings (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 before the skin is punctured. However, local anesthetic should be used before the incision is made and the dilator employed.

Sedation or analgesia may be necessary for certain patients, such as those with procedural anxiety or differing levels of pain tolerance. Of note, 10-20 mg of preservative-free lidocaine can be slowly infused to diminish any 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. [7]  He or she should lie supine, with 10-30° of Trendelenburg and with the head tilted contralaterally from the vein being cannulated. The operator should stand at the head of the bed.

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Monitoring & Follow-up

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

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