Difficult Access – Go for the Jugular

February 8, 2017

Short Attention Span Summary

Go for the jugular
Some IV drug abusers inject directly into the IJ.  You can too!  You can put an IV directly into the IJ in patients with difficult access.  They used an 18 ga 4.8cm IV catheter and ultrasound guidance.  Of 83 attempts in 74 patients, success rate was 88%, took 4 minutes, and only 14% eventually lost patency.  And they had no major complications.

Spoon Feed
In patients with difficult IV access, a 4.8cm peripheral IV catheter in the IJ is an option.  Want a video on how to do it?  Watch one; do one; teach one!

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Abstract

J Emerg Med. 2016 Dec;51(6):636-642. doi: 10.1016/j.jemermed.2016.07.001. Epub 2016 Sep 19.

Safety and Efficacy of the “Easy Internal Jugular (IJ)”: An Approach to Difficult Intravenous Access.

Moayedi S1, Witting M1, Pirotte M2.

Author information:

1Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland.

2Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.

Abstract

BACKGROUND:

The easy internal jugular (Easy IJ) technique involves placement of a single-lumen catheter in the internal jugular vein using ultrasound guidance. This technique is used in patients who do not have suitable peripheral or external jugular venous access. The efficacy and safety of this procedure are unknown.

OBJECTIVE:

We aimed to estimate efficacy and safety parameters for the Easy IJ when used in emergency department (ED) settings.

METHODS:

We conducted a prospective study of the Easy IJ in stable ED patients with severe intravenous access difficulty. The study was conducted simultaneously at two academic EDs and a community university-affiliated ED. Patients were selected for failure of alternative access, hemodynamic stability, and ability to increase the IJ diameter with the Valsalva maneuver. Emergency physicians prepped the skin and inserted an 18-gauge, 4.8-cm catheter using a limited sterile technique. We collected the following data: patient body mass index, age, procedure time, pain score, initial success, loss of patency, occurrence of pneumothorax, infection, or arterial puncture.

RESULTS:

We recorded 83 attempts in 74 patients, with a median age of 44 years and a median body mass index of 27 kg/m2. The initial success rate was 88%, with a mean procedure time of 4.4 min (95% confidence interval 3.8-4.9). The average pain score was 3.9 out of 10 (95% confidence interval 3.4-4.5). Ten of 73 successful lines (14%) lost patency. There were no cases of pneumothorax, arterial puncture, or line infection.

CONCLUSION:

The Easy IJ was inserted successfully in 88% of cases, with a mean time of 4.4 min. Loss of patency, the only complication, occurred in 14% of cases.

Copyright © 2016 Elsevier Inc. All rights reserved.

PMID: 27658558 [PubMed – in process]