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Ultrasound-guided Peripheral IJ Catheter Placement

The importance of intravenous (IV) access is something seared in the mind of every practicing emergency department physician. Over the years, central intravenous access for difficult IV access has been obviated by the intraosseous drill and line. Furthermore, we just see and do less central IV lines. The likely reasons for this are that running vasopressors in peripheral intravenous (IV) lines is becoming more accepted as well as the increased time associated with placing a fully sterile central line (draping, etc.) as well as the risks of the over-the-wire procedure (infection, deep vein thrombosis, cardiac arrhythmias).

Enter the internal jugular vein catheterization using a peripheral…

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 bUltrasound-Guided Central Line Placement Made Easy: Step-By-Step Guide

You will be cannulating the internal jugular vein the vast majority of the time. This post will primarily cover the right internal jugular vein... You should use an alternative vein if there is the presence of a thrombus, infection, distorted anatomy, or extensive scarring at the internal jugular vein .

 The “Easy IJ”

We’re all familiar with the “difficult access” patient: the nurses have tried all possible traditional peripheral routes, both ultrasound-guided and not, the resident has been in with the ultrasound and had no better luck, the EJ blew a few minutes after it was placed. The choices you seem to be left with are intraosseous access (certainly useful in an actual emergent situation, although having a spike drilled into their long bones is not something that most awake and alert patients are thrilled about) or gain central access via a central venous catheter (again, useful and appropriate in some circumstances, but poses increased risk for complications). Fortunately, there is a third option! The ultrasound-guided catheterization of the IJ with a peripheral IV, a technique first described in the literature in 2009, has been shown to be a safe and efficacious means of access when all else fails.

Articles of Interest

Central venous access: placing an Easy IJ

In this video, you'll learn how to master the Easy IJ technique for rapid internal jugular vein cannulation.

Safety and Efficacy of the ``Easy Internal Jugular (IJ)

In summary, our study adds to the growing body of literature suggesting that the Easy IJ technique can be used as a safe and rapid method of achieving short-term venous access in appropriately selected patients.

Seldinger Technique for Placement of “Peripheral” Internal Jugular Line: Novel Approach for Emergent Vascular Access

This is a case report describing the ultrasound-guided placement of a peripheral intravenous catheter into the internal jugular vein of a patient with difficult vascular access. Although this technique has been described in the past, this case is novel in that the Seldinger technique was used to place the catheter. This allows for safer placement of a longer catheter (2.25”) without the need for venous dilation, which is potentially hazardous.

The Easy IJ: Another Option for Difficult IV Access in Stable Patients?

This is an increasing dilemma in the care of EM patients, and gives a nice simple solution, that does not take as long as Central venous access or the discomfort associated with IO in stable awake patients.