The "Easy IJ"

Overview

• Alternative to CVC placement when landmark-based and ultrasound-guided PIV placement as failed
• Relatively new technique
• Does not require full sterile technique (as opposed to traditional CVC placement)

Indications

• Patient with difficult vascular access failing ultrasound-guided PIV placement

Contraindications

• Thrombosis of the internal jugular vein
• Overlying skin or soft tissue infection

Equipment Needed

• Chlorhexidine or alcohol swab
• Ultrasound with high-frequency linear probe
• Bio-occlusive adhesive dressings
• Sterile ultrasound gel media
• Nitrile gloves
• Extra-long 18-gauge intravenous catheter

Procedure

• Place patient in Trendelenburg position
• Prep skin with antiseptic
• Apply adhesive dressing to ultrasound probe and cover with sterile gel
• Identify IJV with ultrasound
• Use same technique for ultrasound-guided PIV placement to cannulate the IJV

Complications

• Prospective study of 74 patients in the Emergency Department reported no arterial punctures, infections, or pneumothorax

References

1. Moayedi S et al. Safety and Efficacy of the “Easy Internal Jugular (IJ)”: An Approach to Difficult Intravenous Access. J Emerg Med 51(6): 636 – 642. PMID: 27658558