External jugular vein cannulation



  • Patients with difficult vascular access (DVA)


  • Thrombosis of EJV
  • Overlying infection

Equipment Needed

  • 16-20 gauge angiocatheter
  • Chlorhexidine or alcohol wipe
  • Disposable gloves
EJV cannulation technique. Operator here is using index finger to tamponade the vein superior to the clavicle and thumb to provide counter traction


  • Place patient in Trendelenburg position and rotate head to opposite side of cannulation
  • Position yourself at the head of the bed facing the patient
  • Clean skin with appropriate antiseptic
  • Use non-dominant thumb to provide counter-traction and index finger to tamponade EJV just superior to clavicle
  • Cannulate vessel midway between angle of mandible and clavicle
  • When "flash" seen, advance catheter over needle
  • Attach pre-flushed IV tubing and apply dressing
  • Having patient perform Valsalva maneuver can dilate vein and aid in cannulation
    • Same effect can be achieved by having the patient hum[1]
    • Can also use stethoscope to act as "tourniquet"


  • Typical risks associated with PIV cannulation

See Also

Vascular access types

External Links


  1. Lewin M, Stein J, Wang R, et al. Humming Is as Effective as Valsalva’s Maneuver and Trendelenburg’s Position for Ultrasonographic Visualization of the Jugular Venous System and Common Femoral Veins. Ann Emerg Med. 2007; 50(1): 73-7.