The "Easy IJ"

Overview

  • Alternative to CVC placement when landmark-based and ultrasound-guided PIV placement has 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 [1]

See Also

Vascular access types

External Links

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