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

See Also

Vascular access types

• Central venous catheterization
  • Central line: internal jugular
  • Central line: subclavian
  • Central line: supraclavicular
  • Central line: femoral
  • Pediatric central line
  • Sheath introducer
• Rapid infusion catheter
• Intraosseous access
• Venous cutdown
• Umbilical vein catheterization
• Ultrasound assisted peripheral line placement
• External jugular vein cannulation
• The "Easy IJ"
• Midlines

External Links

• emDOCs: Approach to the Patient with Difficult Vascular Access

Videos

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