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External Jugular Access

Clinical Indications:

    External jugular vein cannulation is indicated in a critically ill patient > 8 years of age who requires intravenous access for fluid or medication administration and in whom an extremity vein is not obtainable.
    External jugular cannulation can be attempted initially in life threatening events where no obvious peripheral site is noted.

Procedure:

    1. Place the patient in a supine head down position. This helps distend the vein and prevents air embolism.

    2. Turn the patient's head toward the opposite side if no risk of cervical injury exists.

    3. Prep the site as per peripheral IV site.

    4. Align the catheter with the vein and aim toward the same side shoulder.

    5. Tourniqueting the vein lightly with one finger above the clavicle, puncture the vein midway between the angle of the jaw and the clavicle and cannulate the vein in the usual method.

    6. Attach the IV and secure the catheter avoiding circumferential dressing or taping.

    7. Document the procedure, time, and result (success) on/with the patient care report (PCR).

Competency Based Skill Requirements:

    Maintain knowledge of the indications, contraindications, technique, and possible complications of the procedure.

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