Q&A: External Jugular IV’s

Q: I know external jugulars are considered peripheral IVs. Would nursing staff in med-surg require a competency for removal of an EJ?

A: The external jugular vein can be cannulated for both peripheral and central venous access. A peripheral IV catheter inserted into the external jugular vein is considered a peripheral IV, often referred to as EJ PIV. The EJ PIVs are used for emergent access or for individual situations when other veins cannot be accessed. The dwell times for EJ PIVs must be limited and plan to immediately place an alternate venous access device.

Not all EJ access are considered peripheral IVs because a catheter placed via the external jugular vein and advanced into position where the distal tip dwells in the lower one-third of the SVC to the junction of the SVC and RA is considered a central venous access device (central line). If the catheter inserted into the external jugular is a PICC, then that access is considered an EJ PICC.

Would nursing staff in med-surg require a competency for removal of an EJ? I will refer you to the Infusion Nurses Society (INS) Position Paper on the role of the RN in the insertion of External Jugular PICC and External Jugular PIV.

It states that a “qualified licensed RN” may insert, care for, maintain and remove EJ PIV and EJ PICC.
The RN caring for a patient with an EJ PICC or EJ PIV must have demonstrated competency and proficiency in infusion therapy.
On going competency includes validation of the knowledge and ability to perform safe insertion, appropriately care for and maintain the EJ catheter, recognize signs of adverse conditions and discontinue the device.
Formal organization policies and procedures that provide clear responsibility for insertion, care and maintenance, and removal of EJ devices must be in place.

In many facilities, EJ veins are cannulated only with a peripheral IV catheter, so they assume their EJs are PIVs. It is always best to check where the tip of the catheter is before assuming the EJ is a PIV device. Often the EJ access is inserted and used only in the ED and removed/replaced with a better venous access before a patient is transferred to an inpatient unit.

Always check your organization policy/procedure on who can perform EJ removal. While the removal of a EJ PIV may be similar to removing a short peripheral IV in the hand or arm, the nurse must be knowledgeable and take extra precautions to prevent or minimize complications such as hematoma formation in the surrounding area.