No Vein, No Gain

External Jugular Access Action Plan

By: Maria Meza & Dayna Valdez

A need for change

A need for change

Surveys were

conducted in
August of 2015
Emergency

Department
nurses have
spoken

External Jugular Vein Access

What is your title? (circle)
EMT-Paramedic
LVN
RN
How many years of nursing and/or paramedic experience
do you have (circle):
1-5 years
5-10 years
10+ years
True or False: Is it within your scope of practice as an
RN/EMT-Paramedic to insert an external jugular vein
access in the state of Texas?
True
False
In your experience as RN or EMT-Paramedic, have you ever
placed/removed an external jugular vein access in an adult
patient? (circle)
YES
NO
If so how many times, external jugular vein access have
you placed/removed?
1-5
5-10
10+
Would you feel comfortable placing/removing an external
jugular vein access in an adult patient in the emergency
department, after thorough training and education?
YES
NO

Survey Data
Number of Responses

60
50
40
30
20
10
0
YES
NO

Survey Questions

Evidence Based Research

VII. External Jugular Vein Access A. Nurses who are

competent in infusion therapy may insert short peripheral

intravenous (IV) catheters and PICCs, using the external
jugular vein in patients in acute care settings and in
emergency situations when other veins cannot be
accessed.2,21 (V) B. A short peripheral catheter in the
external jugular vein should not be used for contrast media
or with power injectors.21 (V) C. Central venous pressure
monitoring may be performed through PICCs in the external
jugular vein.21 (V) D. When a short peripheral catheter is
inserted into the external jugular vein and infusion therapy
is expected to exceed 72 to 96 hours, the nurse should
collaborate with the LIP for an alternative vascular access
site as soon as possible.3,21 (V)

Purpose
A delay in emergent intravenous IV treatment

due to difficult peripheral vein access is

detrimental to the health of any patient in
emergent need of fluid treatment.

GOALS
Decrease the length of time it takes for initial

IV treatment in the Emergency Department

by:
25% in 2016
50% in 2017;
HOW?

By training RNs on how to place External

Jugular (EJ) peripheral IV access to patients
after multiple failed IV attempts.

Learning Objectives
Identify potential candidates for EJ IV access

and need
Describe the procedure for insertion,
maintenance and removal of EJ IV access
Discuss the role of inter-professional
teamwork and its importance in reducing the
delay in IV treatment, an d unnecessary
central line placements in the ED.

EJ Access Action Plan

Our 5-step Plan:
Policy Development
Performance Improvement (PI) Tool
Competency Assessment for RNs
Collaborating with inter-professionals
Offering in-services to ED RNs

Policy Development
Responsible Associates
Procedure
Equipment
Indications/Contraindications
Step-by-guide
Complications
Documentation

Performance
Improvement Tool
PLACE PATIENTS
LABEL HERE:

DATE:

WHAT TYPE OF ACCESS DID THIS

PATIENT RECEIVE AFTER MULTIPLE IV
ATTEMPTS? (Please circle one)

US-Guided IV
Central Line

EJ

US-Guided IV
Central Line

EJ

US-Guided IV
Central Line

EJ

US-Guided IV
Central Line

EJ

US-Guided IV
Central Line

EJ

References
Costantino, T. G., Kirtz, J.F., Satz, W. A. (2010). Ultrasound-Guided Peripheral Venous

Access vs. the External Jugular Vein as the Initial Approach to the Patient with
Difficult Vascular Access. The Journal of Emergency Medicine. (39)4. Pgs. 462-467.
Retrieved from: http://dx.doi.org/10.1016/j.jemermed.2009.02.004.
Infusion Nurses Society (2011). Infusion Nursing Standards of Practice. Journal of
Infusion Nursing, 34(1s). Hagertown, MD: Lippincott.
Mohamed, M.I. (2015). Case Report: Management of unusual site for contrast media
extravasation in right external jugular vein. The Egyptian Journal of Radiology and
Nuclear Medicine. Retrieved from: http://dx.doi.org/10.1016/j.ejrnm.2015.08.011.
Sansivero, G.E. (2010). Features and Selection of Vascular Access Devices. Seminars
in Oncology Nursing. (26)2. Pgs. 88-101. Retrieved from:
http://dx.doi.org/10/1016/j.soncn.2010.02.006.
Booth, J. MD, Ellis, K. RN, Viles, A. RN. (n.d). External Jugular IV Cannulcation RN
Verification Program. The University of Alabama at Birminham. Retrieved from
cjpems.com/EJ.pdf
The Association for Vascular Access (2011). Cannulation of the Internal and External
Jugular Veins by Registered Nurses and Other Qualified Healthcare Professional, pgs
1-2. Retrieved from: ww.avainfo.org/website