Page 214 - 2026 SMOG

VASCULAR ACCESS VIA EXTERNAL JUGULAR VEIN CANNULATION
Clinical Indications
• In the presence of a life-threatening condition, with clear indications for immediate use of
medication, blood, or fluid bolus. It should only be used when a peripheral IV site cannot be
established (Not for prophylactic IV access)
Equipment
• IV start kit (alcohol swabs 4 × 4s, tourniquet, tape)
• Large-bore IV catheter (14G or 16G)
• IV fluid tubing
Procedure
• Explain the procedure to the patient
• Select the insertion site
• Find the landmarks midway between the angle of the jaw and the midpoint of the clavicle.
• Turn the patient’s head away from the intended site of insertion. Consider placing the patient in
the Trendelenburg position or holding the thumb over the vein to facilitate insertion.
• Palpate for the pulse of the carotid artery and ensure that an IV catheter is not inserted into the
carotid artery. Insertion should be lateral to the carotid artery.
• Insert the IV catheter pointing towards the ipsilateral acromioclavicular joint until a flash fills
the chamber of the catheter, then advance the catheter over the stylet and remove the stylet.
• Attach the IV fluids to the catheter and infuse to verify the intravenous line is patent and does
not infiltrate.
• Secure the IV catheter using tape and Tegaderm dressing or a clear occlusive dressing.
• Dispose of sharps in an approved biohazard container.
Complications
• Infiltration
• Hematoma formation
• Cellulitis/infection
• Thrombosis
• Phlebitis
**Document procedure, results, and vital signs**

206 • PROCEDURES