ej access

At our hospital we've recently been requested to start an ej peripheral on several occasions.   We haven't done so in the past, but we're starting to wonder if it's a valid request since so many of our patients have very limited access.   We'd certainly be better at it than our residents and many of the attendings, but we have what is possibly an invalid fear of doing so.   I know they must do this at some hospitals (and in fact we have a policy and procedure for doing so in our downloads section), but we can't seem to get ourselves to do this as a regular policy.   Do any of you start external jugulars on a regular basis?



I remember one of our IV team members received her NP license and worked in the cardiac cath lab. She did ej's there. I can not think of her name. Maybe Jamie or Leslie can remember her name? She can talk about the learning curve.

Pat Dobson



I think the reality is that we do sometime use up every peripheral vein the patient has despite early assessments.  I believe we are seeing patients outlasting their veins.  In fact I have see patients who can not be treated due to their lack of access or who expire related to complications in trying to place extremely difficult lines when all "conventional" access is destroyed. 

We consider the EJ to be a "last resort" site and it is used because everything else is depleted. I would prefer to place a PICC there than a PIV for maximum benefit.  Ex-premies, chronically ill children (and adults, I'm sure) all present challenges and all those early damaged veins remain damaged for a lifetime.


The external jugular vein is and should always be considered an "emergency vein".   If a patient has an emergent need for access, it is an acceptable practice, as long as your nursing board supports it, to use the ej for peripheral access, but if the patient does not need the access emergently, then some other option needs be looked at.   An ej is not like a vein in the upper extremities.   We do not have multiple ej's, and they are located directly next to, or over a very large artery.   It can make for a dangerous situation if the person placing the line is not trained to do so.   And if you stenose the ej, where is your next access?   If you are using the ej, it would seem to me that the patient is pretty limited to begin with.   Should we not be doing a better assessment on these patients to ensure that they are getting the best access possible?   If we use up every peripheral access the patient has, and then say, "what next?" where do you turn after that?   Pre-assessment is the key here.   Even if the case is emergent, the site needs to be removed ASAP, and a better access placed.  

In North Carolina this is an Advisory Statement activity.   Make sure about your state's laws.  


I'm teaching this out in AZ.   I had a class this summer, but not many responded.   I'll probably have one again in the summer.   Let me know if you are interested.   I teach the class in Arizona.

I have done many ej but only on emergency basis for a very limited time ie; fluid resuscitation trauma etc. The actual placement is not difficult.

Jeff B

Anyone know of a course for placement of jugular PICCs?   When, where, and cost?   Thanks.

Halle Utter, RN

Hallene E Utter, RN, BSN Intravenous Care, INC

No, we don't do this on a regular basis, but there are occations when patients are stenosed on both vessels, very dehydrated, bilateral shunts, bilateral DVT, bilateral mastectomies...you get my drift.   We took this to the state board here in AZ and have classified it as a peripheral so that we can also access this site for PICCs.   Do we use often, no, but it is another site.   We are very careful what we place in the EJ as far as fluids/medications, because of the possibility of tracheal deviation from infilation, and especially no contrast injection.   We don't allow everyone to place EJ's....they have to have a class, be validated, and be either ACLS or PALS certified as well.  

An EJ is rated as a peripheral IV in the ACLS course materials. Great site Sarah! Thanks for all your hard work!


No we don't do this on a regular basis but I have done so twice to get a patient through the night or to get them to the OR.  

Those veins are tough!

 I see the day coming however.