EJ access WTF!?

[Lord_Balsac]

Ok... we were taught to use a cath attached to a 10ml syringe when accessing the external jugular vein. I guess to pull back on the plunger before you advance. Another medic I've talked to just uses a standard 14G cath and thats it, end of story. Im a new medic and havent done one yet in the field. What are your thoughts on this, and is one way better than the next?

:pain10:

[Paramedic275]

First of all start high on the EJ, I am right handed so typically I try the right side. With my left I hold the skin very taught with my first finger and thumb after preping the sight. Then I grab an 18 gauge and puncture the skin and SLOWLY go forward. The reason I say slowly is because usually it is a cardiac arrest situation and with good CPR only moving up to 20% of the normal blood around you will get a slow flash. I was told early on by several excellent seasoned paramedics that the needle doesn't need to be bigger than an 18. I am sure there are several clinical reasons not to go bigger than that but believe me an 18 in the neck flows like a 14 in the AC.

Hope this helps some.

[jdemaio]

Keep in mind that the EJs are under negative pressure, somtimes you just plain won't get a flash.

[medicmade]

In my medic class we were also taught to use no less than a 16 with out a syringe. On the other hand I see the Doc's in the Er use a 10ml syringe.

[Philly Medic]

You usually don't get a flash but you should be able to tell you are in then just run the bag WO and see if it infiltrated. Also I use either a 18 or 20 and I have also mainlined Narcan in the EJ.

[beedub85]

i am in medic school and was taught to never go bigger than an 18 for an ej. fluid boluses and some ecc meds can damage the heart... sounds like bs to me but thats what we were taught.

[medicmade]

I guess it all goes with who teaches it. I would like to know what the NR standerds are for doing an EJ. Does any one know?

[fishy]

I usually take a 14 or 16G. If I attach a syringe or not depends on the situation. If the EJs are clearly visible to me I dont, if not I will so I can add some negativ pressure to aspirate blood as an indicator wheter or not I'm in. (does that sentence make any sence? I think you get the idea.)

[Pilotdan]

If this is true or not, but I recently heard this from a very seasoned medic. Have whoever is doing the chest compressions, push down and hold right when you are ready. This helps show the EJ’s by the thoracic pressure that the held compression makes.

I have not seen this yet, but it makes some sense.

[jdemaio]

If this is true or not, but I recently heard this from a very seasoned medic. Have whoever is doing the chest compressions, push down and hold right when you are ready. This helps show the EJ’s by the thoracic pressure that the held compression makes.

I have not seen this yet, but it makes some sense.

Sounds intersting, worth a shot.

[anthonyt]

I've used anywhere from a 20 to a 14 in the ej... Have never used a syringe to place the cath, but a few times to confirm placement...

I put the patient into the trendellenburg position first, then if they are conscious, and not in a cardiac event, I'll have em grunt. Otherwise, just go for it...

[GHOST]

Ok... we were taught to use a cath attached to a 10ml syringe when accessing the external jugular vein. I guess to pull back on the plunger before you advance. Another medic I've talked to just uses a standard 14G cath and thats it, end of story. Im a new medic and havent done one yet in the field. What are your thoughts on this, and is one way better than the next?

:pain10:

We only have safety caths. except in our chest decomp. kits, so attaching a syringe is not an option. How ever when accessing port-a-caths, or accessing AV fisitulas we prime the lines and attach syringes with 10mls of NSS. I say go with what you know as we all come to understand in EMS, there is more then 105 ways to skin a cat, and tomorrow we find four more ways.

Hi guys and gals back from vacation.

[drthrockmorton]

The syringe (with plunger intact) attached to the trocar and catheter is not used to confirm placement as much as it is used to prevent an air embolism from entering the central vasculature and heart.
The negative pressure from the vena cava and *beating* heart can cause an immediate vacuum of air. Allowing air to enter the catheter takes merely a heartbeat or two to cause a life-threatening embolism.
Preventing an air embolism also requires using the thumb of a gloved hand (sterile if possible) to cover the opening of the catheter from the time after the trocar has been removed until immediately before the pre-flushed line or lock has been attached. Occluding the jugular vein proximal to the point of insertion may also aid in preventing an air embolism.
If your company/dept does not supply the "old-fashioned", basic IV needles that you can attach the syringe to (with trocar in place), it would be a great idea to convince management to order some just for this very instance.
Starting high on the neck is good advice, entering the ED with an EJ induced pneumo/tension pneumo never looks good.
Cheers

[tom10406]

They prefer us doing EJs on prearrest or arrest patients. We were taught both ways (syringe or no syringe). For arrests, I make sure that I don't occlude blood flow, before attaching the IV tubing, and I will have my partner run the line right away. That helps cut down the chance of air embolisim.

A good trick for EJs on cardiac arrests or prearrest and you can't palpate any neck veins, I will get someone to compress the chest, the pressure will cause the neck veins to become visible.

[fyrdog]

I have never used a syringe when starting an EJ. It's just something else to flop around when you don't need it. Any size cath will work I've used a 20 once on a little old lady. Mostly I try to use a 16 or 18. I haven't always gotten a flash and still have had the IV run fine.