External Jugular Peripheral IV

EJ PIV Maintenance and Removal Competency 2011

Questions regarding the content of this presentation should be addressed to

1 = retromandibular vein, 2 = external carotid artery, 3 = facial artery and vein, 4 = lingual artery and vein, 5 = external carotid artery, 6 = internal jugular vein, 7 = external jugular vein

Bialek E J et al. Radiographics 2006;26:745-763

External Jugular Peripheral IV

The external jugular vein is a large, superficial peripheral vein in the neck that can be used for nonsclerosing fluid administration

Indications for use

Placement of a venous access line when other peripheral sites are unavailable Placement of a large-bore venous catheter in an emergent situation to deliver a high flow of fluid or blood products

Policy - Insertion

EJ PIV may ONLY be inserted by physicians in the ED or OR setting Insertion will NOT be done by RN, LPN, or hospital based paramedic at MMH or RGH Prior to transferring patient to medicalsurgical floor attempt to obtain another IV line and remove EJ PIV before transfer.

Policy - Maintenance

Dwell time for EJ PIV catheters must be limited to 24 hours to prevent formation of fibrin sheath If site cannot be changed within that time due to poor venous access it may be left in place if no signs of infection or inflammation are present Must obtain daily order from MD to keep the EJ PIV in place longer than 24 hours

Policy Maintenance, cont

Follow Procedure CPM 6.00 IV Insertion, Maintenance, and Removal of Peripheral Short Catheters for Maintenance guidelines, procedures for phlebitis, suspected infection, and infiltration, and documentation. Note to selflink for CPM 6.00?

Removal of EJ PIV

Only specifically trained Nurses can remove EJ PIVs. If there is not a trained RN available, call the Unit Manager or the supervisor to have them remove EJ PIV. Verify order. Identify patient using 2 approved identifiers. Explain procedure to patient.

Removal of EJ PIV

Wash hands and put on gloves Clamp IV tubing, if applicable, or extension set clamp Loosen all tapes Withdraw catheter carefully and apply firm pressure with dry sterile gauze for a minimum of 5 minutes.

If bleeding continues after 5 minutes continue to hold pressure until bleeding stops

Cover site with sterile 2 X 2 and tape Remove gloves and discard

Additional Guidelines

Change EJ PIV dressing ONLY if it becomes soiled or is no longer occlusive to air. Use IV securement set. During removal of catheter, if hematoma forms, apply ice pack to site to prevent further enlargement of hematoma. If hematoma forms, monitor for signs and/or symptoms of airway obstruction, including shortness of breath and decreased O2 saturation. Does Md need to be notified?

Patient and Family Education

Tell the patient to avoid excessive head movement to help decrease mechanical irritation of vein and therefore decrease the risk of phlebitis.

Documentation

Removal of IV catheter, site location, date/time, dressing applied, and condition of site in Meditech Document any normal saline flushes performed and medication administered prior to discontinuing IV site in EMAR Note pressure held at site at least 5 minutes Note how patient tolerated procedure

Reference

CPM 6.00: IV Insertion, maintenance, and removal of peripheral short catheters CPM 6.56: INS position Paper: The Role of the Registered Nurse in the Insertion of External Jugular Peripherally Inserted Central Catheters (EJ PICC) and external Jugular Peripheral Intravenous Catheters (EJ PIV) Journal of Intravenous Nursing, Infusion Nursing Standards of Practice, January-February: 29 (1Suppl): S1-92 Hankins, J., Alexander, M., Corrigan, A., Gorski, L., Perucca, R., (2010). Infusion Nursing: An Evidenced Base Approach, 3rd Edition. Saunders, St. Louis Proehl, J., (1999). Emergency Nursing Procedures, 2nd Edition. Saunders, Philadelphia.