Central venous access: placing an Easy IJ
In this video, you'll learn how to master the Easy IJ technique for rapid internal jugular vein cannulation.
What should you do when your patient needs an IV, but doesn't have good external veins? In this video, from our Emergency Procedures Masterclass (Part I) course, you'll learn all about a new alternative to central and intraosseous lines—the Easy IJ line! You'll find out how and where to place the line, how to prepare your patient for the procedure, and the safety considerations you should keep in mind for this technique.
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[00:00:00] When I was in residency training in emergency medicine, patients in whom I couldn't get an IV, ended up getting central lines. This was a long time ago. Then ultrasound machines started becoming more available, and I started using the ultrasound to find deep veins in the arms, and that really decreased the number of central lines I was placing. But in a patient who needs an IV but doesn't have good external veins, not even
[00:00:30] by looking with the ultrasound, then the choice was basically between a central line and an intraosseous line, an IO. Of course, IOs are typically reserved for code situations and they're very painful. So now I'm going to tell you about a new alternative to placing a central line in that scenario, it is called the Easy IJ. Essentially, in this procedure, you're going to place a long IV directly into the internal jugular vein, using ultrasound guidance. So, what tools do you need?
[00:01:00] The tools you will need are essentially the same as the ones you'll need for placing an ultrasound-guided IV, except for the IV itself is longer and is at least an 18 gauge. To keep this procedure sterile, place a biofilm over the ultrasound probe and don't touch that sterile part. So, let's start to do the procedure. First, sterilize the skin with chlorhexidine, then place the sterile
[00:01:30] gel on the skin, and ask your patient to perform the Valsalva so that the IJ gets nice and large, and place the catheter into the internal jugular vein with ultrasound guidance. Attach your connector, draw blood and flush, and then place a biofilm over the catheter. You now have an IV, in less than five minutes, in someone who had
[00:02:00] extremely difficult IV access. In case you're wondering about the safety of this technique, my colleagues and I studied this Easy IJ and published a study about its safety and efficacy in 2016. Basically, we had an 88% success rate. The procedure only took 4.4 minutes, and patients reported the same pain score as having a regular IV placed. And most importantly, there were no cases of pneumothorax and we had no infections.
[00:02:30] These study lines were removed within 24 hours, so I don't recommend this procedure for long-term access. Let's talk about why not to use the Easy IJ technique. I don't recommend this technique for morbidly obese patients with very large necks because once they sit up, the IV tends to kink under that weight. I also don't recommend the Easy IJ in anyone who can't make their internal jugular vein big with the Valsalva technique. This includes confused
[00:03:00] patients who can't follow directions. Finally, if the patient is really sick and needs multiple medications, and is going to end up going to the intensive care unit, don't do the Easy IJ, just place a triple lumen catheter. But the good news is, if a patient already has an Easy IJ and suddenly gets worse and needs a triple lumen, you can use the Easy IJ site to place a wire. To do this, you can disconnect the IV and sterilize the site. And because you
[00:03:30] used an 18 gauge IV, you can feed a central line wire directly through the IV into the internal jugular vein and place the central line using the traditional method. Now that you know how to perform the Easy IJ, consider using this simple and fast technique as an alternative to placing a central line in appropriate patients with difficult IV access.