Power Injecting into an External Jugular Line

[NinerNiner999]

Hey Folks-

Does anyone know of any position statements or current radiology guidelines for power injecting into an EJ line? Specifically, are there any sources out there that support of refute power injecting into this site? This is specific to CTA studies.

I have searched the web and cannot seem to find a definitive source from a reputable physician organization...

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[Birdstrike]

Post in the rads forum and I'm sure you'll get an answer quick.

 

[EM4Reals]

My program's hospital doesn't allow us to do contrast studies through an EJ, especially CT angios. Radiology won't allow the studies for fear of contrast extravasation into the neck causing tissue necrosis. If they have bad access and need a contrast CT I'll drop a central line, usually a fem line since the complication rate is lower than a high line. I don't know if there are any official radiology guidelines regarding this issue, unfortunately.

 

[deleted547339]

My program's hospital doesn't allow us to do contrast studies through an EJ, especially CT angios. Radiology won't allow the studies for fear of contrast extravasation into the neck causing tissue necrosis. If they have bad access and need a contrast CT I'll drop a central line, usually a fem line since the complication rate is lower than a high line. I don't know if there are any official radiology guidelines regarding this issue, unfortunately.

Why not just a peripheral with ultrasound? Putting in a CVL just for an imaging study seems unnecessarily invasive.

 

[deleted547339]

And to address the original question: I've never had a problem getting an imaging study done on a patient with a good IV. Radiology will refuse if it's a crappy 22 in the hand or something, but 1) our nurses are amazing at getting good access and 2) if the RN can't find one, I can get an US guided IV in just about anyone. Honestly, I'm probably deficient in EJs because US is my go-to.

 

[e30ftw]

our hospital is the same; no contrasted EJ/IJ. subclavian strongly discouraged. I think it's due to worry of extravasation, as stated above. if it's a stroke rule out I just admit the patient for PICC/mri/mra. This comes up sometimes in low-medium risk PE patients with no venous access who got a positive d-dimer for dubious reasons.. they need a 20-guage to give contrast, have a poor story for PE, but c/o CP/SOB and are tachy/on OCPs w/ BMI of 40.. putting a CVC almost certainly exposes the pt (and you) to more risk than not getting the CTPA for their almost certainly non-existent HD significant PE.. in residency I've had success with U/S guided peripherals but if that were not available it would be admit v/q scan vs. DC w/ iron clad documentation.

 

[brk81144]

I was able to convince radiology to hand inject contrast into a 22 gauge in the patients foot for a cta chest pe protocol... It can be done

 

[RPedigo]

Why not just a peripheral with ultrasound? Putting in a CVL just for an imaging study seems unnecessarily invasive.

There is a recent study that showed that extravasation was more common with ultrasound-guided deep brachial IVs in comparison to standard AC placement of IVs. I don't know any data for an EJ.

 

[deleted547339]

There is a recent study that showed that extravasation was more common with ultrasound-guided deep brachial IVs in comparison to standard AC placement of IVs. I don't know any data for an EJ.

I heard them talking about that on EMRAP. But how often do you place an US guided IV in someone with great veins? Also, not everyone uses the long catheters for deep veins which is a must.

 

[shookwell]

I sometimes use a peds central line kit for my deep US guided lines. My go-to is an a-line catheter but radiology won't do a CTA through those. Placing a standard angiocath into a deep vein is silly, they always blow.