May 4, 2017

Background: IV access is one the most important interventions that must be performed in effectively managing patients in the Emergency Department.  It is part of “Circulation” in the ABCs acronym and is even first in the “IV, O2, Monitor” phrase that we have become accustom to hearing.  Although experienced ED nurses can obtain access quickly and without much difficulty in most patients, there remain a handful of patients that will present to the ED where standard peripheral access is unable to be obtained after multiple attempts.  What is the next step? Peripheral placement of an IV using ultrasound can be a great next step if timing permits, but this too can be troublesome in patients who are difficult to access, especially if dehydration is present.  IOs have become more popular but are painful when medications are given through them, thus making management more difficult in patients who are alert.  Also IOs are limited in regards to what lab testing can be performed.  Central lines are not worth the risk if IV access does not need to be central or if access is only needed temporarily.   External Juglar IV placement can have similar difficulties as traditional peripheral access especially, in patients with a large body habitus or who have had repeated EJ cannulations. What if a peripheral IV was placed into the internal jugular vein (Easy IJ)?  It is an easily visualized structure on ultrasound and cannulating it is a skill that is familiar to most Emergency physicians.  Is this a safe approach?

April 24, 2017

Background: We have all taken care of patients in whom IV access is difficult due to a multitude of reasons including repeated prior IV access, advanced vascular disease and shock. This often creates delays in patient care, increases ED length of stay, and uses up ED staff that have other patients to care for. Many providers have resorted to using IO access, particularly in critically ill patients due to speed of establishing access.  In stable patients, however, this may be a less desirable.  Ultrasound guidance has been a great addition in these patients.  Ultrasound guided peripheral IVs and external jugular access would probably be the next “go to options” in these patients. The authors of this paper evaluate yet another option: The Easy IJ.