IO vs External Jugular IV in trauma patients

[VentMedic]

I know what I have seen here and if we do an EJ or they do a central Line in the hospital after taking them out they keep the patient for 12-24 hours to be monitored. and I checked the book, I am not confusing IJ and EJ.

Could it also be the reason why an EJ or central line was done? Usually if you establish a line, it should be for a reason like giving a med and yes there are some meds as well as medical conditions that may require the patient to be kept longer for monitoring. It would be a stretch to say that all patients with lines initiated, peripheral or otherwise, must stay in the hospital. Few EDs are going to tie up a bed for that and few are going to admit a patient to the hospital if that is the only reason. However, if your technique causes them concern to where they feel they must keep the patient, that should be addressed. As well, if you and your department (or Paramedic program) are weak in peripheral IV starts to where the IO is "just easier" that also needs to be addressed.

One should be well versed in starting an EJ as there will be times where the IO could be done but probably shouldn't.

[RomeViking09]

Aww thanks! Maybe $0.03? woohoo! I feel special now.

On the topic though, an EJ is a pretty common (at least for me) Peripheral IV site with minimal complications associated with it if done properly and as trained. Maybe it is your training that is the issue here? We learned EJ's in a full class session and had to practice them in clinicals. EJ is usually one of my first sites I look at in a code due to the fact that I'm usually at the head anyways, and an AC access just doesn't cut it when you have 3 big FF's clunking around the patient and can pull the line easily. I prefer EJ any day to an IO, but I also know when the situation is appropriate to do both.

Aaron brings up a good point in that if the patients head is conveniently rolled laterally and I see a honkin EJ sticking up at me...I would consider one attempt only if the patients airway is also cleared and they are breathing adequately.

Rome-- If you think an EJ has more aftercare/risk than an IO I suggest you go try having one of each. An IO is drilled in to the bone and the people I have talked to who have seen the site 12-24 hours after removal, say the patient had site discomfort whereas an EJ feels like none other than a peripheral IV...

Have a fantastic week y'all and be safe.

Kate

I have had an IO (for Bone Marrow Sample, it hurts no worse than an IV and the discomfort is about 2 hours and that is it), I have seen two EJs in the field and both patients where in far more discomfort than the awake patients I have seen get IOs (2 in EMS and 4 more in Hospital settings)

[1EMT-P]

I think the IO would be the best choice... If you did an EJ you would have to reposition the patient's head & neck & this in itself could pose a problem not to mention the fact that you would need to be able to apply a Cervical Collar given your patients MOI.

[kohlerrf]

You respond to a high speed MVC, you find a patient entrapped in a SUV with signs and symptoms of shock, abdominal tenderness, and a broken left femur. Your standing orders and protocols call for vascular access on all trauma patients with signs and symptoms of shock but you and your partner can't gain IV access on his arms. What method of access do you think is best: IO access in the right anterior medial tibia with the EZ-IO or start a External Jugular IV. Give you reasons for your chosen method.

IO in the humerus EJ very risky and low percentage

[ERDoc]

IO in the humerus EJ very risky and low percentage

I'm not exactly sure what you are saying but I assume you support the IO over EJ. Why does everyone keep saying the EJ is so risky? It is no more risky than any other peripheral IV (unless you have no clue how to do it and really screw it up). What do you mean by low percentage? In most circumstances, as far as I am concerned, anyone that goes for IO over an EJ is just playing cowboy and using the equipment because it is there (please note that I said most, I agree there are times when IO will be necessary) or just doesn't know how to do an EJ properly.

Edited September 16, 2009 by ERDoc

[P_Instructor]

Has anyone thought about a subclavian? Lets break out the 14G (2.1mm) 5 1/4 (13.3cm) Angios and head for the hills!

[VentMedic]

Has anyone thought about a subclavian? Lets break out the 14G (2.1mm) 5 1/4 (13.3cm) Angios and head for the hills!

Are subclavian CENTRAL lines still in your protocols?

A femoral central line would present a few less risks but is still not a preferred route in the prehospital field setting.

The EJ is a peripheral line and it used frequently both in the hospital for rapid access as well as by many EMS agencies.

If someone or even all in agency can not get the EJ procedure done correctly, I don't think I would want them digging around for a subclavian or femoral central line.

[P_Instructor]

Are subclavian CENTRAL lines still in your protocols?

A femoral central line would present a few less risks but is still not a preferred route in the prehospital field setting.

The EJ is a peripheral line and it used frequently both in the hospital for rapid access as well as by many EMS agencies.

If someone or even all in agency can not get the EJ procedure done correctly, I don't think I would want them digging around for a subclavian or femoral central line.

I apologize...it was meant to be in fun only. Subclavians are cenral lines, and have worked with them in the aeromedical field only upon very discipline Medical Direction only. Have also done a couple of femorals. I do agree with you completely. The EZIO is probably my best choice, even though the EJ is not difficult if done correctly (which would be dependant on availability or position for access).

Again, sorry for the confusion.

[ERDoc]

I apologize...it was meant to be in fun only. Subclavians are cenral lines, and have worked with them in the aeromedical field only upon very discipline Medical Direction only. Have also done a couple of femorals. I do agree with you completely. The EZIO is probably my best choice, even though the EJ is not difficult if done correctly (which would be dependant on availability or position for access).

Again, sorry for the confusion.

Don't worry P_I, some of us got the humor.

[VentMedic]

Don't worry P_I, some of us got the humor.

Yes, but you must remember the Subclavian was taught in the Paramedic text books for many years and central lines are still in some ground ALS protocols and not just for Flight or Specialty. Subclavian lines were no different than chest tubes, intracardiac epi and pericardiocentesis which were all part of the regular Paramedic curriculum not that long ago. Just 20 years ago we didn't have a helicopter and a trauma center on every corner.

Edited September 16, 2009 by VentMedic