Finding an EJ

[FireEMT2009]

Hey guys,

After working with patients for a while now I have a question.

I have noticed that some people have blatent EJ veins but some of the patients that I have thought about attempting the EJ, I have had issues trying to locate and find it even though I know where it should sit anatomically.

Does anyone have any tips to find an EJ for the non-obvious EJ patients?

Thanks in advance,

FireEMT2009

[scubanurse]

You can lay them flat, or in trandelenburg if safe to do so and have them turn their head to the side, again if safe to do so. Sometimes you can have them puff out their cheeks like blowing up a balloon and that can help create a backflow in the EJ and make it more visible. Again, all of these techniques are only used if allowed and won't harm the patient. You can also place firm pressure against the clavicle and sometimes that will help as a "tourniquet", EJ's take a lot of practice as a lot of times you won't get a regular flash like you do on other peripheral IV's, it'll be small and you just have to know what you're feeling.

Also something to keep in mind, a lot of ER's don't even allow their RN's to do EJ's and you have to have special training to perform them since there is increased risks associated with the procedure.

[island emt]

Here is a great program that covers EJ's it is well done and give the anatomical physiology and the indications / contra-indications.

http://www.uabem.com/storage/ej_verification/EJ_Verification_Program_Lecture_ver_c.pdf

[croaker260]

We were taught to do this in a pinch... http://en.wikipedia.org/wiki/Abdominojugular_test

[1EMT-P]

It takes lots of practice locating and placing an EJ, it usually depends on the patients anatomy and positioning. I personally haven't placed one in the field in years so I would attempt to place a traditional IV first, then if that failed I would move on to an IO.

Edited April 27, 2013 by 1EMT-P

[houstonsbravest]

ive placed a bunch of ejs in the field. laying flat and with the legs up helps out alot. ive placed them mostly on cardiac arrest patients but have placed some on hypoglycemic patients with no veins. its aggresive but if their sugar is say below 20 and theyre unconscious i feel its neccessary. the ones that are conscious and need one is tricky but laying flat and turning head is the only way i know.

[Sequel]

I recently placed my first EJ on an 11 month old patient who had no other good sites for placement. I wish I could give you some advice about how to find one, but with mine it was very visible (although bouncing quite a bit due to an increased work of breathing). Don't know that I would place one without it being quite palpable or visible though. When in doubt, remember that there's always IO!

[Just Plain Ruff]

Yeah, it's technique technique and like the Real estate biz "location location location"

There is also increased risk of air embolisms but I've never seen one but my experience is limited to about 15-20 EJ's in my career.

Why not just go IO when you have such an easy placement device???(unless bilat amptations of legs ha ha ha)

But seriously, I think I might go IO before I go EJ. If the patient is bad enough to warrant a EJ then I think in my opinion they warrant an IO. My rule of thumb "3 sticks then IO on critical patients" but sometimes 3 is too many.

I have actually found that the IO drill hurts less if done properly than sticking a 14 ga in the neck of a conscious patient. The thing you have to get past the patient if they are conscious is pulling out the drill to put a big needle in their tibia or bone. I do know in the 15 or so placements of the IO, that removing the IO has been the most painful part.

Edited May 29, 2013 by Captain ToHellWithItAll

[Off Label]

If you have the type of iv catheter that you can put on the end of a syringe, advancing it with the plunger pulled back to create some negative pressure is a good way to get your flash.

[kohlerrf]

EJ's are tough I agree your best bet is trendelenburg. In the old days we use to put a 3 CC syringe on the back of our IV needle and with our pinky pull back on the plunger to create a suction in the needle. Remember the EJ is at a very low pressure and often times you will be in and get no flash! unfortunately you put a syringe on the back of a needle cath today, but the IO work great instead? ;-)