UNCONTROLLED WHEN PRINTED
Indications
  • Intravenous access for fluid or drug administration.
Contraindications
  • Directly over or distal to:
    • Burns
    • Cellulitis
    • Infection
    • Injury
  • Patients with chlorhexidine sensitivity/allergy, use 10% povidone-iodine swab
Patient Factors & Considerations
  • MAXIMUM of 2 attempts prior to transport (only 1 vascular (IV/IO) attempt in traumatic cardiac arrests)
  • High risk of pneumothorax or lung injury
Procedure
  • All relevant infection control methods to be utilised.
  • Prepare equipment required:
    • Cannula
    • 10ml syringe
    • 10ml normal saline for injection
    • 2% CHG 70% Alcohol swab OR 10% povidone-iodine swab
    • Needle-free valve (“bung”)
    • Giving set
    • Single patient use tourniquet
      (peripheral vein only)
    • Transparent IV dressing and "Ambulance Inserted" sticker OR
    • Transparent Emergency IV dressing

     


External Jugular Vein

  • Place patient in supine or Trendelenburg position[5].
  • Divert patient’s head away from site.
  • Select appropriate cannula size and attach to 10mL syringe[6].
  • Clean insertion site with 2% CHG 70% alcohol swab OR 10% povidone-iodine swab
  • Consider local anaesthesia
  • Occlude vein by applying pressure above the clavicle[7].
  • Insert cannula at 30°, bevel up[8].
  • Draw back on syringe and observe for blood.
  • Reduce angle and advance needle
  • Advance the catheter into the vein until a ‘click’ is heard
  • Apply gentle pressure over the tip of the catheter
  • Dispose of sharp
  • Attach bung
  • Flush the catheter with 5-10mL saline
  • Remove the catheter if pain, haematoma, oedema or extravasation occurs
  • Secure catheter using transparent IV dressing.
  • Connect giving set and IV fluid as required
  1. Trendelenberg Position
    Vasc - Trendelenberg

  2. Vasc - ExtJugCath

  3. Vasc - Find

  4. Vasc - ExtJugInsert
Success
  • Ability to administer medications as per specific guidelines.
Discontinue
  • If multiple failed attempts, consider whether vascular access is necessary to manage current patient presentation.
Additional Information

Potential complications of attempting vascular access:

  • Air embolus
  • Arterial puncture
  • Cannula shear
  • Extravasation
  • Haematoma or haemorrhage
  • Infection
  • Nerve damage
  • Phlebitis
  • Vasovagal syncope

References

Cadogan, M. (n.d.). EZ-IO-3. Retrieved June 27, 2016, from Life In The Fast Lane: http://i1.wp.com/lifeinthefastlane.com/wp-content/uploads/2009/09/EZ-IO-3.jpg 

Teleflex. (2013). The Science and Fundamentals of Intraosseous Vascular Access. Retrieved June 27, 2016, from Teleflex: http://www.teleflex.com/en/usa/ezioeducation/documents/EZ-IO_SAFIOVA-M-607%20Rev%20B-PrintVersion.pdf 

Teleflex. (2014). Clinical Principles of Intraossoeus Vascular Access. Retrieved June 27, 2016, from Teleflex: http://www.teleflex.com/en/usa/ezioeducation/index.html 


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