The external jugular vein (EJ) begins at the angle of the mandible and courses to the middle of the clavicle at the posterior border of the sterocleidomastoid (Figure 1)
The EJ is formed by the junction of the posterior division of the posterior facial with the posterior auricular vein and drains into the subclavian vein (Figure 2)
Positioning and technique
Rotate the patient’s neck away from the EJ, stretching the vein to reduce rolling
Place the patient in Trendelenburg to increase venous distention, thereby facilitating placement, and to decrease the risk of air embolism (Video 1)
Other techniques to enhance EJ visualization include: 1) having the patient perform a Vasalva maneuver, 2) compressing the proximal EJ near the clavicle prior to catheter insertion (Figure 3)
Enter the vein high in the neck and maintain a shallow angle (5-10°) when puncturing the skin, as the EJ is a very superficial vein
Using a short catheter can facilitate the required shallow approach
Troubleshooting
Failure to cannulate: Frequently, if no flashback is observed, the needle has passed too deep. Withdraw the needle and attempt a more shallow approach.
Failure to thread the catheter: Valves may obstruct full insertion. To successfully pass the catheter, first withdraw the angiocatheter until venous blood flow returns. Once flow has been established, attach the catheter to IV tubing and then slowly advance the catheter while IV fluids are running.
