External jugular vein (EJV) may be used as a central line, although it is preferred as a peripheral line since the vein is close to the surface of the skin
External jugular vein (EJV) may be used as a central line, although it is preferred as a peripheral line since the vein is close to the surface of the skin.
While using the external jugular vein for central venous access is associated with minimal complications, it has a relatively high failure rate. Many studies have explored ways to use EJV for a central line successfully.
What is an external jugular vein?
The external jugular vein is a superficial vein located in the neck that drains blood from most of the outer structures of the head, including the scalp, to the heart. It originates from the jaw and ends at the middle of the collar bone and is present just below the surface of the skin superficial to a muscle of the neck called the sternocleidomastoid.
The EJV carries deoxygenated blood from the muscles and other structures back to the heart. The blood from the external jugular vein is carried to the right atrium of the heart, from where it is pumped to the lungs to get oxygenated again.
When is the external jugular vein used as a central line vs. peripheral line?
EJV as a central line is preferred in the following situations:
- Long-term antibiotic treatment
- Administration of medicines
- Hemodialysis for kidney failure
- Hemoperfusion (filtering of blood outside the body to remove toxins)
- Hemodynamic monitoring (monitoring how blood flows through the cardiovascular system)
EJV as a peripheral line is preferred in the following situations:
- Frequent blood sampling
- Intravenous (IV) administration of a large amount of fluid
- IV administration of medications
- IV administration of anticancer agents
- IV nutritional support
- IV administration of blood or blood products
- IV administration of radiologic contrast agents (e.g., for computed tomography, magnetic resonance imaging, or nuclear imaging)
When should the external jugular vein be avoided for cannulation?
Because using the EJV is associated with minimal complications, there are hardly any contraindications. Most complications arise due to diminished neck movement.
EJV cannulations should be avoided in the following conditions:
- Superficial skin and soft tissue infection
- Inflammation of the wall of the external jugular vein
- Blood clots on the external jugular vein and corresponding subclavian vein
- Non-visible or palpable EJV
- Any known or suspected neck injury
- Diminished neck movement due to conditions, such as ankylosing spondylitis, cervical syndrome
- Collar bone fracture
- Lump in the neck or any other abnormalities
- Any trauma or injury to the head that might have led to a collection of blood outside the blood vessels of the neck
- Lemierre’s syndrome (inflammation of the internal jugular vein caused by bacterial infection)
- Anatomic abnormalities in the vein
EJV as a peripheral line should be avoided in cases of infection, injury, or burns at the site.
What are the advantages of using an external jugular vein for cannulation?
Since the external jugular vein is close to the skin surface and far away from most vital structures, the risk of complications is low.
Advantages of using EJV include low risk of:
- Lung collapse
- Airway obstruction in people with a severe bleeding disorder
- Bleeding
- Blood pooling in the space between the chest wall and lung (hemothorax)
