EJV (External Jugular Vein) Cannulation (in 5 mins)
- September 8, 2025
- 1:46 pm
In this video we have discussed how & when to go for EJV cannulation! Also, we have shown the exact & sterile procedure of inserting a cannula in External Jugular Vein (EJV).
Summary
External jugular venous cannulation is a simple but vital procedure in emergency and critical care settings. While it may look straightforward, safe practice requires knowledge of anatomy, indications, contraindications, sterile technique, and careful post-procedure care.
This guide will walk you through the essentials of EJV cannulation, from understanding the vein’s anatomy to mastering the sterile technique.
Table of Contents
- Introduction
- Anatomy of the External Jugular Vein
- Indications for EJV Cannulation
- Contraindications
- Step-by-Step Procedure
- Post-Procedure Care
- Conclusion
- Key Takeaways
Introduction
Before attempting any invasive procedure, it is critical to understand the underlying anatomy, indications, contraindications, and the sterile technique required. External jugular venous (EJV) cannulation offers rapid venous access when peripheral options are limited.
Anatomy of the External Jugular Vein
The EJV is formed by the union of the retromandibular vein and the posterior auricular vein.
- It runs obliquely across the side of the neck.
- It drains into the subclavian vein.
- It lies superficial to the sternocleidomastoid muscle, making it accessible for cannulation.
Indications for EJV Cannulation
EJV access may be considered in the following scenarios:
- Rapid fluid resuscitation, as the vein can accommodate a large-bore cannula.
- Difficult peripheral access when limb veins are not available.
- Administration of certain medications such as 3% saline or low-dose vasopressors (noradrenaline, vasopressin).
- Transfusion of blood and blood products.
For high-dose vasopressors, central venous access via the internal jugular or subclavian vein is recommended instead.
Contraindications
Avoid EJV cannulation in:
- Suspected or confirmed thrombosis of the external jugular vein.
- Local infection at the insertion site.
- Situations where central access is clearly required, such as high vasopressor requirements or the need for central venous pressure monitoring.
Step-by-Step Procedure
Preparation
- Use a 14G–16G cannula depending on vein prominence.
- Follow strict aseptic precautions.
- Position the patient supine with slight Trendelenburg tilt to distend the vein.
Technique
- Locate and distend the vein by occluding the EJV just above the clavicle.
- Insert the cannula at a shallow angle and confirm entry by observing flashback of blood.
- Remove the needle and advance the catheter gently into the vein without resistance.
- Confirm placement by checking blood backflow and flushing with saline to rule out swelling or resistance.
- Secure the catheter and apply a sterile dressing.
Post-Procedure Care
- Ensure the site remains sterile and monitor for signs of infection.
- Regularly check catheter patency.
- Remove promptly if no longer indicated to minimize infection and thrombosis risks.
Conclusion
External jugular vein cannulation is a valuable skill for clinicians, especially in emergencies where rapid vascular access is needed. With proper understanding of the anatomy, careful patient selection, and adherence to sterile technique, it can be performed safely and effectively.
Key Takeaways
- The EJV is superficial, accessible, and drains into the subclavian vein.
- Indications include rapid fluid resuscitation, difficult peripheral access, specific medications, and transfusions.
- Contraindications include local infection, thrombosis, or the need for central access.
- Technique involves distending, puncturing, advancing, confirming, and securing.
- Post-care includes maintaining sterility, confirming patency, and monitoring for complications.
Raw Transcript
[00:00] Yes, we did it. This is a normal reaction after procedure. But before going ahead with any kind of procedure, you need to know the anatomy. Secondly, the indications of that procedure. Let's say about this. EJM.
[00:20] may be cannulation that is external jugular vein cannulation. Thirdly, you need to know the exact procedure, the sterile technique of performing that procedure and lastly when not to perform it or the contraindication. So I will talk everything about external jugular venous cannulation in this video. Keep watching till the end.
[00:40] So, welcome again to Intellect Medigos, where learning is made easy. And I'm Dr. Chirag Madan, critical care specialist. So, starting with the anatomy of EJV that is external jugular vein.
[01:00] So it as you can see in this diagram that retro mandibular vein combines with your posterior oricular vein to form EJV and this runs obliquely in your neck and drains into subclavin vein and this runs this EJV runs anterior superficial.
[01:20] to your sternocleidomastoid. And so this is just the anatomy. It is superficial in the skin. Talking about the other important aspect that is the indication. Why do we need to go with it? Why do we need to perform EJV, cannulation? Now, whenever you have to resuscitate
[01:40] the patient. You have to give fluids at a higher rate or a higher speed. Then yes, because this is having a wider bore, then yes, you need to go with it. Secondly, whenever you are not able to find peripheral cannulas, peripheral veins in the limbs, yes, you can go ahead with external jugular venous cannulation. Thirdly, whenever
[02:00] you have to administer somewhat hyper or smaller medicines or fluids, let's say 3% normal selenide or let's say your vasopressors, not adrenaline or vasopressin, but that too on the lower side. Whenever the requirement of your vasopressin on the higher side, you need to go
[02:20] with central venous catheter that is inside your IJV, internal jugular, not the external jugular. And giving the blood and blood products. So these are the few indications where you think, yes, you can go ahead with EJV cannulation. Now coming back to the actual procedure or the
[02:40] sterile manner.
[03:00] So that it does not get infected. Now you have to select a clavicle. In this video I have used 16 gauge. You can go ahead with 14 gauge because of this prominent vein. Now you need to occlude the EJV just above the clavicle so as to make it more prominent. And I am checking the side of the entry. And I will insert the clavicle.
[03:20] third ear and move it very superficially and will check the blood in the hub. As soon as I have seen, I have taken out the needle and proceed inside with the catheter without any resistance as shown. And then you need to check the backflow. Yes, you can see the backflow of the blood over there. Then you need to cap it, secure the cannula.
[03:40] And now you need to check whether you are inside the vein or not. So check with the normal saline flush whether there is any kind of swelling or not or whether you can flush it without any resistance. Right, yes, the cannula is in the vein. The last part is obviously the dressing.
[04:00] You have to put a good dressing over there so that first it looks good, cosmetic reasons and secondly it should be sterile. I mean the important is it should be sterile. The entry point should not be infected. There should be no point of entry for the organism.
[04:20] microorganisms. Now see how beautifully the dressing is done. Yeah, done.
[04:40] because you are going inside the blood. Secondly, if any thrombosis, you can see any thrombosis of EJV, then also you should not go ahead with the procedure. So this is what it is, the EJV cannulation. Very simple. I mean it looks simple, but yes, whenever you keep on performing,
[05:00] it, you will become pro in it. I hope you have enjoyed listening and watching this video. Drop your comments in the comment section. Bye bye. Take care.
