You identify a great external jugular (EJ) vein to cannulate for IV access. You are having a hard time keeping the angle of the angiocatheter aimed at a shallow angle because the mandible is in the way. This is typical of patients with chubby necks (eg. pediatric patients) or who are unable to rotate their neck.

Trick of the Trade: Bend the angle of the angiocatheter

Bend the proximal 1/3 portion of the needle slightly about 10-15 degrees. This allows you to approach the EJ vein at a shallow angle without hitting the mandible. Once you get a flashback of blood, feed the catheter as you normally would.

Tip: Don’t bend right at the hub because it partly obstructs your ability to feed the cathether.

Thanks for Dr. Catilin Bilotti (UCSF-SFGH chief resident) for the video and tip!

Michelle Lin, MD
ALiEM Founder and CEO
Professor and Digital Innovation Lab Director
Department of Emergency Medicine
University of California, San Francisco
Michelle Lin, MD


Professor of Emerg Med at UCSF-Zuckerberg SF General. ALiEM Founder @aliemteam #PostitPearls at https://t.co/50EapJORCa Bio: https://t.co/7v7cgJqNEn
Michelle Lin, MD