Paitents can be a challenge when trying to obtain peripheral IV access. The vein may be collapsed from dehydration or scarred because of IV drug use or repeated cannulation. Before thinking about an ultrasound-guided deep vein IV or a central line, take a look at the external jugular (EJ) vein.

There are, however, a few problems that exist when trying to cannulate this site:
  • There is no tourniquet for the neck.
  • To distend the vein, you often need to put the patient in Trendelenburg, which may be uncomfortable or intolerable for some
Trick of the Trade

Use a stethoscope as an EJ tourniquet

 Arrow points to occlusive point of stethoscope on EJ vein
Wrap your stethoscope around the patient’s neck. This occludes the EJ in a comfortable manner without restricting the trachea. An often obscure EJ plumps up and becomes visible or palpable.

Want to see ultrasound evidence?

The EJ area before and after application of an EJ stethoscope-tourniquet on myself was 0.11 cm2 and 0.46 cm2, respectively. This represents a 4-fold increase in area after 1 minute.

Ultrasound of neck (arrows point to EJ vein)


Want more evidence? We’re in the process of studying the EJ tourniquet’s effectiveness. The results will be in an abstract near you soon!

Timothy Peck, MD
ALiEM Blog Contributor
Emergency Medicine resident
Beth Israel Deaconess Medical Center
Founder, iClickEM
Co-Founder, Parzival
Timothy Peck, MD

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