Sir,
We thank Dr. Uvelin and co-workers for their interest and valuable comments in response to our recent study.
1
We find it quite surprising how much catheterisation practices differ between institutions. On the contrary to Novi Sad University hospital in Serbia, external jugular vein catheterisation is very seldom utilized in our institution, Kuopio University hospital, Kuopio, Finland. We consider external jugular vein (EJV) to be an impractical catheterisation site in hospital care and we have noted that EJV catheters are easily dislocated. The advantages of EJV catherisation are faster access in CPR situations compared to internal jugular or subclavian route and faster cardiac drug responses compared to cubital veins.
2
In severely injured, multiple trauma patients as well as in major surgery we prefer larger lumen central venous or pulmonary artery catheters with large side lumens for fluid and blood product administration. The insertion site is invariably internal jugular or subclavian vein.Naturally EJV is used by prehospital care providers mainly during cardiac arrest. The main focus of our study was to evaluate whether this practise is feasible or not. As we have shown there might be some “pitfalls” related to EJV when performed by prehospital care providers.
We agree with Dr. Uvelin's comment in that more experience may improve the results in EJV catheterisation. In our study, relatively inexperienced emergency department residents and paramedics performed the catheterisations of EJV and cubital veins. We agree that insertion time may have been shorter and success rate higher if experienced anaesthesiologists or emergency medicine specialist had performed catheterisations. However, in our opinion, proposed practice experience in EJV catheterisation suggested by Uvelin and co-workers, with a minimum of 50 successful insertions may be unrealistic and impractical aim for paramedics and emergency care interns.
Finally, we suggest that EJV catheterisation may be useful method in experienced hands, in cardiac arrest when EJV is distended and visible. In those cases it may well be the first attempted access route. Otherwise, we would prefer antecubital vein as the primary iv-access site as shown feasible in our study especially in prehospital care.
1
Conflict of interest statement
No conflicts of interest to disclose.
References
- Is external jugular vein cannulation feasible in emergency care? A randomized study in open heart surgery patients.Resuscitation. 2009; 80: 1361-1364
- Central versus peripheral intravenous routes in cardiopulmonary resuscitation.Am J Emerg Med. 1984; 2: 385-390
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Publication history
Published online: March 15, 2010
Received:
February 5,
2010
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© 2010 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
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- External jugular cannulation is irreplaceable in many situationsResuscitationVol. 81Issue 6
- PreviewWe read with interest article by Lahtinen et al. on external jugular vein (EJV) cannulation in open heart surgery patients. They have shown that the antecubital vein was a faster and more reliable site for intravenous access compared with the EJV.1 Since it is common practice to use the EJV for peripheral venous cannulation (using 14, 16 or 17-gauge peripheral cannula) in our university hospital emergency department, intensive care unit and sometimes during cardiopulmonary resuscitation (CPR), we felt the need to emphasize the importance of this route.
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