First South Carolina Nurse-Placed Internal Jugular CVC – Nurse Clinicians in Action – 54

First South Carolina Nurse-Placed Internal Jugular CVC highlights a case in a Rehabilitation Hospital where a patient needed IV access for the administration of antibiotics, blood products, and blood draws. A Midline was ordered, but because of her extensive venipuncture history and prior PICCs and Midlines, the guidewire could not be advanced for successful Midline placement, so a central line was needed to complete therapy.

First South Carolina Nurse-Placed Internal Jugular CVC

– Clinical Case

An elderly patient in a Rehabilitation Hospital with a left chest pacemaker and cellulitis needed intravenous access for the administration of antibiotics, blood products, and frequent blood draws. The facility made numerous attempts to place a peripheral IV (PIV) but was unsuccessful due to the patient’s difficult intravenous access (DIVA) condition.

Vessels can be more difficult to access in older patients for many reasons. The skin becomes thinner, and dehydration and loss of elasticity – both of which are often seen in elderly patients – make gaining vascular access difficult. In addition, the veins become more fragile and unstable, making them prone to bruising and tearing.

With the need for Zosyn (antibiotic), fluids, and access for blood draws, and knowing the patient’s care team did not want to subject the patient to more unsuccessful and painful sticks, the facility contacted Vascular Wellness and ordered a Midline. This facility has a long-standing relationship with Vascular Wellness and partners with them to gain vascular access, not only for PICCs and Midlines, but also as a vascular access partner in difficult IV access cases such as this.

First South Carolina Nurse-Placed Internal Jugular CVC

– Diagnosis and Treatment

The Vascular Wellness advanced trained nurse clinician arrived at the patient’s room in the facility a short while later. She conducted a thorough physical assessment of the patient and reviewed the treatment plan and medical history. Seeing no contraindications for a Midline based on the patient’s therapy, the clinician began an assessment of the patient’s vasculature with ultrasound guidance. She determined that the vessel sizes in the right arm were too small to safely accommodate a Midline catheter, which could be because of previous access, failed attempts, and/or hydration status.

Moving to the left side, the vascular access clinician noted the brachial was the only vessel large enough to accommodate a Midline, and it was compressible, making it the only candidate for access. Based on the clinician’s extensive training and experience, she knew there was a chance that the patient’s vasculature would not support access in her upper extremities, but she felt it was best to try the most appropriate and least invasive line for the therapy prescribed, and given that the patient’s left side met the requirements, she attempted to place a Midline as ordered.

However, the guidewire could not be advanced, likely due to extensive venipuncture history and many prior Midlines, PICCs, and central lines (which the patient noted).

With the significant bruising on both arms from the previous failed attempts, her DIVA condition, and the inability to advance the guidewire due to what might be stenosis of the veins from the extensive history of vascular access devices, the clinician determined that a central line was the next best option to continue therapy for the patient.

In late September 2025, the South Carolina Board of Nursing issued a decision to follow suit behind numerous other states to allow appropriately trained nurses to place Internal Jugular central lines.

Given the patient’s clinical needs, the remaining options were to (1) transfer the patient to and from the main hospital via ambulance for vascular access which likely would have led to more uncomfortable sticks for the patient and possibly a trip to Interventional Radiology for line placement, or (2) proceed with a nurse-placed Small Bore Internal Jugular (IJ) central line (also known as a CVC, or central venous catheter) at the bedside in this same visit.

Because Vascular Wellness nurses are trained in placing advanced central lines at the bedside – including Internal Jugulars, among many other central lines – the nurse was able to offer a solution that could be implemented immediately.

The Vascular Wellness nurse discussed the situation with the patient’s care team and explained why she recommended a right-sided Small Bore Internal Jugular central line. The provider readily agreed with the recommendation and changed the order. The Internal Jugular CVC was successfully placed at the patient’s bedside in the same visit under ultrasound guidance utilizing Sherlock and ECG tip confirmation technology. Per facility policy and industry standards, a post-procedure chest X-ray verified optimal tip placement at the cavoatrial junction, and the line was cleared for use without delay. The patient tolerated the procedure very well with no complications.

Additionally, the Vascular Wellness clinician consulted with the charge nurse to ensure her team understood how to appropriately care for the central line. She explained the steps in caring for an Internal Jugular central line are substantially similar to caring for a PICC line, and with that, the charge nurse felt much better.

In addition to sharing care and maintenance protocol for a central line, the Vascular Wellness clinician explained that we place Internal Jugular lines anatomically lower and near the clavicle, making care and maintenance of the line much easier than when the catheter is placed high on the neck, as well as making it more comfortable for the patient.

The patient was thankful for the expertise of the vascular access clinician and the care she took during the entire process. The patient stated that she had an Internal Jugular CVC before, and knowing her history of difficult IV access, she was not surprised that an Internal Jugular central line was needed. She was also extremely grateful that she did not need to be transported to another facility for the procedure and that her treatment could continue swiftly.

South Carolina Vascular Access Specialists

– Key Points

Thanks to the South Carolina Board of Nursing’s decision (initiated upon petition by Vascular Wellness based on its data, success, and provider support since 2011 when it started placing central lines at the bedside) to follow suit behind numerous other states to allow nurse-placed internal jugular central lines, this patient was able to receive a much-needed central line and continue her treatment without unnecessary delay and avoidable extra costs.

Instead of needing to be transported via ambulance to and from another facility – which can be costly, complex, cause many delays, and risk patients not returning to the treatment facility – the patient was able to receive an Internal Jugular CVC at the bedside by an expertly trained nurse just a short while after the order for vascular access was placed, enabling swift treatment and mitigating the risk of additional clinical complications caused by delays.

Expert Training. Proven Skills.

Our clinicians are specialists and experts who are trained and precepted in placing Ultrasound Guided PIVs, Midlines, PICCs, and Small and Large Bore central lines, and in identifying contraindications and comorbidities from physical examination and medical history review to help recommend the most clinically appropriate line in every patient case. Having a clinician who is able to pivot when a prescribed line can be downgraded or advanced means that your patient can receive prompt care in place, reducing patient complications, avoiding transportation costs, and allowing your medical team to focus on their field of practice.

With the ability to place a comprehensive line of vascular access devices, including Small Bore Internal Jugular central lines and more, Vascular Wellness can place the right line (as clinically indicated) at the right time, the first time, at the bedside, enabling the partnering facility to avoid delay cascades of treatment, improve patient outcomes, and reduce costs.

Our Vascular Access Specialists are Vascular Access Board Certified (VA-BC) and semi-annually skill-verified to ensure we consistently operate at or above industry standards for patient safety, documentation, and evidence-based practices. We have a Director of Research and Development who is responsible for keeping our employees current on the most recent clinical practice guidelines for vascular access and helps continually improve and advance our vascular access services. We actively participate with AVA, INS, CDC, IDSA, Nursing License Boards, Hospital Boards, and The Joint Commission, and are known as subject matter experts. It was our reputation, experience, knowledge, and industry leadership and participation that helped advance central lines to the South Carolina nursing scope of practice, and we, once again, thank the SC Board of Nursing and its leaders, nurses and doctors who participated in the process, and all nurses as they serve a critical and essential role in delivering the best healthcare.

Nurse Clinicians in Action is a spotlight series highlighting some of the interesting cases that Vascular Wellness clinicians have encountered and participated in treatment. These cases involve challenging situations or intriguing clinical presentations and may involve more than one Vascular Wellness clinician, as our clinicians have the ability to consult each other while in the field, as well as an on-call Clinical Administrator via a HIPAA (Health Insurance Portability and Accountability) compliant communication app. In addition, our extensive training program and diverse client base, including Level 1 Trauma Centers, Short Term Acute Care Hospitals, Long Term Acute Care Hospitals, and Skilled Nursing Facilities, provide our clinicians with a wide array of clinical experience and why we believe our clinicians, as a group, are the most experienced and best trained and supported vascular access clinicians.

If you require Vascular Access or want to learn more, speak to the team at Vascular Wellness today.
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Vascular Wellness provides:
(1) Comprehensive vascular access services to North Carolina, Oklahoma, South Carolina, and Virginia; and
(2) Customized vascular access services to Arkansas, Delaware, Georgia, Mississippi, Pennsylvania, Tennessee, and West Virginia; and
(3) Support vascular access services to Ohio and Kentucky.