Internal Jugular Line and Vasopressors – Nurse Clinicians in Action-07

Internal Jugular Line and Vasopressors describes how the Vascular Access clinician was able to use his advanced skill set to timely place an Internal Jugular (IJ) line in a critical patient on vasopressors and is the focus of this Nurse Clinicians in Action.

Internal Jugular Line and Vasopressors

– Clinical Case

This case occurred in a hospital with a critically ill, unconscious patient, paralyzed in one arm.  The patient was on vasopressors, powerful drugs that constrict the veins to increase blood pressure to the heart, and had received the norepinephrine through the arm resulting in vein constriction.  This made the upper arm veins no longer able to support a PICC line; however, the patient needed vascular access.  The patient’s medical condition was compounded by respiratory closure.  The intrathoracic pressure changes with larger inspiration and smaller expiration were causing instability of the internal jugular vein, making for a difficult Internal Jugular (IJ) placement despite what is clinically indicated.

After two doctors and an anesthesiologist tried unsuccessfully to place an IJ, they placed an intraosseous needle in his bone marrow to have access to his bloodstream.  Unfortunately, this line has only 1 lumen and the patient’s multiple and incompatible medications required separate lumens, making it an incomplete and inferior solution.

Internal Jugular Line and Vasopressors

– Diagnosis and Treatment

Despite the respiratory closure, the Vascular Wellness clinician was able to quickly and timely place a triple lumen Internal Jugular (IJ) line and confirm such placement.  Placing and confirming the line, which was then validated by the physician, gave the physician comfort to commence treatment immediately as needed.  Thrilled that his patient now had access to lifesaving medications in time, the physician thanked the Vascular Wellness clinician.  The physician was very surprised when the clinician explained that he has performed thousands of these procedures and that his diverse experience and expertise in vascular access enabled him to place lines in complex cases.

Vascular Access Expert

– Key Points

Vascular Wellness prides itself on advancing its ability to place complicated lines including small and large bore lines, at the bedside.  As the vascular access specialty continues to evolve with technological advances and additional catheter types, and patients present with complex and novel medical conditions, it is important that the vascular access clinician have the training and experience to provide this service and perform these procedures regularly to maintain the skill set.  This patient was in critical condition, with his blood pressure crashing, and may not have received the necessary vascular access and his medications in time had a vascular access specialist not been present.  All patients, especially those with complicated medical issues and history, have much better outcomes when a vascular access specialist and expert performs the vascular access placement, similar to other medical specialties. Timely, safe, effective, and efficient medical care is critical.

Vascular Wellness clinicians have placed hundreds of thousands of lines and this experience enables us to assess a situation and patient properly and if a patient is contraindicated for a specific central line, to utilize that experience to place a clinically appropriate line such as an IJ.  Further, by having the tools of US Guided PIVs, Midlines, PICCs, Small Bore lines such as Internal Jugular lines (IJs) and Femoral lines (Fems), and Large Bore lines including Vas Caths and Quad Lumens, Vascular Wellness is able to create clinically appropriate access in virtually all patients, while minimizing multiple needle sticks. The ability to minimize sticks and place the right line at the right time, the first time, is incredibly important as the placement of a Central Venous Catheter is an invasive medical procedure that comes with risks.  These factors, along with a consultative approach with the treating physician, are just a few reasons why Vascular Wellness improves patient outcomes, reduces costs, and strengthens infection control.

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.  For the latest articles and insights, follow us on LinkedIn, Facebook, Twitter, YouTube, and Instagram.

Vascular Wellness provides:
(1) Comprehensive vascular access services to North Carolina, South Carolina, and Virginia; and
(2) Customized vascular access services to Tennessee, Georgia, and West Virginia; and
(3) Support vascular access services to Pennsylvania, Ohio, and Kentucky.