Some patients just have no IV access – no superficial peripherals, no deep peripherals, no external jugular veins. In a critical emergency, this is the perfect time for an intraosseous line. But, what about the situation where IV access is simply necessary, but not urgent? Placing a central line is the last thing we're interested in doing – draping, opening a costly central line kit, billing for an expensive procedure, exposing them to risks of over-the-wire techniques in the central circulation.
This technique, described formally here by folks from Highland Hospital, involves placing a standard, peripheral catheter into the internal jugular vein under ultrasound guidance. While I think this is a fantastic idea – much faster and less expensive than a full multi-lumen central line set-up – I wouldn't characterize it as "risk-free", either. The nine cases in this year-long review all demonstrated a lack of complications, but more data would help refine the procedural risks.
"The ultrasound-guided 'peripheral IJ': internal jugular vein catheterization using a standard intravenous catheter."