Difference Between External Jugular Vein (EJV) Line and Central Line
An EJV line is a type of peripheral venous access that can sometimes be advanced into the central circulation, while a "central line" refers to a catheter whose tip terminates in the superior vena cava or right atrium, typically inserted via internal jugular, subclavian, or femoral veins.
Anatomical Location and Access Route
Central Lines (Traditional)
- Central venous catheters (CVCs) are inserted via the internal jugular vein, subclavian vein, or femoral vein with the catheter tip positioned at the junction of the superior vena cava and right atrium 1.
- The right internal jugular vein is the preferred site due to its straighter path to the superior vena cava, requiring shorter catheter length (15 cm) and resulting in fewer mechanical complications 2.
- The subclavian vein has the lowest infection risk among central access sites 2.
- Access to the upper vena cava via internal jugular or subclavian vein is the first choice for CVC placement 1, 3.
External Jugular Vein Lines
- The EJV is a superficial vein that runs from the angle of the mandible to the middle of the clavicle and can be cannulated as an alternative access site 4.
- EJV access is considered when the right internal jugular vein is not available due to occlusion, infection, existing catheter, or anatomical concerns 4.
- EJV catheterization can achieve central venous access when the catheter is successfully advanced into the central circulation, though this is technically more challenging 4, 5.
Technical Success and Insertion Characteristics
Central Lines
- Ultrasound guidance is strongly recommended for all internal jugular vein catheterizations to improve success rates and reduce complications 2, 3.
- Technical success rates for traditional central lines via internal jugular or subclavian approach are consistently high with experienced operators 1.
- Right-sided access is preferable to left-sided approach with respect to risk for thrombotic complications 1.
EJV Lines
- Technical success for EJV catheterization ranges from 73-96%, with the lower success rate often related to difficulty advancing the catheter centrally 4, 6.
- EJV access was successful in 91% of attempts in pediatric open surgical technique 7.
- The EJV approach requires longer catheter insertion length and may require more attempts compared to internal jugular access 5.
- Ultrasound guidance does not significantly improve EJV cannulation success rates compared to landmark technique, particularly for inexperienced operators 6.
Clinical Indications and Duration of Use
Central Lines (by Type)
- For short-term access (days to weeks): Non-tunneled polyurethane catheters are appropriate 2.
- For medium-term access (up to 3 months): PICCs, Hohn catheters, or tunneled catheters are suitable 2.
- For long-term access (>3 months): Tunneled catheters (Hickman, Broviac, Groshong) or totally implantable ports are required 1, 2.
- For home parenteral nutrition: Tunneled central catheters via subclavian or internal jugular vein are the standard, as permanent access is required 1.
EJV Lines
- EJV access is primarily used as an alternative when traditional central venous sites are unavailable 4.
- Mean catheter dwell time via EJV ranges from 2-182 days (mean 62.7 days), indicating suitability for short to medium-term use 4.
- EJV catheters using Groshong design showed comparable infection rates to internal jugular catheters 5.
Complications and Safety Profile
Central Lines
- Subclavian vein has the lowest infection risk, followed by internal jugular, with femoral having the highest risk 2.
- The femoral vein is relatively contraindicated for parenteral nutrition due to high risk of contamination and venous thrombosis 1.
- For hemodialysis patients, avoid subclavian vein as it causes central venous stenosis and precludes future arteriovenous fistula creation 2.
EJV Lines
- EJV catheterization has no severe complications such as pneumothorax, arterial bleeding, or nerve damage that can occur with internal jugular or subclavian approaches 5.
- Catheter-related bloodstream infection rates are comparable between EJV and internal jugular approaches (0.22 per 100 catheter-days for EJV) 4, 5.
- Dislodgement rates may be higher with internal jugular compared to EJV in some studies 7.
- No cases of symptomatic venous thrombosis were noted in EJV catheterization series 4.
Functional Capabilities
Central Lines
- Central venous lines provide access to monitor CVP and venous oxygen saturation in the superior vena cava or right atrium 3.
- The tip position at the right atrial-superior vena cava junction is critical for accurate CVP measurement 1, 3.
- Central lines can deliver high-osmolality solutions, vasopressors, and high-volume infusions safely 1.
EJV Lines
- EJV catheters can be used for CVP monitoring when successfully advanced into the central circulation 8.
- EJV access is suitable for total parenteral nutrition when the catheter tip reaches central circulation 5.
- The success of central advancement determines whether an EJV catheter functions as a true central line 4, 6.
Key Clinical Decision Points
When to choose traditional central line access:
- Long-term parenteral nutrition or chemotherapy requiring tunneled catheters 1
- Need for reliable CVP monitoring 3
- Hemodialysis access (via internal jugular, never subclavian) 2
- When infection risk minimization is paramount (choose subclavian) 2
When to consider EJV access:
- Internal jugular vein is occluded or unavailable 4
- Localized skin infection overlying traditional central venous sites 4
- Patients with coagulopathy or thrombocytopenia where reduced surgical morbidity is desired 7
- Concern for pneumothorax or arterial injury with traditional approaches 5
- Tracheostomy device adjacent to presumed internal jugular catheterization site 4
Important Caveats
- PICC lines are not recommended for long-term home parenteral nutrition due to higher risk of thrombosis and difficulty with self-administration 1.
- Multi-lumen catheters are not recommended for home parenteral nutrition to minimize infection risk 1.
- Left-sided internal jugular placement is associated with poor blood flow rates, higher stenosis and thrombosis rates 2.
- The smallest appropriate catheter diameter should be selected, ideally one-third or less of the vein diameter 2.