External jugular vein hemodialysis catheter insertion approach: bedside pearls and pitfalls

Vascular access remains the cornerstone of the management of end-stage renal disease requiring hemodialysis (HD). While internal jugular vein and subclavian veins are commonly used, the external jugular vein (EJV) is an underutilized alternative that offers a safe, accessible and lifesaving route for HD catheter placement. To evaluate the feasibility, safety, technical considerations of the EJV HD catheter insertion approach and draw clinical recommendations to improve clinical outcomes. This is a review article discussing the EJV vascular access approach from all aspects. The review includes EJV anatomy, indications, contraindicatios, and technical tips for EJV HD catheter placement to minimize complications and optimize success rate. The EJV vascular access approach is a safe, effective, and often overlooked approach for HD catheter placement. Brainstorming and understanding the technical considerations related to EJV approach is essential for increasing its utilization when indicated in daily clinical scenarios. It does not always require ultrasound guidance in most of cases, and can be performed with minimal technical difficulty. It can be an alternative to internal jugular vein approach in case of emergencies and bleeding tendency. This approach should be considered a valuable addition to the vascular access armamentarium, and a viable alternative in challenging cases.