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Emergency Medical Minute


Dec 6, 2022

Contributor: Jared Scott, MD

Educational Pearls:

  • Two conventional ways to aid in external jugular vein (EJ) catheter placement are Trendelenburg’s position and Valsalva’s maneuver by patient 
  • One study compared ultrasound visualization of cross sections of EJ and common femoral vein at baseline and with patients in Trendelenburg's position, Valsalva's maneuver, and while humming
  • The study found all three conditions distended the veins from baseline, but there was no significant difference in diameter between the conditions  
  • Humming may be a viable technique in distended EJ for catheter placement, and may be easier for patients to comprehend than Valsalva 



Lewin MR, Stein J, Wang R, et al. Humming is as effective as Valsalva's maneuver and Trendelenburg's position for ultrasonographic visualization of the jugular venous system and common femoral veins. Ann Emerg Med. 2007;50(1):73-77. doi:10.1016/j.annemergmed.2007.01.024


Summarized by Kirsten Hughes, MS4 | Edited by John Spartz, MD, & Erik Verzemnieks, MD


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