IntroductionThe peripheral internal jugular (IJ), also called the “easy IJ,” is an alternative to peripheral venous access reserved for patients with difficult intravenous (IV) access. The procedure involves placing a single-lumen catheter in the IJ vein under ultrasound (US) guidance. As this technique is relatively new, the details regarding the ease of the procedure, how exactly it should be performed, and the safety of the procedure are uncertain. Our primary objective was to determine the success rate for peripheral IJ placement. Secondarily, we evaluated the time needed to complete the procedure and assessed for complications.MethodsThis was a prospective, single-center study of US-guided peripheral IJ placement using a 2.5-inch, 18-gauge catheter on a convenience sample of patients with at least two unsuccessful attempts at peripheral IV placement by nursing staff. Peripheral IJ lines were placed by emergency medicine (EM) attending physicians and EM residents who had completed at least five IJ central lines. All physicians who placed lines for the study watched a 15-minute lecture about peripheral IJ technique. A research assistant monitored each line to assess for complications until the patient was discharged.ResultsWe successfully placed a peripheral IJ in 34 of 35 enrolled patients (97.1%). The median number of attempts required for successful cannulation was one (interquartile range (IQR): 1 to 2). The median time to successful line placement was 3 minutes and 6 seconds (IQR: 59 seconds to 4 minutes and 14 seconds). Two lines failed after placement, and one of the 34 successfully placed peripheral IJ lines (2.9%) had a complication – a local hematoma. There were, however, no arterial punctures or pneumothoraces. Although only eight of 34 lines were placed using sterile attire, there were no line infections.ConclusionOur research adds to the growing body of evidence supporting US-guided peripheral internal jugular access as a safe and convenient procedure alternative for patients who have difficult IV access.

SUMMARY One hundred and eighty-four cases of malignant melanoma of the lids and epibulbar region were seen in the Radiotherapy Department of the Royal Marsden Hospital during the period 1943-74. Some of these tumours were radiosensitive and could thus be treated by radiotherapy without loss of the affected eye. Their clinical and histological features are described. The treatment policy adopted was based on radiotherapy first, and surgery reserved for the failures. A policy of observation is advised for precancerous melanosis, and active treatment should be undertaken only if malignancy supervenes. The contraindications for radiotherapy, the factors governing radiosensitivity, and the incidence and site of metastases are reported, and the possible effect on the metastatic and survival rates of leaving the eye are discussed. Active treatment of the node-free neck is not advised. Results are given according to site, histology, and treatment method, and the frequency with which the eye was lost is shown, since the sole advantage of radiotherapy over surgery is the possibility of saving the eye without worsening the prognosis for survival.Histological studies largely undertaken in the past decade have greatly increased our knowledge of the cutaneous malignant melanoma. This tumour, which hitherto appeared to be both incomprehensible histogenetically and unpredictable in behaviour, has as a result become more understandable, though much still remains to be discovered. Unfortunately the conclusions drawn by dermatopathologists are not generally accepted by ophthalmic pathologists, and the pathology and treatment of conjunctival malignant melanoma still present unresolved problems, which have been admirably surveyed by Jacobiec. ' Despite advances made in the knowledge of the natural history of malignant melanoma there is still no general agreement on a treatment policy. Surgery understandably dominates treatment, but this dominance is largely based on fear and the laudable desire to rid the patient promptly of a tumour of evil repute. Meanwhile the therapeutic value of radiotherapy remains disputed, the malignant melanoma being customarily regarded as a radioresistant tumour and radiotherapy therefore held to be useless, if not harmful. It must be conceded that the history of radiotherapy in ophthalmology is an unhappy one. The early attempts to use radiant energy in the treatment of eye diseases were so calamitous that its use in the neighbourhood of the eye is regarded with trepidation to this day. However, with modern equipment and an adequate knowledge of the effects and risks of irradiating the eye it is possible to irradiate malignant tumours of the lids and epib;ulbar region without gross damage and still leave a useful functioning eye. The reluctance of ophthalmologists to use radiotherapy as an alternative to surgery in the treatment of epibulbar malignant melanoma is amply borne out by the infrequency with which this method receives, other than cursory or unfavourable, mention in ophthalmic literature. In th...

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