International Journal of Drug Policy 18 (2007) 433–436 Short report Improving access to HCV treatment: External jugular venepuncture can overcome problems with difficult venous access Susan Mason a,∗ , Andrew Watts b,1 , Sinead Sheils a,2 , David Koorey a,3 a AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital (RPAH), Camperdown, NSW, Australia b Anaesthetic Department, Royal Prince Alfred Hospital (RPAH), Camperdown, NSW, Australia Received 30 September 2006; received in revised form 4 January 2007; accepted 6 January 2007 Abstract Many patients requiring antiviral treatment of chronic hepatitis C (HCV) have a background of significant injection drug use (IDU). In a proportion of patients, IDU results in difficulty with blood collection from conventional sites. We audited patients from the Liver Clinics and Drug Health Pharmacotherapy Service of The Royal Prince Alfred Hospital (RPAH) to determine the incidence of difficulty with blood collection. This survey identified the need for an innovative venous access strategy to better manage this group of patients. An external jugular venepuncture (EJV) protocol and education package was developed in collaboration with the Department of Anaesthetics, Gastroenterology and Liver Centre and HCV clinical nurse consultants (CNC). RPAH policy and procedure committee approved the protocol and patient information sheet. Patients with a history of difficulty with blood collection were eligible for the protocol. Patient satisfaction surveys were conducted. The initial survey of patients from the liver clinics and pharmacotherapy service identified that 48 percent had difficulty with blood collection from conventional sites. In the period October 2002 to July 2006, 29 patients (89 percent with history of IDU) were referred for EJV assessment. Major indications for EJV were for blood testing for initiation and monitoring of antiviral therapy and ongoing assessment of HCV infected patients. No adverse events resulted from the procedure. All patients surveyed report high levels of satisfaction with the technique compared to previous venous access attempts. EJV improves access to antiviral therapy and is a safe and effective technique for patients with difficult venous access (DVA). In addition, we have utilised EJV for post-transplant care of patients and used external jugular vein cannulation as vascular access for contrast imaging in hepatocellular carcinoma (HCC) assessment. © 2007 Elsevier B.V. All rights reserved. Keywords: External jugular venepuncture (EJV); Difficult venous access (DVA); Hepatitis C (HCV); Antiviral therapy (AVT) Introduction An estimated 264,000 Australians have hepatitis C (HCV) antibodies. Estimates of the HCV epidemic in Australia (NCHECR, 2006) report 13,000–15,000 new infections per ∗ Corresponding author. Tel.: +61 2 95157049; fax: +61 2 95155182. E-mail addresses: sue.mason@email.cs.nsw.gov.au (S. Mason), awatts@usyd.edu.au (A. Watts), sinead.sheils@email.cs.nsw.gov.au (S. Sheils), kooreyd@email.cs.nsw.gov.au (D. Koorey). 1 Tel.: +61 2 95158507; fax: +61 2 95192455. 2 Tel.: +61 2 95157661; fax: +61 2 95155182. 3 Tel.: +61 2 95157273; fax: +61 2 95155182. year. Injection drug use (IDU) is the most commonly reported mode of transmission. The prevalence of HCV infection among injection drug users is now 60 percent (O’Brien, Day, Black, Thetford, & Dolan, 2006). HCV is a slowly progressive liver disease which can lead to cirrhosis, liver failure and hepatocellular carcinoma (HCC) (Chen & Morgan, 2006). HCV is the most common rea- son for liver transplant in Australia: in 2005, 31 percent of transplants were for HCV cirrhosis (ANZLTR, 2005). A four- fold increase is projected in the number of people with HCV cirrhosis over the next two decades (NCHECR, 2006). The main HCV genotype prevalences in Australia are genotype 1 0955-3959/$ – see front matter © 2007 Elsevier B.V. All rights reserved. doi:10.1016/j.drugpo.2007.01.008