BOISE, Idaho (AP) — Idaho will begin using central veins deep in the groin, neck, chest or arm for executions by lethal injection if attempts to insert standard IV lines fail, officials said Idaho Department of Corrections announced Tuesday.
The exploit of a central venous line – in which a catheter is threaded through deep veins until it reaches a site near the heart – has long been a backup plan under the state’s official execution policy, but was never used, prison officials said Execution chamber this was not designed to protect the dignity of the subject when the line was inserted.
The execution chamber has now been redesigned to allow execution witnesses to watch the midlines being inserted via a closed camera system, minimizing the possibility of accidentally exposing the condemned person’s genitals.
In February, the execution attempt of Thomas Eugene Creech, a man on death row, failed after the execution team failed to create a peripheral IV tube near the surface of the skin despite eight attempts in multiple veins in his arms and legs. Creech’s defense attorneys have sought to block a second attempt on the grounds that it would amount to cruel and unusual punishment and double jeopardy. A state judge rejected those arguments in September.
The failed execution attempt prompted the state to begin renovating its execution chamber, adding a room where a doctor can insert a central venous line.
It is hard to determine which other states allow the exploit of central lines for lethal injections, in part because many death penalty states hide the IV procedure and parts of their standard execution policies from the public, said Robin Maher, the executive director of the Death Penalty Information Center. The exploit of central lines appears to be unusual, Maher said.
“This is certainly not something that has been used recently,” Maher said Tuesday. “It seems to me that states that have experienced blunders should not switch to other methods before they have resolved, understood and corrected the problems that caused the initial problems.”
In many states, including Texas and Oklahoma, execution witnesses are not allowed to see IVs or central venous catheters inserted or to perform the procedures in areas that cannot be seen. In Idaho, the process of inserting an IV line or central venous catheter must be publicly observed because the 9th U.S. Circuit Court of Appeals has ruled that it is a crucial part of an execution. The federal appeals court made the decision after The Associated Press and other news organizations in the state filed a lawsuit seeking expanded witness access.
In some states, a so-called “cut-down” is used to access veins when execution team members are unable to insert a regular IV line. It involves using a scalpel to cut through the person’s skin and cushioned tissue so that members of the execution team can see the vein they are attempting to access.
In 2022, an execution team in Arizona made an incision in Clarence Dixon’s groin to access a vein. This process took about 25 minutes and required execution team members to immaculate up a “fair amount of blood,” according to media reports. Dixon’s execution was declared complete about ten minutes after the injection. It is not clear whether Arizona officials used the cutting method when inserting a centerline or whether they did so simply so team members could see the vein.
Alabama’s lethal injection policy previously allowed for the placement of a central line, but the procedure was not used in the 2022 execution of Joe Nathan James Jr., whose lethal injection was delayed because it took hours for execution team members to successfully perform one had a peripheral infusion put in place. Earlier this year, the state switched to a different method, using nitrogen gas and oxygen deprivation to execute Kenneth Eugene Smith.
Under Idaho’s modern execution policy, media witnesses and others selected to observe the execution will be able to watch the introduction of the line through a closed-circuit camera system as it takes place in a separate room.
Once the center line is inserted, the condemned person is moved to the main part of the execution chamber, where witnesses can watch the rest of the trial through a window.
Standard peripheral IV lines are relatively uncomplicated to set up and typically require only a needle stick into a vein near the surface of the skin on the arm or hand. Paramedics, nurses, and other medical professionals routinely insert standard infusions.
Central venous catheters, on the other hand, often require surgical procedures to gain access to very enormous vessels such as the jugular or femoral vein. They need to be done by a doctor because veins are often very close to arteries, which are under higher internal pressure – increasing the risk of bleeding from accidental needle sticks – and close to other organs, such as the lungs, which can collapse if accidentally punctured.
Introducing a midline is a multi-step process. Typically, the site is numbed, a needle is used to insert a guidewire that is passed through the vein until it is positioned just outside the heart, and then a scalpel and dilation tool is used to expand cushioned tissue around the puncture site. The catheter can then be guided along the guide wire until it is in the correct location.
Central venous catheters are typically used in patients who require medications that are too caustic to be injected into smaller veins or who need to receive nutrients through their veins for an extended period of time.
Last year, Idaho’s Republican Gov. Brad Little signed a law allowing the state to exploit a firing squad to execute convicted people if a lethal injection is not available. However, the Idaho Department of Corrections would first have to build a firing squad facility, which is expected to be an steep and time-consuming process.
