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, the Idaho Department of Correction announced Tuesday.

Using a central venous line — which involves threading a catheter through deep veins until it reaches a location near the heart — has long been a backup plan under the state’s official execution policy, but it has never been used because prison officials said the execution chamber was not designed in a way to protect the subject’s dignity during the process of inserting the line.

The execution chamber has now been remodeled so that execution witnesses can watch the central lines being inserted via a closed-circuit camera system, minimizing the possibility that the condemned person’s genitalia may be accidentally exposed.

In February, the attempted execution of Thomas Eugene Creech, a man on death row, failed after the execution team was unable to establish a peripheral IV line, close to the surface of the skin, despite trying eight times in several veins in his arms and legs. Creech’s defense attorneys have sought to prevent a second attempt on the grounds that it would amount to cruel and unusual punishment and amount to double jeopardy. A state judge dismissed those arguments in September.

RELATED COVERAGE 2 men charged with 7 Baltimore area homicides in gang case Jury seated for Indiana trial of suspect in 2017 killings of 2 teen girls Ex-husband of ‘Real Housewives’ star gets seven years for hiring mobster to assault her boyfriend

The failed execution attempt prompted the state to begin renovating its execution chamber to add a room where a doctor can insert a central venous line.

It’s difficult to determine which other states allow the use of central lines for lethal injections, in part because many death penalty states keep the IV process and parts of their standard operating polices on executions hidden from public view, said Robin Maher, the executive director of the Death Penalty Information Center. The use of central lines appears to be unusual, Maher said.

AP AUDIO: Idaho will begin using deep veins as backup for lethal injection executions, officials say

AP correspondent Haya Panjwani reports on Idaho revamping its execution chamber.

“This is certainly nothing that has been used recently,” Maher said Tuesday. “It would seem to me that states that have experienced botches should not be pivoting to different methods before they solve and understand and correct the issues that caused the first problems.”

Many states, including Texas and Oklahoma, do not allow execution witnesses to see the insertion of IVs or central venous catheters, carrying out the procedures in areas that are hidden from view. In Idaho, the process of establishing an IV line or central venous catheter must be publicly witnessed because the 9th U.S. Circuit Court of Appeals ruled that it is a critical part of an execution. The federal appellate court made the ruling after The Associated Press and other news organizations in the state sued for increased witness access.

Some states use what is called a “cut-down” to access veins when execution team members are unable to set a regular IV line, using a scalpel to cut the person’s skin and soft tissue so execution team members can see the vein they are trying to access.

In 2022, an execution team in Arizona made an incision in Clarence Dixon’s groin to reach a vein, a process that took about 25 minutes and required the execution team members to wipe up a “fair amount of blood” according to media witnesses. Dixon’s execution was declared complete about 10 minutes after he was injected. It’s not clear if Arizona officials used the cut-down method while inserting a central line, or if it was done simply so team members could see the vein.

Alabama’s lethal injection policy previously allowed for central line placement, but the procedure wasn’t used during the 2022 execution of Joe Nathan James Jr, whose lethal injection was delayed because it took hours for execution team members to successfully establish a peripheral IV. The state switched to a different method earlier this year, using nitrogen gas and oxygen deprivation to execute Kenneth Eugene Smith.

Under Idaho’s new execution policy, media witnesses and others selected to view the execution will be able to watch the insertion of the line through a closed-circuit camera system as it takes place in a separate room.

Once the central line is inserted, the condemned person will be taken to the main portion of the execution chamber where witnesses will be able to view the rest of the process through a window.

Standard peripheral IV lines are fairly straightforward to establish and typically just require a needle stick into a vein that is close to the surface of the skin in the arm or the hand. Emergency medical technicians, nurses, and other health care professionals routinely insert standard IVs.

Central venous catheters, meanwhile, often require surgical procedures to access very large vessels like the jugular or femoral veins. They must be done by a doctor, because the veins are often very close to arteries that are under higher internal pressure — increasing the risk of bleeding from accidental needle sticks — and near other organs like lungs that can collapse if they are inadvertently punctured.

Inserting a central line is a multistep process, and it typically involves numbing the site, using a needle to insert a guidewire that is threaded through the vein until it is positioned just outside of the heart and then using a scalpel and dilation tool to widen the soft tissue around the puncture site. Then the catheter can be threaded along the guidewire until it is in the correct location.

Central venous catheters are typically used for patients who need medication that is too caustic to be injected into smaller veins, or who need to be given nutrition through their veins for an extended period of time.

Last year, Republican Idaho Gov. Brad Little signed a law allowing the state to use a firing squad to execute condemned people when lethal injection is not available. The Idaho Department of Correction would first have to build a firing squad facility, however, which is expected to be an expensive and time-consuming process.