Site Selection
|
FEMORAL LINE |
|
|---|---|
|
ADVANTAGES |
DISADVANTAGES |
|
Compressible site |
Higher risk of deep vein thrombosis |
|
No risk of pneumothorax |
Potential higher risk of infection |
|
Better for patients in respiratory distress (does not require Trendelenburg) |
Limits patient mobility |
|
Better for emergent situations (easier cannulation during CPR) |
Discomfort with hip flexion |
|
Lower mechanical complications |
|
When to consider a different site:
- Prior DVT on ipsilateral side.
- Desire for patient to ambulate.
- Prior condition that alters local anatomy.
Catheter length: 25cm
Anatomy:
Technique
Positioning:
- Supine. Ipsilateral leg should be straight, abducted, & externally rotated (opens femoral triangle).
- Operator standing on ipsilateral side.
Locating the access point:
NOTE: at UCSF cannulation is done with ultrasound guidance with the exception of emergency situations.
- Landmarks: start 2-3cm below the inguinal ligament and 2cm lateral to the pubic tubercle. Remember in the femoral triangle lateral to medial are the Nerve → Artery → Vein (NAVEL).
- Use ultrasound to differentiate the femoral artery from the femoral vein. The vein is inferior and medial to the femoral artery and is compressible, nonpulsatile, with Doppler flow towards the heart.
- In emergent situations, palpate femoral arterial pulse and plan for access 1cm medial to palpated pulse.
Entry:
- Ensure entry site is 2-3cm BELOW the inguinal ligament. There is increased risk of retroperitoneal bleed and peritoneal injury above this point.
- Direct needle tip directly cranial at 30° angle to the skin.
- Use ultrasound guidance to confirm entry into femoral vein (typically about 2-4cm deep).
- See Principles of Vascular Access: Procedural Technique for remainder of procedural approach.
