Femoral

Consider the following:

Preparation

For preparation:

• Sterile setting, drapes, gloves, etc.
• Seldinger cannula of choice or use long cannula over needle
• Sterile sheath for ultrasound probe
• Standard gel within the sheath and sterile gel outside can use catheterization lignocaine
• Set ultrasound to 10mHz linear probe. Set appropriate depth, gain and focus.
• Sterile drapes and local anaesthetic

Positioning

Positioning the patient with a very slight (5 degrees) head-up ensures filling of the femoral vein but without undue filling pressure.

Never attempt this with the head down (risk of air embolism) or with the patient sitting at any angle (femoral vein pressure high and bleeding will be marked).

Procedure

Image 1

Image 2

Click the images to see larger versions

The procedural technique for femoral is as follows:

1. Use normal gel inside and sterile gel outside
2. Secure with a sterile band
3. In cross section, find the vein (medial or med/ant to artery) (image 1)
4. Rotate the probe to see the vein in longitudinal section. Check it is still compressible
5. Use a local anaesthetic
6. Introduce the needle through the skin bevel upwards
7. Watch the needle enter the vein
8. When blood has been obtained, feed in the wire or, if the cannula is over the needle, thread the cannula into the vein
9. Observe progress on the screen (image 2)
10. Check the wire remains in the lumen
11. Beware of acoustic shadow
12. If Seldinger, feed the cannula over the wire
13. Secure the line