Makindo Medical Notes

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Ensure that you remain medial to the arterial pulse.

Procedure

• For optimal exposure of the femoral region, externally rotate and abduct the patient’s leg away from midline.
• The femoral vein cannot be felt but lies medial to the femoral artery pulsation. Localize the vein with ultrasonography.
• Prep the skin with chlorhexidine, and create a sterile field. Prepare the kit. Flush kit and ports with sterile saline
• Prepare the ultrasound probe for sterile use. Anaesthetise Locally with Lignocaine
• After ensuring that the femoral area has been properly anesthetized. Confirm anatomy with ultrasound or palpation.
• Insert the introducer needle at a 45° to the skin aiming down and pull back on the plunger.
• Once you see a flash of blood, carefully anchor the needle to avoid dislodging it from an intraluminal location.
• Detach the syringe and thread the guidewire through the needle. It should pass easily and without resistance into the lumen of the vessel.
• While maintaining your grasp of the wire, remove the introducer needle. Incise the skin at the wire-entry site with a scalpel, keeping the sharp edge away from the wire.
• Advance the dilator over the wire to make a tract through the tissues into the vessel.
• Larger catheters may have dilators that fit inside them and must be advanced together with the catheter. Unless that is the case, remove the dilator and thread the catheter over the wire.
• Before advancing the catheter past the skin, firmly grasp the guidewire protruding from the proximal end of the catheter.
• It is often necessary to feed the wire back through the catheter to accomplish this. After the catheter has been threaded into the vessel, remove the wire. Confirm the intravenous location of the catheter, flush sterile saline through each port, and secure the catheter with sutures or staples. Place a sterile dressing over the site before removing the drapes.
• Place all sharp and soiled materials in an appropriate receptacle

Complications

• Infection, thromboembolism, arterial puncture, and haematoma formation. Caution with those with coagulopathy who may need prolonged pressure applied.
• Rare complications are arteriovenous fistula and pseudoaneurysm.
• If the femoral artery has been punctured, apply pressure to the site for at least 10 minutes.
• Small haematomas may be managed conservatively, but continuing haemorrhage may require surgical intervention

Graphic

References

• Femoral Vein Cannulation NEJM