Central Venous Catheterization: Femoral Approach (Emergency Medicine)

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  • Administration of agents into the central vasculature
  • Central circulation and intracardiac access
  • Maintenance of venous access
  • Hemodialysis and plasmapheresis
  • Absolute contraindications
    • Adequate peripheral IV access (see Intravenous Cannulation for further details)
    • Operator inexperience
    • Uncooperative patient
  • Relative contraindications
    • Significant uncorrectable bleeding disorder
  • Contraindications unique to the femoral approach
    • Filter in the IVC
    • DVT
    • Abdominal trauma
  • Central venous catheterization kit
    • Clear fenestrated plastic drape
    • Paper drape
    • Chlorhexidine antiseptic with applicators
    • 1% lidocaine
    • Small anesthetizing needle (25 gauge × 1 inch)
    • Large anesthetizing/finder needle (22 gauge × 1.5 inch)
    • Introducer needle (18 gauge × 2.5 inch)
    • Several syringes, 5 mL each
    • J-tipped guidewire with housing and a straightener sleeve
    • Scalpel with a No. 11 blade
    • Skin dilator
    • Catheter (e.g., triple lumen or sheath introducer)
    • Gauze pads
    • Suture with curved needle
    • Disposable needle holder
  • Sterile gloves, sterile gown, cap, and mask with a fluid shield for each member of the insertion team **STERILE TECHNIQUE** **UNIVERSAL PRECAUTIONS**
  • Large sterile drape (half-sheet)
  • Lidocaine 1% (often provided in the kit, although extra may be required)
  • Sterile saline suitable for injection
  • Sterile dressing (e.g., Tegaderm, 3M Corporation, Huntingdon Valley, PA)
  • Femoral vein
    • The femoral vein lies within the femoral sheath and courses under the inguinal ligament; it then becomes the external iliac artery.
    • The vein is located approximately 1 cm medial to the femoral artery.
    • The femoral nerve is lateral to the vein.
    • Needle entry occurs 2 to 3 cm inferior to the inguinal ligament, 1 cm medial to the femoral artery pulsation.

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The full content of this section includes:
  • Step-by-step text instructions for performing the procedure
  • Clinical pearls providing practical clinical tips from medical experts
  • Patient safety guidelines consistent with Joint Commission and OHSA standards
  • Links to medical evidence and related procedures

  • Confirmation of line placement
  • Dressing changes at least every 72 hours
  • Infection
  • Bleeding
  • Thrombosis
  • Intra-abdominal organ injury
  • Nerve injury
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