Central Venous Catheterization: Femoral Approach

• 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.

Figure 1 :  Femoral central venous catheter

View Larger Image

Figure 5 :  Equipment

View Larger Image

Figure 9 :  Femoral anatomy

View Larger Image

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

Figure 16 :  Insert the introducer needle

View Larger Image

Figure 19 :  Advance the guidewire into the vessel

View Larger Image

Figure 22 :  Advance the triple-lumen catheter over the wire

View Larger Image

• Confirmation of line placement
• Dressing changes at least every 72 hours

• Infection
• Bleeding
• Thrombosis
• Intra-abdominal organ injury
• Nerve injury