Chapter 10. Femoral Venous Catheterization

• • Any situation that requires central venous access or venous access that cannot be obtained peripherally.

  • An emergency resuscitation requiring administration of large amounts of fluids.

  • The need for central venous pressure monitoring.

  • Placement of a pulmonary artery catheter.

  • The need for frequent blood draws.

  • Infusion of hyperalimentation, concentrated solutions (ie, KCl, dextrose concentrations greater than 12.5%, chemotherapeutic agents, hyperosmolar saline).

  • Infusion of vasoactive substances (ie, dopamine and norepinephrine) that can extravasate and cause soft-tissue necrosis.

  • The need for hemodialysis.

Advantages of Catheter Placement at Femoral Site

• • It does not interfere with procedures or monitoring involving the head, neck, or chest (such as cardiopulmonary resuscitation).

  • Pressure can be applied easily in the event of femoral artery puncture or catheterization.

  • It leaves the patient’s neck free of devices.

Disadvantages of Catheter Placement at Femoral Site

• • It is a relatively “dirty” area (though this can be managed with good sterile technique and dressing changes).

  • Placement of a long line is required for central venous pressure monitoring.

  • It can be challenging to place a pulmonary artery catheter through a femoral venous catheter.

Absolute

• • Severe abdominal trauma (provided that adequate venous access can be obtained elsewhere).

Relative

• • A patient with distorted anatomy or landmarks.

  • Risk factors for excessive bleeding, such as thrombocytopenia, coagulopathy, and anticoagulant or thrombolytic therapy.

  • Skin lesions (such as cellulitis, burns, abrasions, or dermatitis).

  • Conditions that predispose the patient to sclerosis or thrombosis (such as vasculitis).

  • Known thrombus of the femoral vein.

• • The catheter.

  • An appropriate size guidewire (at least 2 times the length of the catheter).

  • An appropriate size introducer needle.

  • A tissue dilator if the catheter is larger than 3F.

  • Two or three 3- to 5-mL syringes.

  • 1% lidocaine and a 26-gauge needle to inject the lidocaine.

  • Skin preparation solution (either 2% chlorhexidine-based preparation for patients older than 2 months or 10% povidone-iodine).

  • Sterile drapes.

  • Scalpel blade.

  • Suture (ie, 3.0 silk).

  • Sterile gauze pads.

• • Bleeding (can usually be managed by applying pressure to the site).

  • Infection (can be minimized with the use of good sterile technique during placement and regular catheter care).

  • Embolization of the guidewire if the operator does not use proper technique.

  • Vessel perforation.

  • Embolization of a preexisting thrombus.

• • Attach the insertion needle so that the numbers on the syringe are facing up when the bevel is in the upward position. This way, you will always know how to hold the syringe so that the bevel is facing upward.

  • After the skin is punctured with the insertion needle, inject a small amount of saline (approximately 0.2 mL) into the subcutaneous tissue.

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