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Femoral venous access

Equipment

Prepare all the equipment on a sterile trolley with the help of an assistant.

• Skin preparation solution (eg, povidone-iodine, alcohol or chlorhexidine solutions)

• Sterile drapes and towels

• Sterile gloves

• Nitrile gloves

• Gown, mask, and cap

• Local anaesthetic (lidocaine 1%)

• 25-26G needle, with a 2-5ml syringe (for local anaesthetic injection)

• 20-22G needle, with 10ml syringe (to access the femoral vein)

• Flexible guide wire with J-tip

• Scalpel

• Dilator device

• Single- or multiple-lumen catheter

• Silk or nylon sutures, 3-0 or 4-0

• Needle holder

• Suture scissors

• Sterile dressing

• Syringe for sterile saline flush

• Sharps container

• Ultrasound machine (if available).

Contraindications

Absolute contraindications for femoral central venous access include:

• Venous injury (known or suspected) at the level of the femoral veins or proximally

• Known or suspected thrombosis of the femoral or iliac veins on the proposed side of venous cannulation

• Intra-abdominal haemorrhage or regional trauma

• Local infection at the insertion site

• Antibiotic-impregnated catheter in a patient with a known allergy.

Relative contraindications include:

• Coagulopathy, including therapeutic anticoagulation

• Local anatomic distortion (traumatic or congenital), or gross obesity

• History of prior catheterisation of the intended central vein

• Uncooperative patient (sedated should be considered if necessary)

• Ambulatory patient.

Indications

• Emergency access for drugs and fluids during cardiopulmonary resuscitation

• Inability to obtain peripheral venous access or intraosseous infusion

• Hypotensive trauma patients

• Urgent or emergency haemodialysis access

• Haemoperfusion access in patients with severe drug overdose

• Central venous pressure monitoring

• Secure or long-term venous access that is not available using other sites

• Intravenous infusion of concentrated or irritating fluids

• Intravenous infusion of high flows or large fluid volumes if placement of large-bore peripheral venous catheters or other central venous catheters is not feasible

• Transvenous cardiac pacing

• Placement of inferior vena cava filter

• Central venous access required in patients with superior vena cava syndrome

Complications

• Arterial puncture

• Pseudoaneurysm

• Haematoma

• Bowel penetration

• Bladder puncture

• Psoas abscess

• Septic arthritis

• Femoral nerve injury with resulting paraesthesias

• Infection

• Arteriovenous fistula

• Thrombosis of the femoral or iliac veins

• Retroperitoneal bleeding

• Venous damage

• Air embolism.

Aftercare

Once the catheter is in an intravenous position and the guide wire has been withdrawn, suture the flanges of the catheter to the skin. It is important to confirm intraluminal placement of the catheter by aspirating venous blood from the ports and then flushing with sterile saline solution.