Placement of femoral venous catheters
- Mark P Androes, MD
Mark P Androes, MD
- Assistant Professor of Surgery
- University of South Carolina School of Medicine
- Alan C Heffner, MD
Alan C Heffner, MD
- Director of Critical Care
- Director of ECMO Services
- Pulmonary and Critical Care Consultants
- Department of Internal Medicine
- Department of Emergency Medicine
- Carolinas Medical Center
- Associate Clinical Professor
- University of North Carolina School of Medicine
- Section Editors
- Joseph L Mills, Sr, MD
Joseph L Mills, Sr, MD
- Section Editor — Vascular and Endovascular Surgery
- Professor and Chief
- Division of Vascular Surgery and Endovascular Therapy
- Baylor College of Medicine
- John F Eidt, MD
John F Eidt, MD
- Section Editor — Vascular and Endovascular Surgery
- Professor of Surgery
- University of South Carolina School of Medicine Greenville
- Allan B Wolfson, MD
Allan B Wolfson, MD
- Section Editor — Adult Procedures
- Professor of Emergency Medicine
- University of Pittsburgh
Central catheters provide dependable intravenous access and enable hemodynamic monitoring and blood sampling [1-4]. Although femoral vein cannulation is often considered less desirable due to higher complication rates, the femoral veins remain a reliable central venous access site, particularly under urgent or emergent circumstances [5,6]. The femoral site is increasingly used for the introduction of venous devices (eg, inferior vena cava, iliac venous stent).
Femoral venous cannulation and catheter placement will be reviewed here. General considerations for venous access and issues related to other access sites are discussed elsewhere. (See "Overview of central venous access" and "Complications of central venous catheters and their prevention" and "Placement of jugular venous catheters" and "Placement of subclavian venous catheters".)
The femoral veins are commonly viewed as an alternative access site for central venous access due to higher incidence of infection and catheter-related deep vein thrombosis compared with jugular or subclavian access (table 1). With contemporary skin preparation and proper routine catheter maintenance, infection rates appear to be comparable to other sites [7-9]. A meta-analysis suggests there is no longer a demonstrable difference in infection risk based upon catheter position . However, short-term use does not completely eliminate the risk of deep vein thrombosis, which can occur within one day of cannulation [11,12]. (See 'Complications' below.)
The femoral veins are frequently preferred when other access sites are exhausted or there is increased risk for complications such as with emergency access, coagulopathy, and in the uncooperative patient . The femoral veins are generally easier to cannulate and provide dependable access for less-experienced operators, or when there is concern for arterial injury at upper extremity sites because of altered local anatomy. Caution is needed when this approach is used in pulseless patients because chest compressions can produce femoral venous pulsations that may be misinterpreted as arterial. Catheter misplacement at the femoral site occurs in up to 30 percent of cardiac arrest resuscitations [14,15].
Femoral venous access is also used for the delivery of most inferior vena cava filters, and for lower extremity venous intervention. (See "Placement of vena cava filters and their complications".)
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- Hamilton HC, Foxcroft DR. Central venous access sites for the prevention of venous thrombosis, stenosis and infection in patients requiring long-term intravenous therapy. Cochrane Database Syst Rev 2007; :CD004084.
- Deshpande KS, Hatem C, Ulrich HL, et al. The incidence of infectious complications of central venous catheters at the subclavian, internal jugular, and femoral sites in an intensive care unit population. Crit Care Med 2005; 33:13.
- Marik PE, Flemmer M, Harrison W. The risk of catheter-related bloodstream infection with femoral venous catheters as compared to subclavian and internal jugular venous catheters: a systematic review of the literature and meta-analysis. Crit Care Med 2012; 40:2479.
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- Guilbert MC, Elkouri S, Bracco D, et al. Arterial trauma during central venous catheter insertion: Case series, review and proposed algorithm. J Vasc Surg 2008; 48:918.
- Sznajder JI, Zveibil FR, Bitterman H, et al. Central vein catheterization. Failure and complication rates by three percutaneous approaches. Arch Intern Med 1986; 146:259.
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- Horowitz R, Gossett JG, Bailitz J, et al. The FLUSH study--flush the line and ultrasound the heart: ultrasonographic confirmation of central femoral venous line placement. Ann Emerg Med 2014; 63:678.
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- FEMORAL VEIN ANATOMY
- GENERAL PREPARATION
- Skin preparation
- FEMORAL VEIN CANNULATION
- Needle access
- - General techniques
- Access with introducer needle
- Using finder needle
- Using an angiocatheter
- - Approach to the femoral vein
- - Dynamic ultrasound-guided femoral access
- Venous confirmation
- CATHETER PLACEMENT
- Guidewire handling
- Tract dilation
- Positioning the catheter
- Catheter flushing and fixation
- CONFIRMATION OF FEMORAL CATHETER POSITION
- CATHETER MANAGEMENT
- SUMMARY AND RECOMMENDATIONS