Femoral Vein - Central Line Placement - https://www.nejm.org/doi/full/10.1056/NEJMvcm0801006
Advantages:
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Femoral Vein - Central Line Placement - https://www.nejm.org/doi/full/10.1056/NEJMvcm0801006

Advantages:

 • Compressible 

 • No risk of PTX 

 • Can be cannulated more easily during CPR 

 • Large caliber vein technically easier to cannulate

Disadvantages:

 • Femoral artery puncture 5-10%

 • Risk of development of deep venous thrombosis

 • Less patient comfort in hip flexion, requires immobility

 • May occlude flow if patient is obese

 • Caution in patients with inferior vena cava filters

Positioning: head of bed flat; abduct lower extremity and externally rotate the hip

Entry: Bevel up, 2-3 cm below inguinal ligament, 1cm medial to palpated pulse → femoral vein lies medial & inferior to the femoral artery

 • If non-urgent use ultrasound to visualize

 • “NAVEL toward the NAVEL” → Nerve, Artery, Vein, Empty, Lymphatics (alternative: venouspenis)

 • Two fingerbreadths lateral to pubic tubercle if pulse not palpable

 • DO NOT approach vein above inguinal ligament → risk for RP bleed & peritoneal perforation

Target: Directly superior at 30-45°.



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