Femoral line

Dr Malik

1. Femoral LineFemoral Line
Malik AL-RawahiMalik AL-Rawahi

2. ObjectivesObjectives
Introduction.
Anatomy.
Advantages and Disadvantage.
Indications and Contraindications.
Video.

3. IntroductionIntroduction
All routes of central venous access are associated with
complications and possible failure.
The less than ideal conditions under which such access is
established also contribute to the incidence of
complications.
One of the most common methods to gain central venous
access in emergent situations is via femoral vein
cannulation.
The technique of accurately placing a femoral vein catheter
depends on appropriate patient selection and a sound
knowledge of anatomy.
As with most other central venous cannulations, the
modified Seldinger technique is used.

4. AnatomyAnatomy

5. The femoral vein lies within the femoral triangle in the inguinal-
femoral area.
The superior border of the triangle is formed by the inguinal
ligament.
The medial border by the adductor longus.
The lateral border by the sartorius muscle.
The apex of the triangle is formed by the sartorius crossing the
adductor longus muscle.
The roof of the triangle is composed of the skin, subcutaneous
tissue, the cribriform fascia, and the fascia lata.
The concave floor is formed of underlying adductor longus,
adductor brevis, pectineus, and iliopsoas muscles.

6. The neurovascular bundle consists of the femoral vein, artery,
and nerve, and lies within the triangle in a medial-to-lateral
position.
The femoral sheath encloses the femoral artery and vein, and
the nerve lies outside the sheath.
The femoral canal is a space within the femoral sheath and
medial to the femoral vein.
The femoral artery lies at the mid-inguinal point, which lies
midway between pubic symphysis and the anterior superior iliac
spine.

7. The surface anatomy of the femoral vein is identified for
venipuncture by palpating the point of maximal pulsation of the
femoral artery immediately below the level of the inguinal
ligament and marking a point approximately 0.5 cm medial to this
pulsation.
Distally in the leg, the femoral vein lies almost posterior to the
artery. This is important because arterial puncture is more likely
in the sites distal to the inguinal ligament.

8. AdvantagesAdvantages
In patients who are critically ill because the femoral area is
relatively free of other monitoring and airway access
devices.
In patients with severe coagulopathy or profound
respiratory failure, femoral access precludes the risks of a
development of a hemothorax or pneumothorax, both of
which are potential complications of supraclavicular venous
access.

9. COMPLICATIONS COMPLICATIONS
Infection
Bleeding
Thrombosis
Intra-abdominal organ injury
Nerve injury

10. IndicationsIndications
Emergency venous access during CPR.
In hypotensive trauma patients, with failure of peripheral
lines.
It is preferred to supraclavicular central venous access in
patients with suspected superior vena caval injuries.
Urgent or emergent hemodialysis access.
Hemoperfusion access in patients with severe drug
overdose.
Central venous pressure monitoring.

11. Absolute ContraindicationsAbsolute Contraindications
Venous injury 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.
Ambulatory patient (Ambulation increases the risk
of catheter fracture and migration)

12. Relative ContraindicationsRelative Contraindications
Presence of bleeding disorders.
Distortion of anatomy due to local injury or deformity.
Previous long-term venous catheterization.
Absence of a clearly palpable femoral artery.
History of vasculitis.
Prior injection of sclerosis agents.
Previous radiation therapy.

13. EQUIPMENTEQUIPMENT
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

14. Triple-lumen catheter kit.

15. Thank YouThank You