Venous Access - Femoral Line

Clinical Indications: &= nbsp; &nbs= p; &= nbsp;

= ______ 1. Cent= ral venous access in a patient with an urgent need for fluid or medication

administration.

= ______ 2. Inab= ility to obtain adequate peripheral access.

= ______ 3. Pati= ent aged great than 16 years of age.

= ______ 4. No evidence of pelvic trauma.

= ______ 5. No evidence of trauma in the extremity in which the catheter is to be placed.<= o:p>

Procedure:

= ______ 1.      Obta= in central access kit with a 6.0 to 8.0 French cordis and equipment to place catheter by Selinger technique.

= ______ 2.      Comp= letely expose the groin area on the side where the catheter is to be placed.<= /o:p>

= ______ 3.      Palp= ate the femoral pulse in the inguinal crease.&= nbsp; Recall that the inguinal ligament connects the pubic symphysis with = the anterior and superior iliac spine and that all attempts to access should be made inferior to this ligament to avoid from entering the abdominal cavity.=

= ______ 4.      Once= the femoral pulse has been palpated distal to the ilio-inguinal, prep a large a= rea of the skin with Betadine.

= ______ 5.      Use sterile gloves and place sterile drapes around the Betadine prepped field.<= o:p>

= ______ 6.      With= one hand palpate the femoral pulse. The femoral vein will be located medially when compared with the femoral artery= .

= ______ 7.      With= the induction needle from the kit, enter the skin over the anticipated position= of the femoral vein. Gently aspi= rate as the needle is advanced. An= gle the needle approximately 45= ° to = 60° in reference to the skin on the thigh.

= ______ 8.      Once non-pulsitile, venous blood is obtained stop advancing the needle and hold = the needle in position. Remove the needle and observe for pulsating blood flow. If the blood appears to be arteria= l in nature or pulsating blood is noted, immediately remove the needle and apply direct pressure over the insertion site.&n= bsp; Once the bleeding is controlled. Return to the previous step or cons= ider the other extremity, if there are no contraindications.
= ______ 9.      If t= he needle appears to be in the femoral vein, insert the guide wire with a ster= ile technique. Stop advancing the needle if any resistance is met; you may gently withdraw the needle and reattempt insertion if sterility is maintained.

= ______ 10. Adva= nce the wire until there is approximately 10 cm still left externally to the hu= b.

= ______ 11. Proc= edure 53

= ______ 12. DO N= OT LET GO OF THE WIRE.

= ______ 13. Hold= ing the wire in the distal hand, remove the needle over the wire. Once the needle reaches the end of= the wire, use the proximal hand to control the wire and the distal hand to remo= ve the needle from the wire.

= ______ 14. Use = the scalpel to create a small incision in the skin at the base of the wire. Make certain the incision extends completely to the wire so there is no skin tag.

= ______ 15. Plac= e the catheter over the wire; use the wire as a guide to place the catheter. Some gentle force may be required = as the catheter enters the skin, this should not however, require excessive force.= Again, one hand should always main= tain control of the wire.

= ______ 16. Once= the catheter is completely inserted, remove the wire.

= ______ 17. Atta= ch a syringe to the port of the catheter, release the clamp, and aspirate for blood. There should be an eas= y flow of venous blood.

= ______ 18. Once= all the air has been removed from the catheter through aspiration of blood, re-clamp the line.

= ______ 19. Atta= ch the desired IV fluid, blood, etc. and begin infusion. Note that “wide-open” = lines will deliver large amounts of fluid quickly, mon= itor the patient’s fluid status closely.

= ______ 20. Secu= re the catheter with sterile dressing or sutures.

= ______ 21. Docu= ment the procedure, time, complications, and clinical results in the electronic = PCR.

Certification Requirements:

Succ= essfully complete a biannual evaluation including the indications, contraindications, technique, and possible complications of the procedure.