I rarely access the femoral vein for central venous catheterization… except in medical or trauma resuscitations. Oftentimes in these resuscitations, there are too many people near the IJ or subclavian vein site. People are intubating, performing CPR, trying to get peripheral vein access, etc.
The patient’s femoral veins are relatively accessible areas. Use the ultrasound if it is readily available to you and is easy to maneuver between providers to reach the patient. For me, the ultrasound machine is often too large and unwieldy to wedge between providers.
Trick of the trade
In hypotensive patients, the femoral artery (which sits just lateral to the femoral vein) may not be palpable. Instead of using the patient’s vascular anatomy to estimate the location of the vein, use the patient’s surface anatomy.
- Position your thumb along the lateral edge of the patient’s pubic tubercle.
- Position your index finger at the anterior superior iliac spine (ASIS).
- Cannulate the femoral vein at the base of the V shape, created by your hand’s first webspace.