Femoral Central Vein Catheter Placement

Femoral Central Vein Catheter Placement

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This high quality video demonstrates central venous catheter placement. One of the most common hospital and emergency room procedures, the femoral venous catheter is inserted under sterile conditions, and each step of the procedure is shown and discussed in detail. Clinical pearls to optimize success are discussed.  The video is not downloadable but may be accessed indefinitely by internet from any computer, smart phone, or tablet. Click below to preview the femoral line video.

 

The right groin is prepped and draped in a sterile fashion and the femoral pulse is now being palpated. The skin and underlying soft tissue medial to the pulse is now being anesthetized with 1% lidocaine. A needle is now being introduced with the bevel up and constant negative pressure is applied until a flash of venous blood is obtained.

The syringe is now being removed, and you can see non-pulsatile venous blood returned. A wire is now being threaded through the needle, and it is being introduced without any resistance. The wire sheath is then removed and the needle is then withdrawn over the wire.

Control of the wire is being maintained at all times. A scalpel is now being used to make a skin incision over the wire. A dilator will then be introduced over the wire and used to dilate up a subcutaneous tract into the vein.

As you can see, the dilator is being introduced with a turning motion to facilitate passage through the subcutaneous tissue. The dilator is now withdrawn and it is good to have some gauze readily available when the dilator is withdrawn; as you can see, there can be a significant amount of blood that is released.

A catheter is now placed over the wire and the wire is grasped at the distal port of the catheter. The wire is being withdrawn until it grasped at the distal port. The catheter is now being introduced over the wire until the blue hub is at the skin. Of course the catheter ports have been pre-flushed with sterile saline prior to the start of the procedure. 

The wire is then withdrawn from the distal port and the port is clamped. The ports are now being flushed with sterile saline until the tubing is essentially clear. 

As you can see the clamps are kept closed until the syringe is placed onto the port hub and then the clamp is then opened when the sterile saline is ready to be injected into the tubing. Prior to disconnecting the syringe from the hub, the clamp is then closed again so that no blood can return into the tubing.

The caps are now placed onto the port hubs. And the catheter is now secured in place with suture on both sides. A dilator can be used to help facilitate this so that the suture is not tied too tight, such that the skin becomes strangulated.

As you can see the needle is being passed through the hole with the blunt end first to minimize the chance of an inadvertent needle stick. 

The ports are then flushed with 1,000 units per milliliter heparin with a volume designated on the respective ports. After this a sterile op site is then placed over the catheter to keep the insertion site sterile.