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Nov 24, 2021

Ultrasound-guided cannulation of the femoral artery

Ultrasound-guided cannulation of the femoral vein uses real-time ultrasound to guide the arterial puncture and a guide wire for catheter placement.

This solution is typically used in critically ill and unstable patients, particularly those with refractory shock and respiratory failure:

  • continuous blood pressure measurement;
  • repeated blood gas analysis;
  • continuous measurement of cardiac function;
  • repeated blood samples for laboratory tests.

Let's see, below, some aspects to pay attention to and the main steps of the procedure.

Femoral vein cannulation: contraindications and complications

Ultrasound-guided cannulation of the femoral vein requires first of all experienced and adequately trained personnel.

It is also important to know the main contraindications, to avoid using the procedure in unsuitable situations. Some examples may be an unsuitable, thrombized, heavly atherosclerotic or inaccessible artery (as seen by ultrasound) or, on the contrary, an artery that is neither palpable nor detectable by ultrasound. In fact, an arterial site should not be cannulated if no artery can be detected.

Other contraindications may be related to full-thickness burns, infection at the insertion site, or inadequate circulation.

In general, complications of ultrasound-guided cannulation may involve:

  • hematoma;
  • infection;
  • thrombosis due to the catheter;
  • artery or nerve damage;
  • arterial puncture;
  • embolism.

More rare, however, are complications such as limb ischemia and necrosis, pseudoaneurysm, and arteriovenous fistula.

Ultrasound-guided cannulation of the femoral vein: the main steps

Before proceeding with the cannulation of the femoral vein, it is important to check that the ultrasound machine is configured and functioning correctly.

Below, by macro points, we see the main steps of the procedure:

  • preparation of the equipment and sterile field;
  • placement of a sterile cover over the ultrasound probe;
  • anesthetization of the cannulation site, using the ultrasound guide along the short axis;
  • insertion of the femoral artery introducer needle using the ultrasound guidance (if the needle tip strays from the artery, adjust the direction to keep the tip above the center of the artery. If the tip is approaching too slowly, withdraw the needle a bit and increase the angle of insertion before readvancing);
  • insertion of the guidewire (once inserted, continue to hold it securely in place, checking it for the remainder of the procedure);
  • removal of the introducer needle (after successful guidewire insertion);
  • extension of the skin insertion site (incision < 5 mm) to facilitate catheter insertion;
  • placement of the catheter, advancing it over the guidewire and using ultrasound to verify proper position;
  • removal of the guidewire and checking of the arterial pressure waveform;
  • dressing of the site.

For more detailed information on each step of the procedure, please refer to the following article: How To Do Femoral Artery Cannulation, Ultrasound-Guided (Paula Ferrada, MSD Manual).

Delta Med central venous catheters are available in both normal and high-flow versions to meet all adult and pediatric needs. Effective devices to prevent infections and ensure the safety of patients and healthcare professionals.

To learn more about our CVC solutions, and get more details from one of our professionals, contact us here.



- How To Do Femoral Artery Cannulation, Ultrasound-Guided, Paula Ferrada, MSD Manual

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