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Bedside ultrasonography detects significant femoral vessel overlap: implications for central venous cannulation

Published online by Cambridge University Press:  11 May 2015

Francesca L. Beaudoin ,
Roland C. Merchant ,
James Lincoln ,
Fenwick Gardiner ,
Otto Liebmann  and
Jamieson Cohn
Francesca L. Beaudoin*
Affiliation:
Department of Emergency Medicine, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI
Roland C. Merchant
Affiliation:
Department of Emergency Medicine, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI
James Lincoln
Affiliation:
Department of Emergency Medicine, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI
Fenwick Gardiner
Affiliation:
Department of Emergency Medicine, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI
Otto Liebmann
Affiliation:
Department of Emergency Medicine, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI
Jamieson Cohn
Affiliation:
Department of Emergency Medicine, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI
*
Department of Emergency Medicine, Rhode Island Hospital, 593 Eddy Street, Claverick 2, Providence, RI 02903; [email protected]

Abstract

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Objective:

Our goal was to gain a better understanding of the femoral vessel anatomy as it relates to central venous cannulation. The primary objective of this study was to use bedside ultrasonography to determine the amount of exposed femoral vein at three sites corresponding to surface anatomy of the landmark-based procedure.

Methods:

This cross-sectional study enrolled a random sample of 180 adult patients presenting to a large urban academic emergency department. Subjects underwent standardized ultrasonography to identify and measure the depth and diameter of the femoral vessels and amount of exposed femoral vein at the level of the inguinal ligament (0 cm) 2 cm and 4 cm below. Repeated measures analysis of variance was used to determine significant relationships between vessel measurements and distance from the inguinal ligament.

Results:

The median age was 44.5 (range 19–90) years; 101 patients were male. The mean (± SD) percentage of exposed vein at the inguinal ligament was 83% (± 21). This decreased significantly (p < 0.01) with increasing distance from the inguinal ligament: 65% (± 25) at 2 cm and 56% (± 30) at 4 cm. At every distance away from the inguinal ligament, there were some subjects with no vein exposed.

Conclusion:

This study demonstrates significant overlap of the femoral vessels at sites where landmark-based femoral vein cannulation is often attempted. Our results suggest that ultrasound guidance would be beneficial as femoral vein cannulation may be difficult or impossible in certain individuals owing to anatomic variations.

Keywords

central venous accessfemoral arteryfemoral veinultrasonography
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 13 , Issue 4 , July 2011 , pp. 245 - 250
Copyright
Copyright © Canadian Association of Emergency Physicians 2011

References

REFERENCES

1.Moore, CL, Molina, AA, Lin, H. Ultrasonography in community emergency departments in the United States: access to ultrasonography performed by consultants and status of emergency physician-performed ultrasonography. Ann Emerg Med 2006;47:147–53, doi:10.1016/j.annemergmed. 2005.08.023.CrossRefGoogle ScholarPubMed
2.Stein, JC, River, G, Kalika, I, et al. A survey of bedside ultrasound use by emergency physicians in California. JUltrasound Med 2009;28:757–63.CrossRefGoogle ScholarPubMed
3.Reichman, EF, Simon, RR. Emergency medicine procedures. New York: McGraw-Hill;2004.Google Scholar
4.Roberts, JR, Hedges, JR. Clinical procedures in emergency medicine. 3rd ed. Philadelphia: WB Saunders; 1998.Google Scholar
5.Baum, PA, Matsumoto, AH, Teitelbaum, GP, et al. Anatomic relationship between the common femoral artery and vein: CT evaluation and clinical significance. Radiology 1989;173:775–7.CrossRefGoogle ScholarPubMed
6.Hughes, P, Scott, C, Bodenham, A. Ultrasonography of the femoral vessels in the groin: implications for vascular access. Anaesthesia 2000;55:1198–202, doi:10.1046/j.1365-2044.2000.01615-2.x.CrossRefGoogle ScholarPubMed
7.Seyahi, N, Kaveci, A, Altiparmak, MR, et al. Ultrasound imaging findings of femoral veins in patients with renal failure and its impact on vascular access. Nephrol Dial Transplant 2005;20:1864–7.CrossRefGoogle ScholarPubMed
8.Warkentine, FH, Pierce, MC, Lorenz, D, et al. The anatomic relationship of femoral vein to femoral artery in euvolemic pediatric patients by ultrasonography: implications for pediatric femoral central venous access. Acad Emerg Med 2008;15:426–30, doi:10.1111/j.1553-2712.2008.00087.x.CrossRefGoogle ScholarPubMed
9.Riley, W, FitzGerald, D, Cohn, L. Single, percutaneous, femoral venous cannulation for cardiopulmonary bypass. Perfusion 2007;22:211–5, doi:10.1177/0267659107083021.CrossRefGoogle ScholarPubMed
10.Hopkins, JW, Warkentine, F, Gracely, E, et al. The anatomic relationship between the common femoral artery and common femoral vein in frog leg position versus straight leg position in pediatric patients. Acad Emerg Med 2009;16: 579–84, doi:10.1111/j.1553-2712.2009.00430.x.CrossRefGoogle ScholarPubMed
11.Werner, SL, Jones, RA, Emerman, CL. Effect of hip abduction and external rotation on femoral vein exposure for possible cannulation. J Emerg Med 2008;35:73–5, doi:10.1016/j.jemermed.2007.03.023.CrossRefGoogle ScholarPubMed
12.Williams, JF, Seneff, MG, Friedman, BC, et al. Use of femoral venous catheters in criticallyill adults: prospective study. Crit Care Med 1991;19:550–3.CrossRefGoogle Scholar
13.Maecken, T, Grau, T. Ultrasound imaging in vascular access. Crit Care Med 2007;35 Suppl:S178-85, doi:10.1097/ 01.CCM.00002 60629.86351.A5.CrossRefGoogle ScholarPubMed
14.Altin, RS, Flickers, S, Nalden, HJ. Pseudoaneurysm and arteriovenous fistula after femoral artery catheterization: association with low femoral punctures. AJR Am J Roentgenol 1989;152:629–31.CrossRefGoogle ScholarPubMed
15.Randolph, AG, Cook, DJ, Gonzales, CA, et al. Ultrasound guidance for placement of central venous catheters: a meta-analysis of the literature. Crit Care Med 1996;24:2053–8, doi:10.1097/00003246-199612000-00020.Google Scholar
16.Leung, J, Duffy, M, Finckh, A. Real-time ultrasonographi-cally-guided internal jugular vein catheterization in the emergency department increases success rates and reduces complications: a randomized, prospective study. Ann Emerg Med 2006;48:540, doi:10.1016/j.annemergmed.2006.01.011.CrossRefGoogle ScholarPubMed
17.Hilty, WM, Hudson, PA, Levitt, MA, et al. Real-time ultrasound-guided femoral vein catheterization during car-diopulmonary resuscitation. Ann Emerg Med 1997;29:331–6, doi:10.1016/S0196-0644(97)70344-5.CrossRefGoogle Scholar