This document provides information on ultrasound-guided femoral vein cannulation. It discusses the advantages and disadvantages of the procedure, as well as contraindications. Key steps of the procedure are outlined, including patient positioning, identifying the vein with ultrasound, needle puncture under real-time ultrasound guidance, and confirming wire and catheter placement. Anatomy of the femoral vein and artery is described. Potential complications are also noted. The goal of the document is to provide guidance on performing femoral vein cannulation safely and effectively using ultrasound.

1. FEMORAL
VEIN
CANNULATION
DR AFIFAH
ULTRASOUND-GUIDED VASCULAR ACCESS CANNULATION COURSE
EMERGENCY DEPARTMENT HOSPITAL SUNGAI BULOH
DECEMBER 2021

2.  Advantages vs disadvantages
 Contraindications
 Anatomy
 USG findings
 Quick guide

3. ADVANTAGE
Easy to perform
Easily compressible
No risk of pneumothorax
or haemothorax
Relatively free of other
monitoring and airway
access device
DISADVANTAGE
High risk of infection
High rate of thrombosis
Rare complications:
 Retroperitoneal bleeding
 Bowel penetration
 Bladder rupture
ULTRASOUND-GUIDED VASCULAR ACCESS CANNULATION COURSE | EMERGENCY DEPARTMENT HOSPITAL SUNGAI BULOH | DECEMBER
2021

4. ABSOLUTE
 Venous injury at level of femoral vein
or proximally
 Known or suspected thrombosis
 Patient refusal
RELATIVE
 Bleeding disorders
 Skin infection over the site of access
 Obscure anatomical landmarks
 Absence of a clearly palpable femoral
artery
 History of vasculitis
 Previous radiation therapy

5. ULTRASOUND-GUIDED VASCULAR ACCESS CANNULATION COURSE | EMERGENCY DEPARTMENT HOSPITAL SUNGAI BULOH | DECEMBER
2021

6. ULTRASOUND-GUIDED VASCULAR ACCESS CANNULATION COURSE | EMERGENCY DEPARTMENT HOSPITAL SUNGAI BULOH | DECEMBER
2021

7. ULTRASOUND-GUIDED VASCULAR ACCESS CANNULATION COURSE | EMERGENCY DEPARTMENT HOSPITAL SUNGAI BULOH | DECEMBER
2021

8. ULTRASOUND-GUIDED VASCULAR ACCESS CANNULATION COURSE | EMERGENCY DEPARTMENT HOSPITAL SUNGAI BULOH | DECEMBER
2021

9.  Common femoral artery
 midpoint of inguinal
ligament
 Common femoral vein
 medial to common
femoral artery
ULTRASOUND-GUIDED VASCULAR ACCESS CANNULATION COURSE | EMERGENCY DEPARTMENT HOSPITAL SUNGAI BULOH | DECEMBER
2021

10. ULTRASOUND-GUIDED VASCULAR ACCESS CANNULATION COURSE | EMERGENCY DEPARTMENT HOSPITAL SUNGAI BULOH | DECEMBER
2021

11. ULTRASOUND-GUIDED VASCULAR ACCESS CANNULATION COURSE | EMERGENCY DEPARTMENT HOSPITAL SUNGAI BULOH | DECEMBER
2021

12. ULTRASOUND-GUIDED VASCULAR ACCESS CANNULATION COURSE | EMERGENCY DEPARTMENT HOSPITAL SUNGAI BULOH | DECEMBER
2021

13. 1. Position patient
2. Identify insertion site, localize the vein
3. Prep area
4. Puncture target vein with real time ultrasound guidance
5. Confirm wire & catheter position
ULTRASOUND-GUIDED VASCULAR ACCESS CANNULATION COURSE | EMERGENCY DEPARTMENT HOSPITAL SUNGAI BULOH | DECEMBER
2021

14. 1. Position patient
2. Identify insertion site, localize the vein
3. Prep area
4. Puncture target vein with real time ultrasound guidance
5. Confirm wire & catheter position
ULTRASOUND-GUIDED VASCULAR ACCESS CANNULATION COURSE | EMERGENCY DEPARTMENT HOSPITAL SUNGAI BULOH | DECEMBER
2021
Slight abduction +
external rotation
Reverse
Trendelenburg

15. 1. Position patient
2. Identify insertion site, localize the vein
3. Prep area
4. Puncture target vein with real time ultrasound guidance
5. Confirm wire & catheter position
ULTRASOUND-GUIDED VASCULAR ACCESS CANNULATION COURSE | EMERGENCY DEPARTMENT HOSPITAL SUNGAI BULOH | DECEMBER
2021
Vein medial to
artery
View short axis &
long axis
Compressible vein,
no thrombus

16. 1. Position patient
2. Identify insertion site, localize the vein
3. Prep area
4. Puncture target vein with real time ultrasound guidance
5. Confirm wire & catheter position
ULTRASOUND-GUIDED VASCULAR ACCESS CANNULATION COURSE | EMERGENCY DEPARTMENT HOSPITAL SUNGAI BULOH | DECEMBER
2021
Aseptic technique
Local anaesthetic

17. 1. Position patient
2. Identify insertion site, localize the vein
3. Prep area
4. Puncture target vein with real time
ultrasound guidance
5. Confirm wire & catheter position
ULTRASOUND-GUIDED VASCULAR ACCESS CANNULATION COURSE | EMERGENCY DEPARTMENT HOSPITAL SUNGAI BULOH | DECEMBER
2021
Short axis OR long
axis
Identify & confirm
needle tip position

18. 1. Position patient
2. Identify insertion site, localize the vein
3. Prep area
4. Puncture target vein with real time ultrasound guidance
5. Confirm wire & catheter position
ULTRASOUND-GUIDED VASCULAR ACCESS CANNULATION COURSE | EMERGENCY DEPARTMENT HOSPITAL SUNGAI BULOH | DECEMBER
2021

19. ULTRASOUND-GUIDED VASCULAR ACCESS CANNULATION COURSE | EMERGENCY DEPARTMENT HOSPITAL SUNGAI BULOH | DECEMBER
2021

20. ULTRASOUND-GUIDED VASCULAR ACCESS CANNULATION COURSE | EMERGENCY DEPARTMENT HOSPITAL SUNGAI BULOH | DECEMBER
2021