Femoral vein access

Abstract

A ccess to the central venous system can be readily achieved by percutaneous puncture of the jugular, subclavian, or femoral vein. Although the femoral vein can be easily found in most patients, many physicians are more familiar with approaches to the jugular or the subclavian vein. The choice of a specific access site may be dictated by the clinical situation; however, despite many studies demonstrating its efficacy and safety, the femoral vein is less commonly used. 1-5 Femoral vein access was first described by Shaffer 5 in 1946 for the purpose of rapid volume infusion in hypotensive patients. In 1950, Bosch and colleagues 6 confirmed the safety and efficacy of using this site. Since then, a few series have shown a trend toward more complications and lower success rates associated with femoral veto access. TM However, many reports have demonstrated both success and complication rates comparable to those associated with the internal jugular and subclavian veins. 1-4 Femoral vein access can be easily achieved, and the success rate varies from 75% to 96%. 1'2'8-~~ Direct comparisons with alternative sites have shown mixed results. Although some had better success with the femoral vein than the subclavian vein, s the opposite has also been demonstratedfl Indeed, one direct comparison between the femoral and subclavian sites found little difference in success and complication rates) Examining the differences between access sites, Emerman and colleagues s reported a high degree of interoperator variability, with success rates ranging from 56% to 100% for the femoral vein and from 88% to 100% for the subclavian vein. More recently, the use of ultrasound guidance to aid femoral access in the emergency setting has been reported to result in more rapid catheterization times and very precise localization.11