Abstract
Objectives: Ultrasound guidance increases the success of internal jugular central venous catheter (CVC) placement. The common femoral vein (CFV) is considered an easier site and physicians frequently place CFV CVCs using anatomical landmark guidance. No research has demonstrated the effect of patient weight on placement of a femoral CVC. The authors hypothesized that resident physicians could determine by anatomical landmarks the insertion site of a femoral CVC in normal and overweight adults. Methods: Investigators consented adult patients in the Emergency Department to serve as study models. Patients were grouped by BMI: Normal (BMI (BMI > 25). PGYI-III Emergency Medicine residents who volunteered to participate were included. Residents inspected and palpated the inguinal regions on a patient and marked the patient’s skin directly over the CFV. A faculty member assessed success using a 10 MHz linear probe (Sonosite Micro Maxx) centered over the mark. The attempt was successful if the mark was directly over the CFV and unsuccessful if distal, lateral, or medial to the CFV. Results: Nineteen residents (6 PGYI, 7 PGY II, and 6 PGYIII) assessed 17 patients. There were 43 attempts on Normal patients and 57 attempts on Overweight patients. The success rate on Normal patients was 74% and on Overweight patients was 42% (p = 0.0021). Conclusion: Residents were more successful in correctly identifying the CFV by anatomical landmarks in Normal patients. Training year had no effect on success. Ultrasound guidance may increase the success rate of placing a femoral CVC in patients with BMI > 25.
Highlights
The placement of a central venous line is a common and vital procedure in the emergency department in the treatment of patients in whom peripheral access is unobtainable or in whom invasive monitoring, cardiac pacing, or infusions of vaso-active agents are needed quickly
Ultrasound guidance increases the success of internal jugular central venous catheter (CVC) placement
The accuracy rate for locating the common femoral vein (CFV) on patients with body mass index (BMI) < 25 was 74% compared to 42% on patients with BMI > 25 (p = 0.02) (Figure 2)
Summary
Research has shown that the use of ultrasound can reduce complications of central line placement and decrease the length of time needed to perform the procedure [1,2,3,4]. Many of these studies have focused on accessing the internal jugular vein, since this is a site that allows for invasive monitoring, but carries risk for serious complication such as pneumothorax, hematoma, line misplacement, and hemothorax. There has been no research that describes what factors may affect the success in ac-
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