Femoral Venous Catheterization Research Articles

Determination of Central Venous Catheter Complications: Internal Jugular Vein versus Femoral Vein Catheterization

Aim: This research aimed to compare the mechanical, thrombotic, and infectious complication ratio of the internal jugular vein with those of femoral vein catheterization. Materials and Methods: It is a single-center retrospective study. One hundred seventy-nine pediatric patients undergoing central venous catheter insertion in the intensive care unit were selected from February 2020 to August 2021. The patients were divided into 2 groups based on catheter type; internal jugular versus femoral venous catheterization. Procedure complications rates were assessed. However, jugular catheterization was performed under ultrasound guidance, and femoral venous catheterization was inserted via an original landmark-based technique. Thromboprophylaxis was performed on all patients without coagulopathy. Results: The overall rate of procedural complications was 20%. The subcutaneous hematoma was the most common mechanical complication and higher in femoral attempts (p= 0.001), followed by arterial injury (p= 0.002). Thrombotic complications were similar between the two groups (p= 0.053). Infections complications were higher in femoral venous catheterization (p= 0.016). Conclusion: Femoral venous catheterization is associated with a greater risk of mechanical and infectious complications than internal jugular venous catheterization. Usage of ultrasound during catheterization procedures decreases mechanical complications.

Accidental loss of guidewire during femoral central venous catheterization: A case report

Accidental loss of guidewire during femoral central venous catheterization: A case report

Manual Compression of External Iliac Vein to Increase the Size of Femoral Vein for Femoral Central Venous Catheter Insertion in Small Children: Pilot Experimental Study and Randomized Trial

Highlights Abstract Aim: Pediatric femoral central venous catheter insertion is sometimes difficult due to small vein size. External iliac vein (EIV) compression may provide a tourniquet effect to the femoral vein (FV) and may facilitate catheterization. This study was conducted to determine the effect of EIV compression on FV size and femoral venous catheterization success rates. Methods: This study had 2 parts. The first part was a single-arm experimental study. The second part was a randomized controlled trial. Children weighing 2.5–15.0 kg were included. First part: All patients received the same intervention and measurements. FV anteroposterior and medial-lateral diameters were measured by ultrasound without EIV compression, after which EIV was compressed using the assistant’s finger, and FV diameters were measured. Second part: Patients were randomized into compression and control groups. The compression group received EIV compression during femoral venous catheterization. The control group did not receive the compression. Results: A total of 30 patients (15 in each group) participated. EIV compression significantly increased FV anteroposterior diameter (3.36 ± 1.01 mm with compression, 2.39 ± 0.76 mm without compression, mean difference = 0.97 mm, 95% CI = 0.73, 1.21, P < 0.001) and medial-lateral diameter (4.58 ± 1.40 mm with compression, 3.86 ± 1.32 mm without compression, mean difference = 0.72 mm, 95% CI = 0.43, 1.01, P < 0.001). Catheterization success rates were not different between groups. Conclusions: EIV compression increased FV size, but the effect on femoral venous catheterization success rates was inconclusive due to a small sample size.

Central venous catheterization into the femoral vein

A central venous catheter (CVC) is usually placed to replace the spilled blood volume or inject a vasopressor. Among central catheterizations, the anatomy of the femoral vessel is lesser complex than that of others, and femoral venous catheterization is most easily cannulated percutaneously. However, endovascular training should be considered to complete the deployment of the central catheter and prevent complications systematically. Therefore, this study aimed to share the precise CVC procedure in the femoral vein and to impart endovascular techniques through simulation video clips and pictures.

Covid-19 and a lost guidewire: A misty tale of misery!

Central venous catheterization (CVC) is a routine procedure in patients admitted in Intensive Care Units (ICU) worldwide. Most commonly, seldinger technique is being practiced irrespective of the site of insertion. Though considered very safe, guide wire related complications have been reported in the literature and incidence has increased in the COVID era where intensivists have to work in personal protective equipment (PPE). We are reporting about a patient of severe COVID-19, admitted in ICU. His right femoral venous catheterization was done to start vasopressors. The guide wire accidentally slipped inside the femoral vein during the procedure. It was immediately detected and managed with the assistance of interventional radiologist under fluoroscopic guidance. Complications like misplacement of guide wire can be catastrophic during CVC. We have discussed the measures that can prevent or reduce such complications while working in PPE in COVID ICUs.

Ultrasound guidance for urgent arterial and venous catheterisation: randomised controlled study

BackgroundHaemodynamically unstable patients often require arterial and venous catheter insertion urgently. We hypothesised that ultrasound-guided arterial and venous catheterisation would reduce mechanical complications. MethodsWe performed a prospective RCT, where patients requiring both urgent arterial and venous femoral catheterisation were randomised to either ultrasound-guided or landmark-guided catheterisation. Complications and characteristics of catheter insertion (procedure duration, number of punctures, and procedure success) were recorded at the time of insertion (immediate complications). Late complications were investigated by ultrasound examination performed between the third and seventh days after randomisation. Primary outcome was the proportion of patients with at least one mechanical complication (immediate or late), by intention-to-treat analysis. Secondary outcomes included success rate, procedure time, and number of punctures. ResultsWe analysed 136 subjects (102 [75%] male; age range: 27–62 yr) by intention to treat. The proportion of subjects with one or more complications was lower in 22/67 (33%) subjects undergoing ultrasound-guided catheterisation compared with landmark-guided catheterisation (40/69 [58%]; odds ratio: 0.35 [95% confidence interval: 0.18–0.71]; P=0.003). Ultrasound-guided catheterisation reduced both immediate (27%, compared with 51% in the landmark approach group; P=0.004) and late (10%, compared with 23% in the landmark approach group; P=0.047) complications. Ultrasound guidance also reduced the proportion of patients who developed deep vein thrombosis (4%, compared with 22% following landmark approach; P=0.012), and achieved a higher procedural success rate (96% vs 78%; P=0.004). ConclusionsAn ultrasound-guided approach reduced mechanical complications after urgent femoral arterial and venous catheterisation, while increasing procedural success. Clinical trial registrationNCT02820909.

Central Venous Catheter-Related Infectious Complications in Pediatric Surgical Patients: A Single-Center Experience.

The purpose of this study was to estimate the rate of central venous catheter (CVC) colonization and catheter-related bloodstream infections (CRBSIs) in pediatric surgical patients at our institute and to determine the various risk factors for their occurrence. The electronic medical records of 260 children undergoing surgery with simultaneous CVC insertion were retrospectively reviewed. Data on demographics, primary organ system involved, site of CVC, CVC dwell time, CVC colonization, CRBSI, and organisms isolated on culture were collated, categorized, and analyzed. The rate of CVC colonization and CRBSI was 32.8 per 1,000 catheter days (19.6%) and 17.4 per 1,000 catheter days (10.4%), respectively. Patients with CVC colonization and CRBSI had a significantly higher proportion of patients younger than 1 year of age ( p = 0.014). The CVC dwell time was significantly higher in both CVC colonization (7 [5-8] days) and CRBSI (6 [5-9] days) patients ( p = 0.005). The frequency of femoral catheterization was significantly higher in patients with CRBSI and CVC colonization ( p < 0.001). Coagulase negative staphylococcus was the commonest isolate in CVC infections. Age (adjusted odds ratio [OR] = 0.87; p = 0.009), CVC dwell time (adjusted OR = 1.28; p = 0.003), and femoral CVC (adjusted OR = 9.61; p < 0.001) were independent risk factors for CRBSI. Conclusion: This study reveals important observations regarding the infectious complications of CVC in pediatric surgical patients. The rates of CVC colonization and CRBSI in this study were found to be higher as compared with previously reported rates in Western literature. However, these findings are significant in view of paucity of existing literature in pediatric surgical patients. In our study, higher risk of CRBSI was associated with younger age, increasing CVC dwell time, and femoral venous catheterization. We recommend strict compliance with CVC insertion and maintenance practices and adherence to CVC care bundles to minimize these serious complications.

Inferior Vena Cava Agenesis-Associated Thrombosis in a Neonate

Background: Inferior vena cava (IVC) malformations are rare developmental anomalies and are usually asymptomatic. Agenesis of IVC is an uncommon form of IVC malformation, and symptomatic neonatal presentation is unusual. We describe an unusual case of symptomatic venous thrombosis in the neonatal period after central venous cannulation, which was later found to have agenesis of IVC. Clinical Description: An extreme preterm (28 weeks) baby developed deep vein thrombosis of the femoral and external iliac vein after femoral venous catheterization and required anticoagulation therapy. Later, during the hospital stay, he was noted to have developed dilated abdominal veins over the flanks and paraspinal region, with the direction of flow below upward 2 months after the resolution of the thrombus. Management and Outcome: Ultrasonography (USG) color Doppler ruled out portal hypertension or persistence of IVC obstruction. Computed tomography (CT) venography resolved it to be the case of agenesis of the infrarenal portion of IVC. No consensus guidelines exist for neonatal management and it is usually conservative. Conclusion: IVC developmental anomalies including agenesis of IVC are very rare and are usually an asymptomatic condition, but can cause symptoms due to venous congestion in the lower limb or pressure from enlarged collaterals and rarely associated with deep venous thrombosis usually seen in young adults. Neonatal presentation is extremely rare. Diagnosis is by USG color Doppler and CT venography. Neonatal management guidelines are lacking and the risk of anticoagulation must be cautiously weighed against the risk of hemorrhage.

Percutaneous Inserted Venous Catheter via Femoral Vein in Extremely Low-Birth-Weight Infants: A Single-Center Experience.

This study aimed to assess the applicability of the insertion of small diameter catheters through the femoral vein in extremely low-birth-weight (ELBW) infants. All femoral small diameter catheters (Silastic or femoral arterial catheter [FAC]) inserted in ELBW infants in a tertiary level neonatal intensive care unit were retrospectively reviewed. Success rate, dwelling time, and percutaneously inserted central venous catheter-related complications were recorded. Thirteen small diameter catheters were inserted in seven ELBW infants. Mean gestational age at birth was 25+3 weeks (standard deviation [SD] ± 2.12) and mean birth weight was 686 g (SD ± 204.9). Mean weight at the first time of insertion was 1,044 g (SD ± 376.3). In two occasions, a FAC was used instead of a Silastic. In most cases (11/13, 84.6%), the patient was intubated prior to the procedure. The mean dwelling time was 16.7 days (SD ± 9.8). Most of the inserted small diameter catheters were removed electively (8/12, 66.7%), except for one episode of clinical sepsis from coagulase-negative Staphylococcus and three cases of accidental line extravasation. No other complications were reported. The success rate was 92.3%. Femoral venous catheterization using small diameter catheters in ELBW infants may be promising when other routes have been exhausted. Our results support that it is a feasible technique that can be performed at the bedside with successful results when conducted by experienced personnel.

The angle range of leg abduction with external hip rotation which can minimize femoral artery and vein overlap in pediatric patients.

Since the femoral artery frequently overlaps the femoral vein, femoral central venous catheterization carries the risk of arterial puncture in pediatric patients. We evaluated the angle range of leg abduction with external hip rotation to minimize the overlap between the femoral artery and vein in pediatric patients undergoing general anesthesia. Eighty-two pediatric patients who underwent elective surgery with general anesthesia were enrolled in this study. Using ultrasonography, patients were divided into groups N (patients with non-overlap) and O (patients with continuing overlap) based on the presence of non-overlap range between the femoral artery and vein. The range minimizing the overlap was defined as the range without overlap in group N and as the range presenting the overlap that was less-than-half of the radius of the femoral vein in group O. By increasing the angle of leg abduction with external hip rotation, the starting and ending angles minimizing the overlap were found using ultrasonographic images. The angle range of leg abduction with external hip rotation minimizing the overlap between the femoral artery and vein was defined as the range from the maximum 99% confidence interval of starting angles to the minimum 99% confidence interval of ending angles, which was between 45° and 65° in group N and between 48° and 58° in group O, respectively. Positioning patients in a range of 48° and 58° leg abduction with external hip rotation can minimize the overlap between the femoral artery and vein. However, the clinical usefulness of this positioning for femoral venous catheterization remains to be seen.

Value for money in self-regulated procedural simulation.

In self-regulated procedural simulation, learners practise on many simulators (e.g. paracentesis), self-regulating their choice of simulators, time and goals. Current needs assessments cannot predict the number of simulators needed to plan cost-effective self-regulated simulation. Knowing the ratios of simulators and participants would allow for better-informed purchase decisions to be made. We designed 90-minute sessions of self-regulated procedural simulation for internal medicine residents. In Phase1, 51 participants (8.5 per group) could use 22 simulators (US$69925): ultrasound-guided central (n=6) and peripheral (n=2) venous catheterisation; thoracocentesis (n=2); paracentesis (n=2); lumbar puncture (n=6); and arthrocentesis (n=4). We calculated minimal numbers of simulators based on the time that participants used each simulator in order to design a resource-effective Phase2, with 24 participants (with 12 per group) using 14 simulators (US$48720) to meet their needs. Calculated from time of use (83minutes in total), the optimal ratios of simulators expressed for 10 participants were 9.2: 3.7 for jugular and subclavian venous catheterisation (33minutes); 1.5 for thoracocentesis (13minutes), 1.0 for femoral venous catheterisation (9minutes), 1.0 for lumbar puncture (9minutes), 0.8 for peripheral venous catheterisation (8minutes), 0.7 for paracentesis (6minutes) and 0.5 for arthrocentesis (5minutes). In Phase2, the usage rate of simulators increased from 35.5% to 76.6%, maintaining the total time of use at 80.4minutes. We present a replicable method for the cost-effective planning of self-regulated simulation by measuring the use of simulators. Expressed as ratios of simulators per participant, this information can support purchase decisions and be shared with similar programmes.

Landmark Based Femoral Central Venous Catheterization, A Reliable And Safe Method In Acute Burns Resuscitation: An Institutional Based Study

Landmark Based Femoral Central Venous Catheterization, A Reliable And Safe Method In Acute Burns Resuscitation: An Institutional Based Study

Epidemiology of Lower Extremity Deep Venous Thrombosis in Critically Ill Adolescents

To determine the epidemiology of lower extremity deep venous thrombosis (DVT) in critically ill adolescents, which currently is unclear. We performed a multicenter, prospective, cohort study. Adolescents aged 13-17 years who were admitted to 6 pediatric intensive care units and were anticipated to receive cardiopulmonary support for at least 48 hours were eligible, unless they were admitted with DVT or pulmonary embolism or were receiving or anticipated to receive therapeutic anticoagulation. While patients were in the unit, serial sonograms of the lower extremities were performed, then centrally adjudicated. Bayesian statistics were used to leverage the similarities between adults and adolescents. A total of 88 adolescents were enrolled, from whom 184 lower extremity sonograms were performed. Of these, 9 adolescents developed DVT, with 1 having bilateral DVT. The frequency of DVT was 12.4% (95% credible interval: 6.1%, 20.1%), which ranged from 6.3% to 19.8% with a variability of 41.0% across units. All cases of DVT occurred in adolescents who received invasive mechanical ventilation (frequency: 16.5%; 95% credible interval 8.1%, 26.6%). DVT was associated with femoral central venous catheterization (OR 15.44; 95% credible interval 1.62, 69.05) and severe illness (OR for every 0.1 increase in risk of mortality 3.11; 95% credible interval 1.19, 6.85). DVT appears to be associated with prolonged days on support. Our findings highlight the similarities and differences in the epidemiology of DVT between adults and adolescents. They support the conduct and inform the design of a trial of pharmacologic prophylaxis in critically ill adolescents.

Accidental Migration of a Guide Wire during Femoral Venous Catheterization for Hemodialysis: A Case Report

Femoral venous catheterization is the most used technic in emergency he-modialysis. Some uncommon mechanical complications can occur during a catheterization. We report the case of an accidental migration of a guide wire during the placement of a hemodialysis femoral catheter. The case of a patient admitted in the nephrology department at Aristide Le Dantec University Hospital for malignant hypertension was investigated. Emergency hemodialysis was indicated. Surgical extraction of the metal guide has been performed and the outcome was favorable.

Cross-sectional area of the femoral vein varies with leg position and distance from the inguinal ligament.

PurposeThe risk of complications associated with femoral venous catheterization could be potentially reduced if the procedure was performed at the location where the cross-sectional area (CSA) of the vessel is the largest. The diameter of the femoral vein depends on leg position as well as the distance from the inguinal ligament. We determined the CSA of the right femoral vein in three different leg positions at two distances from the inguinal ligament.Subjects and methodsInformed consent was given by 205 healthy volunteers aged 19–39 years, mean: 23±3 years (108 women, 97 men). Ultrasonographic examinations were performed using a linear 14-MHz transducer with CSA measurements in three leg positions: abduction, abduction+external rotation, abduction+external rotation+90° knee flexion/frog-leg position; at levels 20 mm caudally to the inguinal ligament, and 20 mm caudally to the inguinal crease.ResultsWe found significant differences in mean values of CSA in three leg positions regardless of the measurement level. The largest mean CSA (114 mm2±35 mm2) was found at the proximal level in the frog-leg position. There was a significant association of the CSA with sex and height. The CSA in males was greater than in females in all leg positions at the level of 20 mm caudally to the inguinal crease, while 20 mm caudally to the inguinal ligament the CSA was larger in females. The CSA of 25% of the femoral vein was smaller than 45.0 mm2 at the proximal level, and 31.5 mm2 at the distal level, which refers to diameters of 5.3 mm, and 4.5 mm, respectively.ConclusionsThe cross-sectional area of the femoral vein is the largest in the frog-leg position, and depends on gender.

3:18 PMAbstract No. 314 - Understanding the patient preferences for femoral central venous catheterization among patients with sickle cell disease

3:18 PMAbstract No. 314 - Understanding the patient preferences for femoral central venous catheterization among patients with sickle cell disease

Early initiation of low-level parenteral dextrose induces an accelerated diabetic phenotype in septic C57BL/6J mice

Development of hyperglycemia during sepsis is associated with increased morbidity and mortality. Nutritional support is common practice in the intensive care unit, but the metabolic effects are not well understood. The purpose of this study is to determine the effect of early low-level calorie provision on the development of hyperglycemia in a clinically relevant murine model of sepsis. C57BL/6J mice underwent femoral arterial and venous catheterization followed by cecal ligation and puncture (CLP) or sham surgery and low-dose intravenous dextrose or saline infusion. Blood glucose, plasma insulin, and cytokines were measured after 24 h. Additional septic mice underwent hyperinsulinemic-euglycemic clamps or received intravenous insulin concurrent with dextrose to determine whole-body insulin sensitivity and test the efficacy of insulin to reverse hyperglycemia. Neither dextrose infusion nor CLP alone induced hyperglycemia. Early initiation of low-level dextrose in septic mice produced a variable glycemic response: 49% maintained euglycemia (blood glucose < 200) and 27% developed severe hyperglycemia (blood glucose ≥ 600). Hyperglycemia was associated with increased inflammation and reduced insulin secretion and sensitivity compared with control mice or CLP mice maintaining euglycemia. Insulin prevented the progression to severe hyperglycemia but was ineffective in reestablishing glycemic control once hyperglycemia had developed. In conclusion, early initiation of clinically relevant low-level dextrose (∼ 20% daily caloric requirements) precipitated hyperglycemia akin to an acute diabetic phenotype in septic mice characterized by decreased insulin sensitivity, decreased insulin secretion, and an increased inflammatory response.

Retrospective analysis of incidence of complications of central venous catheterization at an intensive care unit

Objectives: To compare mechanical, infectious, and thrombotic complications of internal jugular; subclavian and femoral venous catheterization at an post surgical and medical intensive care unitsMethods: It is a retrospective study in which the data from the medical records was evaluated and analyzed. Data, such as sex, date of insertion and removal, failure to place, malposition, complications and site of central venous catheterization were recorded. Landmark-based central venous catheterization using seldinger technique was performed under all aseptic precautions in 597 patients in postsurgical and medicine intensive care units. Central venous catheterization by three different routes i.e. IJV, SV and femoral vein were performed in critically ill patients.Results: Incidence of mechanical, infectious, and thromboembolic complications of central venous catheterization was 8.71%, 7.37 %, and 2.68% respectively. Incidences of different mechanical complications are as follows, arterial puncture4.18%, hematoma 3.18%, pneumothorax 1 %, haemothorax 0.33% .Incidence of central venous catheter with failure to place at various sites were 11.72 %. Incidences of central venous catheter with malposition at various sites were 6.36%.Conclusion: We found that complication rates of CVC insertion at our hospital are similar to those reported previously. Based on our experience, internal jugular venous access is associated with a low rate of mechanical complications like arterial punctures, hematoma, pneumothorax, thrombosis. Incidence with infection was least with subclavian cannulation.

PC.88 National survey of the usage of percutaneous femoral arterial and venous catheterisation in Level 3 NICU units

BackgroundFemoral vessel cannulation in neonates is more difficult and done when other forms of access are not available.AimThe aim of this study was to analyse the usage pattern of Percutaneous...

The Impact of a Medical Procedure Service on Patient Safety, Procedure Quality and Resident Training Opportunities

At some academic hospitals, medical procedure services are being developed to provide supervision for residents performing bedside procedures in hopes of improving patient safety and resident education. There is limited knowledge of the impact of such services on procedural complication rates and resident procedural training opportunities. To determine the impact of a medical procedure service (MPS) on patient safety and resident procedural training opportunities. Retrospective cohort analysis comparing characteristics and outcomes of procedures performed by the MPS versus the primary medical service. Consecutive adults admitted to internal medicine services at a large academic hospital who underwent a bedside medical procedure (central venous catheterization, thoracentesis, paracentesis, lumbar puncture) between 1 July 2010 and 31 December 2011. The primary outcome was a composite rate of major complications. Secondary outcomes included resident participation in bedside procedures and use of "best practice" safety process measures. We evaluated 1,707 bedside procedures (548 by the MPS, 1,159 by the primary services). There were no differences in the composite rate of major complications (1.6 % vs. 1.9 %, p = 0.71) or resident participation in bedside procedures (57.0 % vs. 54.3 %, p = 0.31) between the MPS and the primary services. Procedures performed by the MPS were more likely to be successfully completed (95.8 % vs. 92.8 %, p = 0.02) and to use best practice safety process measures, including use of ultrasound guidance when appropriate (96.8 % vs. 90.0 %, p = 0.0004), avoidance of femoral venous catheterization (89.5 vs. 82.7 %, p = 0.02) and involvement of attending physicians (99.3 % vs. 57.0 %, p < 0.0001). Although use of a MPS did not significantly affect the rate of major complications or resident opportunities for training in bedside procedures, it was associated with increased use of best practice safety process measures.