⚠️ Key Safety Notes: Always remain medial to the femoral arterial pulse to avoid arterial puncture. Ultrasound guidance significantly improves success rate and reduces complications (arterial puncture, attempts, infection risk).

🩺 Procedure Steps

Patient Position: Supine, leg slightly externally rotated and abducted for optimal femoral triangle access.
Landmark: Femoral vein lies immediately medial to femoral artery (mnemonic: NAVY – Nerve, Artery, Vein, Y-fronts). Use real-time ultrasound rather than landmark/palpation alone (standard of care).
Preparation: Full aseptic technique — chlorhexidine skin prep, maximal barrier drapes, sterile probe sheath, flushed ports, sterile gown/gloves.
Local Anaesthetic: Infiltrate skin and subcutaneous tissue with 1% lidocaine (under US if possible).
Needle Insertion: Insert 18G introducer needle at ~45° angle to skin while aspirating continuously. Confirm venous flashback (dark, non-pulsatile blood). Anchor needle securely.
Guidewire: Advance J-tip guidewire smoothly through needle. Never force if resistance met (risk of vessel perforation or wire kinking).
Needle Removal: Withdraw introducer needle while holding wire firmly in place.
Skin Incision: Small nick with #11 scalpel blade to ease dilator passage (avoid cutting wire).
Dilatation: Pass dilator over wire to form tract; remove dilator once tract created.
Catheter Insertion: Advance central venous catheter over wire, always controlling the proximal end of the wire. Remove wire once catheter fully seated.
Confirmation: Aspirate and flush all lumens (venous blood), secure with sutures/staples, apply occlusive sterile dressing.
Disposal & Documentation: Dispose sharps immediately; document indication, technique, US findings, complications, and post-procedure CXR (if required for tip position).

⚠️ Complications & Management

Common: Line-related infection (CLABSI), thromboembolism/DVT, arterial puncture (1–5% landmark, <1% US), haematoma (prolonged manual pressure in coagulopathy).
Rare: Arteriovenous fistula, pseudoaneurysm, retroperitoneal haemorrhage, vessel perforation, nerve injury.
Arterial Puncture: Withdraw needle, apply firm pressure ≥10–15 min; monitor for expanding haematoma or distal ischaemia; consider surgical consult if persistent.
Haematoma: Usually conservative management; ongoing bleeding or compartment syndrome → urgent surgical review.

📚 References

NEJM: Femoral Vein Cannulation Technique (classic article/video series)
TeachMeAnatomy / Elsevier / Cardiac Interventions Today (US-guided access tutorials)
Current guidelines: CDC, SHEA, ASE (ultrasound mandatory for femoral CVC in most settings)

Clinical Pearl:
Always confirm venous placement (aspiration of dark non-pulsatile blood + US visualization) before advancing wire/catheter or using the line.
In OSCEs/MCQs, examiners expect emphasis on: real-time ultrasound guidance, medial-to-artery approach, guidewire safety ("never force"), strict asepsis, and prompt complication recognition.

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Femoral Vein Cannulation

🩺 Procedure Steps

⚠️ Complications & Management

📚 References

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