“How To Place An Intra-arrest Femoral Arterial Line” From EmCrit 332 With Links To Additional Resources

In addition to today’s resource, please see and review these YouTube videos by Dr. Weingart:

In this post, I link to“How To Place An Intra-arrest Femoral Arterial Line” From EmCrit 332 from Dr. Scott Weingart*. In order to access this outstanding resource, you will need to become a member of EmCrit. (This is a link for you to join. It is NOT an affiliate link. I just think everyone who can afford it, should join and help support Dr. Weingart and his associate bloggers’ work [IBCC, PulmCare, and more].)

*Scott Weingart, MD FCCM. EMCrit 332 – Procedural Errors I See at the REANIMATE ECPR Course and How to Place an Intra-Arrest Femoral Arterial Line. EMCrit Blog. Published on September 11, 2022. Accessed on September 25th 2022. Available at [https://emcrit.org/emcrit/procedural-errors-at-ecpr-course/ ].

Dr. Weingart’s podcast is full of outstanding tips on placing a femoral arterial line during a cardiac arrest. He points out that the procedure is different than when placing a femoral arterial line in a patient not in cardiac arrest.

Dr. Weingart recommends that we first review his YouTube video, Central Line Micro-Skills, 11:36, Jul 13, 2020:

Breaking down the pieces of the seldinger technique for deliberate practice

And see also Dr. Weingart’s YouTube video, Central Line – Dilation (MicroSkills), 9:13, Aug 29, 2017

The next installment of the Sledinger/central line microskills series

So here are my notes on Dr. Weingart’s podcast, EmCrit 332.

First, in arrest, you cannot rely on the color of the blood coming out of your introducer needle. The color will be the same in both the femoral artery and the femoral vein.

Second, you cannot rely on pulsatility. During CPR, both blood vessels will be pulsatile.

You can’t use compressibility because, in cardiac arrest, both vessels will be compressible.

So what can you use? You use anatomy. The anatomy is not always consistent, so you can’t rely on the artery to always be lateral to the vein. The artery is thick-walled and the vein is thin-walled.

You need to use ultrasound imaging

Don’t use the art line introducer in the art line kit. Use an 18 gauge introducer that is 10 cm long. Dr. Weingart mentions a brand he uses in the podcast but I couldn’t catch the name.

Doing the puncture using the vessel trig method.

You will place the probe transversely over the common femoral artery or over the common femoral vein where you want to enter the vessel.

You need to be in the common femoral vessel, not the superficial vessel.

So you go down the common femoral vessels to where they split into the deep and superficial vessels and then you enter the common femoral vessel two centimeters proximal to the branch point.

You do not want to puncture the vessel under the inguinal ligament. If you do that and you puncture the back wall you can get a retroperitoneal bleed which you can’t control.

Please see the diagram from Dr. Weingart’s show notes. [Site is down. will place diagram tomorrow.]

Dr. Weingart states that when he is placing the femoral artery catheter he does not use a syringe. He holds the needle like a dart–ultrasound in one hand and needle in the other.

If you are inserting the needle into the common femoral vein, you must put a syringe on the needle before puncturing the vessel.

You need to prepare the wire before you put the needle in (before you perform the needle puncture).

Dr. Weingart recommends taking out about five inches of wire from the wire holder.

And you are going to have the sheath on the wire which helps keep the j-tip of the wire straight.

So now you perform the needle puncture using the trigonometry method.

So with the sheath on the tip of the wire, you will grasp the wire four to five inches behind the sheath and insert the wire through the sheath into the needle and vessel.

Note to me and to my readers: Listen to Dr. Weingaart’s podcast for details and be sure to review Dr. Weingart’s three videos referenced at the very start of the post for details. I put this post in just for a quick partial review.


This entry was posted in Advanced Cardiac Life Support, Central Line Placement, EMCrit. Bookmark the permalink.