Placing A Femoral Line In Shock And Cardiac Arrest

Update 8-25-2019: Dr. Weingart and Dr. Orman have posted one of the very best ever procedure videos on central line placement at EMCrit 254 – Central Line Tips and Tricks with Robby O and Me from EEM 2019, August 22, 2019 by Dr Scott Weingart.

So start by watching the above video first and then go on to review the rest of the resources below.

Femoral arterial and venous catheterization is very often the most appropriate vascular access for cardiac arrest patients and for hemodynamically unstable patients.

And in this post, I have assembled the resources that will help a person review the steps of femoral line placement.

First  Dr. Farkas, intensivist, of the PulmCrit blog has a great post to get us started: Hemodynamic access for the crashing patient: The dirty double,
March 1, 2015 by Dr. Josh Farkas.  Resource (1)

Dr. Weingart of EMCrit has a number of resources for central line placement.  And they need to be reviewed along with the YouTube videos below. See Resources (2), (3), and (4)

See Resource (5),  DIY Vascular Access Simulator For Use With Ultrasound, for links to a great article and videos on practicing vascular cannulation with a DIY ultrasound phantom.

Resource (6), Using Mental Practice For Femoral Line Placement, has some thoughts on using visualization techniques for femoral line placement.

And finally, the links to the videos below allow you to view some examples of femoral line placement:

PLACEMENT OF A FEMORAL VENOUS CATHETER. 12:25, YouTube. Dr. GABER SAIED MUBARAK. Uploaded on Oct 9, 2010. [This is actually a New England Journal of Medicine Procedure Video that Dr. Mubarak has uploaded]

Common femoral arterial access technique – Teaching module 1. 4:33, YouTube. Zeenat Qureshi Stroke Institue. Published on Sep 27, 2016

USG guided placement of introducer sheath in common femoral artery: Teaching module 8. 2:57, YouTube. Zeenat Qureshi Stroke Institue. Published on Dec 27, 2016

Femoral CVC & Artline Insertion. 17:42, YouTube. Vascular Access.
Published on Dec 21, 2013

Ultrasound Guided Femoral Arterial Access. 4:41, YouTube. UKETS
Published on Jun 26, 2013

Additional Resources:

(1) Hemodynamic access for the crashing patient: The dirty double,
March 1, 2015 by Dr. Josh Farkas. [And be sure to carefully go over the Pulmcrit Table Of Contents – this is a great resource for emergency physicians, intensivists, and hospitalists]

(2) EMCrit show notes of Podcast 156–The Central Line Show–Part 1: Avoiding Complications from Dr. Scott Weingart

(3) EMCrit show notes of Podcast 157 – Central Lines II – Placement Tips from Dr. Scott Weingart.

(4) EMCrit show notes of Podcast 80 – Uhmmmm, Maybe Groin Lines Are Not So Bad with Paul Marik August 19, 2012 by Scott Weingart.

(5) DIY Vascular Access Simulator For Use With Ultrasound Posted on March 17, 2017 by Tom Wade MD.


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