critical care medicine
How To Do Femoral Artery Cannulation, Ultrasound Guided
Contraindications to Femoral Artery Cannulation, US Guided
Absolute contraindications Untrained or inexperienced ultrasound operator Unsuitable artery, thrombosed, heavily atherosclerotic, or inaccessible as seen by ultrasound An artery that is neither palpable nor detectable by ultrasound (ie, an arterial site should never be cannulated if no artery is evident) Inadequate circulation (eg, Raynaud syndrome, Buerger disease) Full-thickness burns Local infection at the insertion site Antibiotic-impregnated catheter in allergic patient Relative contraindications Coagulopathy, including therapeutic anticoagulation* Local anatomic distortion, traumatic or congenital, or gross obesity History of prior surgery or catheterization of the intended site† Atherosclerosis Inadequate collateral flow Uncooperative patient: Such patients should be sedated if necessary. * Therapeutic anticoagulation (eg, for pulmonary embolism) increases the risk of bleeding with femoral artery cannulation, but this must be balanced against the increased risk of thrombosis (eg, stroke) if anticoagulation is reversed. Discuss any contemplated reversal with the clinician managing the patient's anticoagulation and then with the patient. † The femoral artery should be avoided after vascular bypass surgery (because of potential injury to the bypass graft) and in patients with distal vascular insufficiency (to avoid precipitating ischemia). 