critical care medicine
How To Do Femoral Vein Cannulation, Ultrasound Guided
Relevant Anatomy for Femoral Vein Cannulation, US Guided
The femoral vein and artery are accessible within the femoral triangle, which is defined by the inguinal ligament superiorly, the adductor longus muscle medially, and the sartorius muscle laterally. The inguinal ligament is defined as a line drawn between the symphysis pubis and the anterior superior iliac spine. The femoral artery is imaged inferior to the midpoint of the inguinal ligament. The femoral vein is imaged medially adjacent to the artery. With increasing distance from the inguinal ligament, the vein runs under the artery. The desired point of femoral vein impalement is proximal to the saphenous vein entrance and 1 to 2 cm inferior to the inguinal ligament. Bleeding due to a vascular impalement here can be controlled by externally compressing the vessels against the femoral head. The retroperitoneal space lies superior to the inguinal ligament. Bleeding due to a vascular impalement here causes retroperitoneal bleeding, and external compression of the vessels is nearly impossible. The skin insertion site is influenced by both the imaging and the dimensions of the transducer tip (ie, the skin insertion site for long-axis ultrasound guidance may be several centimeters distal to that for short-axis ultrasound guidance). 