ever put a central line in a coding patient? i’m guessing it was probably a femoral line (lot of stuff going on usually at the chest/head/neck area)
how did it go? how did you find it?
DID YOU FEEL FOR A PULSE?
femoral central venous access is often aided by palpating the femoral artery, and going a bit medial (to access the vein)
refresher on anatomical landmarks, and a handy procedural tip
artery’s tend to pulse, which is nice to feel as a landmark (this is fine in a living or even crashing patient, who still has a pump that’s doing something)
during CPR, there might be some pulsatile (w/ chest compressions) venous backflow that you can palpate
SOME (small but interesting bits of) DATA:
Femoral venous pulsations during open-chest cardiac massage.
- two peds cases with easily palpated femoral pulses during open-chest cardiac massage after aortic occlusion
- pulsations must have arisen from the femoral veins;
- usual landmarks may be unreliable
- femoral pulsations do not necessarily reflect arterial flow.
ultrasound-guided femoral vein catheterization during CPR
20 patients presenting with apnea and pulselessness in the ED.
Each patient received bilateral femoral lines, one by ultrasound guidance and one by the landmark approach (control).
Real-time ultrasound-guided catheterization had
-
a higher success rate (90% versus 65%, P = .058)
-
a lower number of needle passes (2.3 +/- 3 versus 5.0 +/- 5, P = .0057),
- a lower rate of arterial catheterization (0% versus 20%, P = .025)
- slightly faster in time to blood flash and in time to catheterization.
- incidental finding of interest was that real-time ultrasound demonstrated the presence of femoral vein pulsations during CPR.
BOTTOM LINE:
caution when using palpation of pulses as your landmark with a patient getting CPR; you may not be feeling what you think you are
with more commonplace (EZ) IO needles and ultrasounds, might be better ways nowadays to get access during CPR if you can’t get a peripheral IV
References: article 1; article 2; weingart talks about a bit on this podcast; picture 1; picture 2
