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passing a 2.5Fr, 2.5-cm catheter (or IV catheter) over the wire and into the arterial
lumen.

FEMORAL ARTERY/VEIN PUNCTURE
Indications
1. Arterial or venous blood sampling during resuscitation
2. Venous blood sampling in infants with inadequate peripheral veins

Contraindications
Avoid femoral punctures in children
hypercoagulable states, or cardiac shunts.

who

have

coagulation

defects,

Complications
1. Hematoma of femoral triangle
2. Thrombosis—femoral artery or vein
3. Superficial infection
4. Osteomyelitis/arthritis—proximal femur, hip joint

Equipment
Butterfly needle (1-in, 21- to 23-gauge needle in a child 2 to 3 years of age or
older); syringe on 1.5-in, 19- or 21-gauge needle when child is 9 to 10 years of
age or older; 5- to 10-mL syringe; povidone-iodine or chlorhexidine antiseptic
solution; 70% alcohol; sterile gauze; blood sample containers. Ultrasound may be

useful to locate vessel and guide advancement of needle (see Chapter 131
Ultrasound ).

Procedure
If time allows, apply topical or local anesthetic over the expected puncture site to
achieve local anesthesia of the superficial skin. Have an assistant restrain the
infant. This can be done using one of two methods. The first method is illustrated
in Figure 130.4A , whereby the trunk and contralateral leg are restrained by the
assistant and the ipsilateral leg is restrained by the operator. The second method is
diagrammed with the illustration for suprapubic bladder aspiration (see Procedure
in Suprapubic Bladder Aspiration section), in which the assistant leans over the
infant with arms pressing on the infant’s arms above and holding the distal thighs
below in the frog-leg position.
Gently flex the knee and externally rotate the hip to identify the landmarks of
the femoral triangle. Locate the inguinal ligament, and gently palpate midway
between the anterior-superior iliac spine and pubic symphysis. The femoral artery