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pulsatile femoral artery or 0.5 cm medially for the vein, whichever is desired.
Apply constant suction to the syringe as the needle is advanced into the thigh to
ensure blood is obtained on entering the vessel. The assistant should work to
avoid uncontrolled leg movements by the infant leading to loss of alignment of
the needle and vessels. If unsuccessful, withdraw the needle to just below the skin
surface and reattempt vessel puncture after shifting the medial or lateral
alignment of the needle tip. After obtaining the sample, stop suction on the
syringe. After needle withdrawal, the assistant should apply constant manual
pressure on the puncture site for 5 minutes with sterile gauze.

PERCUTANEOUS FEMORAL VEIN CATHETERIZATION
Indications
Emergency access to central venous circulation. See Chapter 131 Ultrasound for
discussion of ultrasound guidance. The femoral vein is more accessible than the
internal jugular or subclavian veins during resuscitation.

Complications
1. Inadvertent arterial catheterization
2. Arterial or venous laceration
3. Infection (especially if placed in an emergency situation without reliable use of
infection control technique)
4. Hematoma
5. Catheter or wire fragment in central circulation

Equipment
Commercial tray containing introducer needle, 5- to 10-mL syringe, guide wire,
no. 11 blade scalpel, dilator, and catheter; 3Fr (younger than 2 years of age) or
4Fr (2 to 7 years old) or 5Fr (older than 8 years of age); sterile drapes and gloves;
povidone-iodine or chlorhexidine antiseptic solution; sterile gauze pads; use
larger single-lumen set in trauma patients; ultrasound machine if available.

Procedure
If time allows, apply topical or local anesthetic over the expected puncture site to
achieve local anesthesia of the superficial skin. Restrain the lower extremities and
trunk of the child. Externally rotate the hip to facilitate palpation of the femoral
triangle. Consider use of a towel roll under the gluteal muscle to improve
exposure of the vein. Palpate the femoral artery 1.5 cm below the inguinal
ligament, halfway between the anterior-superior iliac spine and symphysis pubis.