Pediatric emergency medicine trisk 4329 4329

The femoral vein lies 0.5 to 1 cm medially. Alternatively, use ultrasound to
identify the vein and its relationship to the artery. Catheter length can be
estimated as the distance from the insertion site to the umbilicus.
Cleanse the site with antiseptic solution and allow to dry. Wearing sterile
gloves, mask, and gown, drape the area. Check all equipment and attach the
syringe to the introducer needle. Repalpate the femoral artery. Hold the
syringe/introducer needle parallel to the blood vessel and 30 degrees above the
horizontal ( Fig. 130.5A ). Stabilize it with the heel of the lateral aspect of the
hand against the child’s leg. Puncture the skin 0.5 to 1 cm medial to the arterial
pulsation. Apply gentle suction to the syringe while advancing the needle. When
venous blood returns, advance the introducer needle 1 to 2 mm and recheck for
flow. Stabilize the needle, and detach the syringe. Place a gloved thumb over the
open needle hub to decrease bleeding.
Using the free hand, insert the guide wire (J tip or soft straight tip) through the
introducer needle ( Fig. 130.5B ) into the vein. Pass the wire several centimeters
beyond the tip of the introducer needle in a cephalad direction into the vein. If it
does not pass easily, the introducer needle tip is usually not in the lumen of the
vein. If so, remove the wire and reposition the needle to establish blood flow
again. Then reintroduce the wire.
Stabilize the wire with the hand that inserted it, and gently withdraw the
introducer needle from the vein along the wire ( Fig. 130.5C ). Move the hand to
stabilize the guide wire proximally once the wire is exposed at the puncture site.
Support the wire and pull the introducer needle off the guide wire. Make a small
incision at the skin puncture site where the wire emerges, and pass the dilator
over the wire to dilate the soft tissue located between the external surface of the
skin and the vessel, being careful not to kink the wire. Remove the dilator from
the wire, leaving the wire in place. Pick up the infusion catheter at the proximal
end and advance it over the wire to the skin entry site. Twist it at the skin entry
site ( Fig. 130.5D ) to facilitate passage through the soft tissue, and advance it
over the wire in a cephalad direction while stabilizing the wire distally.
Last, as in Figure 130.5E , withdraw the wire while holding the catheter in

place; blood flows immediately if the vein has been cannulated. Suture the
catheter in place, and attach the infusion system to the catheter. Location of the
catheter should be documented with a radiograph or with ultrasound. Ensure that
throughout the procedure, the wire is visible and can be grasped at all times if
necessary.