Real-Time Ultrasound–Guided Femoral Vein Catheterization During Cardiopulmonary Resuscitation☆,☆☆,★
Section snippets
INTRODUCTION
Central IV access is a relatively common procedure in the emergency department. Emergency physicians rely on their skill to establish a central line as a lifesaving procedure for delivery of critical care medications, for volume resuscitation with saline or blood products, and for central cardiac monitoring and pacing. The success rate, the time to completion, and the rate of complications are all important aspects of this procedure.
Ultrasound-guided IV catheterization in the ED is an emerging
MATERIALS AND METHODS
We used a convenience sample comprising serial patients who presented in cardiopulmonary arrest to the ED at Highland General Hospital when either of two investigators (WH or PH) was present. CPR and resuscitative efforts following the Advanced Cardiac Life Support protocol were directed by an attending physician or other senior emergency medicine resident to allow the study investigators to focus on the establishment of femoral venous access. This study was approved by the Highland General
RESULTS
Twenty patients completed the study protocol. No patients had femoral scars from previous surgery or use of injection drugs. None of the study patients survived to hospital discharge. The mean age of study patients was 64±15 years (range, 30 to 82 years). Thirteen were men and seven women. Average weight was 76.3 kg (range, 50 to 160 kg). Average height was 170.9 cm.
The Table summarizes the results of the 20 ultrasound-guided and 20 landmark-oriented catheterizations. Of the seven failures by
DISCUSSION
Femoral vein catheterization in the ED is a useful technique for the administration of fluid, blood products, and medications and for limited central venous monitoring.8 Its application has been studied in trauma,7, 9, 10, 11, 12 in critically ill patients,13 in comparison with saphenous vein cutdown11, in subclavicular and internal jugular vein catheterizations9, and in CPR.12, 14 Many studies have touted its usefulness and accessibility. The scope of reported complications with femoral line
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2021, British Journal of Anaesthesia
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From the Department of Emergency Medicine, Highland General Hospital, Oakland, California*; and the Division of Emergency Medicine, Barnes-Jewish Hospital, Washington University School of Medicine, St Louis, Missouri.‡
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Reprint no.47/1/79382
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Address for reprints: William M Hilty, MD Highland General Hospital Department of Emergency Medicine 1411 East 31st Street Oakland, California 94602 510-437-4564 Fax 510-437-8322 E-mail [email protected]