Skip to main content

Femoral line....abduction make it easier

Jugular line access become easier by, putting patient head down,valsalva maneuver,lateral oration les than 45 degree.

What about femoral line ....any way makeit easier ?

This study was done in adult patients, with the knee straight and no abduction applied. External rotation is also helpful in kids, with abduction up to sixty degrees.

Simple external rotation of the leg increases the size and accessibility of the femoral vein



Objective: To determine if external rotation of the leg increases the size and accessibility of the femoral vein compared with a neutral position.



Methods: One hundred patients presenting to a tertiary teaching hospital were prospectively recruited. The right common femoral vein of each subject was scanned with a linear probe (5–10 MHz) inferior to the inguinal ligament, with the leg in a neutral position and then in the externally rotated position. The transverse diameter of the femoral vein, the accessible diameter of the vein (lying medial to the femoral artery) and the depth of the vein were measured.



Results: The mean diameter of the femoral vein in the externally rotated leg was greater than with the leg in the neutral position (15.4 mm vs 13.8 mm); the mean difference was 1.6 mm (95% CI 1.3–1.9). The mean accessible diameter of the femoral vein was larger with the leg externally rotated (13.8 mm vs 11.7 mm, mean difference 2.1 mm, 95% CI 1.8–2.5). The depth from the skin to the femoral vein was less with the leg in external rotation (20.9 mm vs 22.6 mm, mean difference 1.7 mm, 95% CI 1.2–2.2). The mean diameter and depth were greater in patients with overweight or obese body mass index (BMI) measurements in both leg positions. The increase in femoral vein diameter and accessibility with external rotation was observed in all BMI groups.



Conclusion: The total and accessible femoral vein diameter is increased and the surface depth of the vein is decreased by placing the leg in external rotation compared with the neutral position.





Comments

Post a Comment

Popular posts from this blog

power injectable peripherally inserted central catheters

Clinical experience with power injectable peripherally inserted central catheters in intensive care patients     Introduction In intensive care units (ICU), peripherally inserted central catheters (PICC) may be an alternative option to standard central venous catheters, particularly in patients with coagulation disorders or at high risk for infection. Some limits of PICCs (such as low flow rates) may be overcome by the use of power-injectable catheters . Method We have retrospectively reviewed all the power injectable PICCs inserted in adult and pediatric patients in the ICU during a 12-month period, focusing on the rate of complications at insertion and during maintenance. Results We have collected 89 power injectable PICCs (in adults and in children), both multiple and single lumen. All insertions were successful. There were no major complications at insertion and no episodes of catheter-related blood stream infection. Non-infective complications ...
1 comment
Read more

Things to Avoid in Anesthesia for Pregnant with Pulmonary hypertension

Anesthesia for Pregnant woman with Pulmonary Hypertension is a real challenge for anesthesiologist. It is very crucial to remember the pathophysiology of pulmonary hypertension in pregnant women and to avoid some practices that will worsen the cardiac status. 1-Avoid single shot spinal anesthesia. Some authorities consider pulmonary hypertension as absolute contraindication for single shot spinal anesthesia specially in patients with NYHA III ,IV. Spinal anesthesia causes major hemodynamic instability(decrease SVR, decrease VR, decrease in CO) The preferred neuroaxial techniques are (epidural anesthesia and CSE with minimal spinal dose) 2-Avoid PAC. Pulmonary Artery catheters insertion may lead to pulmonary artery rupture or thrombosis. TEE is better cardiac monitor/Arteial line is mandatory. 3-Avoid Nitrous oxide in gas mixture.N2O increase the PVR 4-If MV to be started, avoid High TV and PEEP 5-Avoid Oxytocin Boluses, or rapid administration of Pitocin. Oxytocin causes ...
Post a Comment
Read more

The 12 decision making steps for post dural puncture headache treatment

Treatment decision-making algorithm for postdural puncture headache. 1. When diagnosis is made, all patients should receive supportive measures (reassurance, bed rest, analgesics, hydration, quiet environment). 2. Severity of symptoms should be classified using VAS scale (mild 1–3, moderate 4–6, severe 7–10). 3. Virtually all patients will improve in time even without additional therapy. (dashed lines) 4. Symptoms worsen or fail to resolve within 5 days. 5. Patient preference dictates the choice between pharmacologic (less effective) and epidural blood patch (EBP). 6. In patients with severe symptoms, EBP is strongly suggested. 7. The most common pharmacologic measure is  caffeine  prescription. 8. The failure, worsening, or recurrence of symptoms after pharmacologic measures favors the use of EBP. 9. In addition to EBP, other epidural treatment options can be considered in select patients (eg,  dextran , saline). 10. A period of 24 h should lapse before repeating EBP. 11...
1 comment
Read more