Femoral line allows accurate measure of CVP, even in the morbidly obese or cirrhotic/ascites patient - *unless* intra-abdominal pressure exceeds CVP. Measure can be validated by looking at wave form, measuring bladder pressure, and correlating with bedside estimate of jugular venous pressure, a lost skill that can easily be resurrected.
Femoral line to measure venous saturation is not helpful and does not reflect central venous saturation. The tip of the typical 16-20 cm line lies in the iliac vein and may only reflect oxygen uptake by the leg. Preference for a femoral vein in coagulopathy is a questionable decision. It is easy to hide 1-4 units of blood in a leg and hard to compress the source of bleeding. The neck site, on the other hand, does not hide significant bleeding and can be readily compressed with one finger. Delay in line insertion to correct coagulopathy may result in delays of adequately guided resuscitation for 6-12 hours, leading to significant under-resuscitation in the most critical time period. The mortality risk of under-resuscitation greatly exceeds the mortality risk of inserting a central line in a coagulopathic patient. Risks of insertion should be minimal with skilled operators and the use of ultrasound. Ron Elkin MD California Pacific Medical Center San Francisco On Thu, May 9, 2013 at 1:33 PM, Diaz, Kim <[email protected]> wrote: > Please excuse this question if it has already cycled: I have some ED > physicians who insist on placing femoral lines for sepsis care if the > patient’s INR >2 because the site is more compressible. This gives us > access for fluid resuscitation, yet limits us with CVP monitoring and > gathering ScVO2 information. I have been unsuccessful in retrieving > research as far as the use of femoral lines for CVP and ScVO2 monitoring. > Can I gain some insight from this team of professionals?**** > > ** ** > > Kim Diaz RN, CCRN**** > > Nurse Manager CCD**** > > Sutter Amador Hospital**** > > 200 Mission Blvd.**** > > Jackson, CA 95642**** > > (209)223-7529**** > > fax: (209)257-7637**** > > ** ** > > Don’t let your victories go to your head, or your failures go to your > heart.**** > > ** ** > > _______________________________________________ > Sepsisgroups mailing list > [email protected] > http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org > >
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