Contraindications for femoral venous catheter placement
Patient refusal
Deep venous thrombosis of vein
Overlying burn or cellulitis
Thrombocytopenia with platelets <20,000
Anticoagulation is a relative contraindication for accessing a compressible vein and an absolute contraindication for a non-compressible vein (subclavian vein)
DIC and a non-compressible vein
Inability to lie flat for IJ and Subclavian lines
Complications of a femoral venous catheter placement
Central line-associated Bloodstream Infection (CLABSI) (femoral>IJ>subclavian)
Deep venous thrombosis (femoral > IJ = subclavian)
Pneumothorax (subclavian > IJ)
Hemothorax (subclavian > IJ)
Hematoma (femoral > subclavian = IJ)
Arterial injury or arterial cannulation (femoral > IJ > subclavian)
Bleeding (femoral > IJ > subclavian)
Air embolus (IJ = subclavian)
Dysrhythmias (IJ > subclavian)
Lost guidewire (all sites equal)
Central line-associated Bloodstream Infection (CLABSI)
>250,000 cases of CLABSI per year in United States
Cost per CLABSI is >$35,000
Increased Length of Stay
Increased Mortality
WAYS TO MINIMIZE CLABSI
Wash hands thoroughly before placement of central lines and before accessing catheter ports
