An 82-year-old woman is sent to the hospital from a nursing home after 2 days of fever, confusion, and lethargy. The patient has a history of mild dementia, hypertension, and osteoarthritis. Her temperature is 38.8 C (102 F), blood pressure is 90/60 mm Hg, and pulse is 116/min. She has mild suprapubic and right costovertebral angle tenderness. Her leukocyte count is 18,000/mm³, and urinalysis is consistent with acute cystitis. A femoral venous access is planned for administration of intravenous fluids and antibiotics. The femoral artery pulsation is palpable immediately below the inguinal ligament. Which of the following describes the optimal cannulation site for the femoral vein?

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11ec160b_3559_78e1_9249_7729cc2a288c_MD0001_00 Femoral vein catheter placement is usually done in patients with unavailable preferred access sites (eg, subclavian, jugular vein) or those at increased risk of complications (eg, emergency access, uncooperative patient). The femoral vein is the major deep vein of the lower extremity and passes through the femoral triangle beneath the inguinal ligament before entering the pelvis as the external iliac vein. The femoral triangle is a subfascial space in the upper thigh that is bordered by the inguinal ligament (superiorly), adductor longus muscle (medially), and sartorius muscle (laterally). Within the femoral triangle lies (lateral to medial) the femoral nerve, femoral artery, femoral vein, and deep inguinal nodes/lymphatic vessels. The femoral artery is located at the midinguinal point (midway between the pubic symphysis and anterior superior iliac spine), and the femoral vein lies immediately medial to the artery. Cannulation of the femoral vein should occur approximately 1 cm below the inguinal ligament and 0.5-1.0 cm medial to the femoral artery pulsation (Choices C, D, and E). (Choice A) The femoral nerve is approximately 1 cm lateral to the femoral artery pulsation and could be damaged by needle insertion at this site. Educational objective: The femoral triangle (lateral to medial) consists of the femoral nerve, femoral artery, femoral vein, and deep inguinal nodes/lymphatic vessels. Cannulation of the femoral vein should occur approximately 1 cm below the inguinal ligament and just medial to the femoral artery pulsation.

An 82-Year-Old Woman Is Sent to the Hospital from a Nursing