What is the pathway from the femoral vein to the lungs?

From the Guidelines

To access the lungs from the femoral vein, it is not recommended due to the high risk of contamination and venous thrombosis associated with femoral vein catheterization, as stated in the ESPEN guidelines on parenteral nutrition 1.

Alternatives to Femoral Vein Access

Instead, alternative routes such as the internal jugular or subclavian veins are preferred for central venous catheter placement due to lower risks of infection and thrombosis.

• The internal jugular vein can be accessed using the low lateral approach, which has been shown to have a lower risk of mechanical complications compared to other approaches 1.
• The subclavian vein can also be used, although it carries a higher risk of malposition compared to the internal jugular vein 1.

Importance of Ultrasound Guidance

Ultrasound-guided venepuncture is strongly recommended for all central venous catheter insertions, as it has been shown to reduce the risk of complications and improve the success rate of catheter placement 1.

Key Considerations for Catheter Placement

When placing a central venous catheter, it is essential to consider the following factors:

• Choice of vein: The internal jugular or subclavian veins are preferred due to lower risks of infection and thrombosis.
• Insertion technique: Ultrasound-guided venepuncture is recommended to reduce the risk of complications.
• Catheter material: While there is limited evidence on the importance of catheter material, Teflon, silicone, and polyurethane are associated with fewer infections than polyvinyl chloride or polyethylene 1.

Reducing the Risk of Catheter-Related Infection

To minimize the risk of catheter-related infection, the following measures are recommended:

• Use of maximal barrier precautions during insertion
• Proper education and training of staff
• Adequate hand washing policy
• Use of 2% chlorhexidine as skin antiseptic
• Appropriate dressing of the exit site
• Regular change of administration sets 1

From the Research

Accessing Femoral Vein to Lungs

• The femoral vein can be accessed for central venous catheterization using ultrasound guidance, which has been shown to decrease the number of needle puncture attempts, complications, and failure rates 2.
• A study published in 2022 found that ultrasound-guided cannulation of the superficial femoral vein at mid-thigh was a safe and effective technique for central venous access, with a 100% success rate and negligible immediate/early complications 3.
• Another study published in 2020 described the use of ultrasound guidance for internal jugular and femoral central venous catheter insertion, highlighting the importance of adequate cognitive knowledge, workflow understanding, and manual dexterity to safely execute this invasive procedure 4.
• A systematic review published in 2015 found that two-dimensional ultrasound guidance reduced the risk of inadvertent arterial puncture and haematoma formation during subclavian vein catheterization, and increased the success rate of femoral vein catheterization on the first attempt 5.
• A study published in 2019 described the use of femoral vein homograft as a right ventricle to pulmonary artery conduit in the Norwood operation, with good pulmonary artery growth and preserved ventricular function 6.

Key Findings

• Ultrasound guidance is a safe and effective technique for accessing the femoral vein for central venous catheterization.
• The use of ultrasound guidance can reduce the risk of complications and increase the success rate of catheterization.
• The femoral vein can be used as a conduit for right ventricle to pulmonary artery connection in certain surgical procedures.

Relevant Studies

• 3: Ultrasound-guided cannulation of the superficial femoral vein for central venous access.
• 2: Ultrasound Guidance for Central Venous Access: Current Evidence and Clinical Recommendations.
• 4: How I Do It: Ultrasound-Guided Internal Jugular and Femoral Central Venous Catheter Insertion.
• 5: Ultrasound guidance versus anatomical landmarks for subclavian or femoral vein catheterization.
• 6: Experience of a single institution with femoral vein homograft as right ventricle to pulmonary artery conduit in stage 1 Norwood operation.