C E N T R A L V E N O U S A C C E S S
Medications given via the femoral route in secondand third trimester may not be distributed effectively. Consider other sites.
1. Prepare equipment in advance.2. Identify the anatomical landmarks
Locate the femoral arterial pulse 1 cm caudad of the inguinalfold. The puncture site for femoral vein catheterization is just
and parallel to the artery.3. Using aseptic technique, prepare the insertion site.4. Palpate the femoral pulse. Using a long 14 or 16-gauge over-the-needle catheter with an attached 10-12 cc syringe, insert the needleand advance cranially at a
angle to the skin, parallel to the arterialpulse. Continually aspirate the syringe during insertion.5. Upon free aspiration of blood, advance the catheter over the needle.6. Attach the infusion set to the catheter, observe for free flow of solutionand blood return when the infusion set is lowered below the level ofthe patient’s heart.7. Secure the catheter and place an occlusive dressing over theinsertion site.
Internal Jugular approach
Care should be taken when accessing the internal jugular vein because of theproximity of adjacent structures.
1. Prepare equipment in advance.2. Place the patient in the Trendelenburg position with the face rotatedaway from the side of insertion.3. Identify the anatomical landmarks:
Locate the triangle formed by the sternal and clavicular headof the sternocleidomastoid muscle.4. Using aseptic technique, prepare the insertion site.5. Using a long 14 or 16-gauge over-the-needle catheter with anattached 10-12 cc syringe, insert the needle into the apex of thetriangle formed by the three heads of the sternocleidomastoid muscle.Direct the needle on a 45-60 degree angle, laterally toward theipsilateral nipple. Continually aspirate the syringe during insertion.6. Upon free aspiration of blood, advance the catheter over the needle.7. Remove the stylet
and immediately occlude thecatheter with a gloved finger to reduce the risk of air embolism.