To reduce the risk of infection, the decision was made to tunnel the catheter from the common femoral vein down to the mid-thigh region.Ĭonclusion: In the patient with thoracic central occlusion, successful CVP monitoring and critical care venous access can be achieved from the femoral approach with the catheter tip terminating in the inferior vena cava or at the right atrial junction. Although the initial attempt to the right common femoral vein by anesthesia was unsuccessful, the plan was to attempt access with a micropuncture needle and attempt to thread an 80 cm floppy tip hydrophilic guide wire. Ultrasound assessment of the femoral vasculature with the RaFeVA protocol revealed evidence of a right femoral bypass, and compressible common femoral vein without signs of echogenic material. The vascular access service was consulted for triple lumen central venous catheter placement.Ī visual inspection of the thoracic cavity revealed discernable signs of dilated external veins to the chest wall. The patient was returned to the critical care unit requiring multi-lumen central venous access and central venous pressure monitoring. The right femoral vein was attempted without success and a cordis catheter was placed successfully in her left femoral vein. Anesthesia was unsuccessful at threading a central venous catheter to the right and left jugular veins. In the centrally occluded patient, accurate central venous pressure monitoring can be achieved from the right femoral vein approach with the catheter tip residing within the iliac veins or at the junction of the inferior vena cava and right atrium.Ĭase Report: The patient was an 81-year-old female with multiple medical comorbidities, including severe aortic stenosis, sick sinus syndrome, end-stage renal disease on hemodialysis, a left-sided implantable pacemaker, significant peripheral vascular disease, status post amputations of multiple digits, status post right-sided femoral popliteal bypass surgery, and status post cardiac bypass surgery who presented to the Cardiothoracic Surgical Service for evaluation for transcatheter aortic valve replacement (TAVR). The measurement of right atrial pressures is commonly achieved with catheter placement from the internal jugular vein to the right atrium. Introduction: Central venous pressure monitoring is a common assessment tool in patients undergoing heart surgery.
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