This came up in Question 3 from the first paper of 2005: "Outline the anatomical structures relevant to the insertion of a femoral venous catheter."
Here is a classic diagram to help one remember.
The femoral vein lies within the femoral triangle:
- The superior border is formed by the inguinal ligament.
- The medial border is formed by the adductor longus.
- The lateral border by the sartorius muscle.
- The apex is formed by the sartorius crossing the adductor longus muscle.
- The roof is composed of the skin, subcutaneous tissue, the cribriform fascia, and the fascia lata.
- The floor is formed of underlying adductor longus, adductor brevis, pectineus, and iliopsoas muscles.
- Lateral to the femoral vein is the femoral artery in a fibrous sheath
- Medial to the femoral vein is the fatty lymphatic contents of the femoral sheath.
The insertion point of the femoral CVC is:
- 1cm inferior to the inguinal ligament
- 1cm medial to the maximal pulse of the femoral artery
Critically important issues:
Ensure that the puncture of the vein occurs below the level of the inguinal ligament.
Puncture above the inguinal ligament is in fact a puncture of the external iliac vein.
The external iliac vein ends up being as deep retroperitoneal structure; if it is lacerated and begins to bleed, it will be impossible to place pressure on the puncture wound.
Embarrassing retroperitoneal haematoma will result.
If one selected the femoral vessels as a favourable site because of concerns regarding coagulopathy, a puncture of the external iliac vein will completely obliterate any possible haemostatic benefit. You may as well have gone for a subclavian vessel- at least a haemothorax is accessible via a chest drain.