Ultrasound-guidance for femoral vein cannulation is a critical skill for acute care practitioners. Inter-individual differences can lead to anatomic variation, including direct overlap and aberrancy, in the arrangement of the common femoral artery and vein (Hoffman et al. 2006). Ultrasound allows you to directly visualize both the (common) femoral artery and vein, ensure patency, and anticipate anatomic variation. Ultrasound is now recommended as the standard approach in central venous cannulation of the femoral vein (Franco-Sadud et al. 2019). Research shows that ultrasound-guidance reduces number of cannulation attempts, improves success rate and reduces mechanical complications, even by inexperienced operators (Airapetian et al. 2013; Seto et al. 2010). Ultrasound can not only prevent unintentional puncture fo the femoral artery, but can prevent damage to the femoral nerve, and development of avascular necrosis (by preventing injury of vessels: blood supply to femoral head). Importantly, while ultrasound is recommended as the standard approach, “blind” cannulation is acceptable in many instances where ultrasound is unavailable.

This section will not review the indications or contra-indications to placement of a femoral central venous catheter, but will instead review key steps of the procedure.