Ultrasound guided cannulation of the femoral vein

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.


Whether or not you use ultrasound, it is critical to understand the anatomy of the femoral triangle. This triangle is made up of the inguinal ligament (superior border),the adductor longus muscle (medial border) and by the sartorius muscles (lateral border).  Within the femoral triangle are the (common) femoral artery and femoral vein in the inguinal-femoral region. As for the internal jugular cannulation, we recommend you map this region first without ultrasound.


Prior to prepping the patient for the procedure it is useful to ensure you can easily localize the vessel, plan your site of entry and ensure there are no contra-indications to femoral vein cannulation (ex. infection overlying site). We encourage you to use caution in your approach, as cannulation above the inguinal ligament, can lead to puncture of the iliac vessels. Generally, central vein cannulation should occur ~2 cm distal to the inguinal ligament and where the common femoral vein and artery are side-by-side. Also, double check to ensure the screen marker aligns with your anatomical approach.


One extra step is to compress the vessel to ensure there is not occult clot/VTE. In this clip, firm pressure is applied directly overlying the vessel. Under normal circumstances, the femoral vein will compress completely. In this clip, firm pressure is applied, but the walls do not occlude. The lack of compressibility is pathognomic for a deep ven thrombsis.

Creep technique

With the femoral vein in the centre of the screen, the “Creep technique” can be used to help guide the needle into the target.

verify wire placement

Once the vessel is cannulated and the wire inserted, the practitioner can ultrasound the length of the wire to ensure correct placement prior to dilation for catheter placement.

femoral vein cannulation tutorial

The following video tutorial was not produced by Alberta Sono (work in progress), but does provide an outstanding demonstration of this technique. Click on the YouTube link to be brought to the site to view the video.