Introduction with a case
How I used to manage this
How I might manage this currently
Advantages of emergent femoral arteriovenous access
It’s OK to be dirty, as long as you come clean about it
Beware of the intubation trap for hemodynamic crashes
To ultrasound or not to ultrasound?
Approach in morbid obesity
- For a crashing patient who needs immediate arterial and venous access, one approach is to place adjacent catheters into a femoral artery and vein.
- With the exception of severe obesity, this is generally fast and technically straightforward (especially with the use of ultrasonography).
- It may be difficult to place a completely sterile central line in the middle of a resuscitation. In an emergency it is reasonable to intentionally place “dirty” lines with a plan of removing these within ~24 hours. Placing “dirty” lines in the femoral position leaves the remainder of the vasculature available for placing a sterile line when time allows.