Femoral Line for Cavagram – Nurse Clinicians in Action-09

Femoral Line for Cavagram describes how the Vascular Access clinician chooses a more clinically appropriate and safer Femoral Line to achieve access for the patient and is the focus of this Nurse Clinicians in Action.

Femoral Line for Cavagram

– Clinical Case

This case took place in a long-term acute care hospital (LTACH). A Vascular Wellness clinician was called to place a peripherally inserted central catheter (PICC) line on a patient when he overheard an emergent situation on a different patient being discussed between the managing physician and radiologist.  The managing physician’s patient had rapidly deteriorated overnight and a morning chest X-ray revealed a new mass causing superior vena cava (SVC) syndrome, an obstruction of blood flow through the SVC.  The radiologist was urgently requesting the patient immediately undergo a cavogram, which is used to identify the cause of obstruction of the SVC, to evaluate this mass constricting the SVC.

Along with the need to diagnose and treat this new mass, the medical team needed the patient to start vasopressors as a result of falling blood pressure. Vasopressors are a class of drugs that increase blood pressure by creating constriction in the blood vessels.  The managing physician ordered a PICC to infuse the vasopressors, even though the patient was experiencing superior vena cava syndrome.

Femoral Line for Cavagram

– Diagnosis and Treatment

Although the managing physician ordered a PICC STAT, the Vascular Wellness clinician was concerned that the superior vena cava syndrome was so severe that it would prevent access to the superior vena cava.  He consulted with the radiologist and explained that vascular access via the inferior vena cava (IVC) using a Femoral Line inserted in the mid-thigh would be a much better option and the radiologist agreed.  The clinician placed the Femoral Line in the mid-thigh successfully without incident or any complications, and he was able to perform the procedure while keeping the patient comfortable the entire time.

The cavagram, administered through the Femoral Line revealed that the patient did not have a mass, but a rapidly growing aortic aneurysm, a bulge in an artery.  The patient was immediately transferred to a local hospital to begin a lifesaving repair of the aneurysm, on the same day of the diagnosis.  After successful aortic repair, the patient was healthy enough to be transferred back to the LTACH to complete his rehabilitation, and eventually, he was discharged to his home.  Given the speed and timeliness of the diagnosis and treatment, the Vascular Wellness clinician feels that the Femoral Line was a lifesaving vascular access procedure for the patient.

Vascular Access Experts

– Key Points

The Femoral central catheter line is a clinically appropriate line when the patient has superior vena cava syndrome or other medical conditions that do not allow access via other lines such as the axillary or the internal jugular.  Vascular Wellness clinicians are aware that sometimes the Femoral line is avoided due to the risk of infections or other complications, and developed a less intrusive and less risky approach, creating access in the middle of the thigh, with high success rates and a 0% infection rate similar to our PICC lines. This approach avoids the inguinal fold which can be a source of infection.  Vascular Wellness continues to advance healthcare and empower nurses by improving, developing, and innovating vascular access procedures such as it has done with the traditional Femoral line by making the insertion in the mid-thigh.

Vascular Wellness clinicians have placed hundreds of thousands of lines and this experience enables us to assess a situation and patient properly, and if a patient is contraindicated for a specific central line, to utilize that experience to place a clinically appropriate line such as a Femoral Line.  Further, by having the tools of US Guided PIVs, Midlines, PICCs, Small Bore lines such as Internal Jugular lines (IJs) and Femoral lines (Fems), and Large Bore lines including Vas Caths and Quad Lumens, Vascular Wellness is able to create clinically appropriate access in virtually all patients, while minimizing multiple needle sticks. The ability to minimize sticks and place the right line at the right time, the first time, is incredibly important as the placement of a Central Venous Catheter is an invasive medical procedure that comes with risks.  These factors, along with a consultative approach with the treating physician, are just a few reasons why Vascular Wellness improves patient outcomes, reduces costs, and strengthens infection control.

Nurse Clinicians in Action is a spotlight series highlighting some of the interesting cases that Vascular Wellness clinicians have encountered and participated in treatment. These cases involve challenging situations or intriguing clinical presentations and may involve more than one Vascular Wellness clinician, as our clinicians have the ability to consult each other while in the field, as well as an on-call Clinical Administrator via a HIPAA (Health Insurance Portability and Accountability) compliant communication app. In addition, our extensive training program and diverse client base, including Level 1 Trauma Centers, Short Term Acute Care Hospitals, Long Term Acute Care Hospitals, and Skilled Nursing Facilities, provide our clinicians with a wide array of clinical experience and why we believe our clinicians, as a group, are the most experienced and best trained and supported vascular access clinicians.

If you require Vascular Access or want to learn more, speak to the team at Vascular Wellness today.  For the latest articles and insights, follow us on LinkedIn, Facebook, Twitter, YouTube, and Instagram.

Vascular Wellness provides:
(1) Comprehensive vascular access services to North Carolina, South Carolina, and Virginia;
(2) Customized vascular access services to Tennessee, Georgia, and West Virginia; and
(3) Support vascular access services to Pennsylvania, Ohio, and Kentucky.