Resident accuracy in locating the common femoral vein in normal weight vs. obese patients

Objectives: Ultrasound guidance increases the success of internal jugular central venous catheter (CVC) placement. The common femoral vein (CFV) is considered an easier site and physicians frequently place CFV CVCs using anatomical landmark guidance. No research has demonstrated the effect of patient weight on placement of a femoral CVC. The authors hypothesized that resident physicians could determine by anatomical landmarks the insertion site of a femoral CVC in normal and overweight adults. Methods: Investigators consented adult patients in the Emergency Department to serve as study models. Patients were grouped by BMI: Normal (BMI < 25) and Overweight (BMI > 25). PGYI-III Emergency Medicine residents who volunteered to participate were included. Residents inspected and palpated the inguinal regions on a patient and marked the patient’s skin directly over the CFV. A faculty member assessed success using a 10 MHz linear probe (Sonosite Micro Maxx) centered over the mark. The attempt was successful if the mark was directly over the CFV and unsuccessful if distal, lateral, or medial to the CFV. Results: Nineteen residents (6 PGYI, 7 PGY II, and 6 PGYIII) assessed 17 patients. There were 43 attempts on Normal patients and 57 attempts on Overweight patients. The success rate on Normal patients was 74% and on Overweight patients was 42% (p = 0.0021). Conclusion: Residents were more successful in correctly identifying the CFV by anatomical landmarks in Normal patients. Training year had no effect on success. Ultrasound guidance may increase the success rate of placing a femoral CVC in patients with BMI > 25.