Common Femoral Vein

Simple catheter relocations can be performed with a forceful injection of saline, insertion of guidewire, or transfemoral relocation (Olcott et al. 1989). A transfemoral catheter relocation involves a common femoral vein puncture and the placement of a tightly curved catheter, reversed curved catheter, or catheter with a tip deflecting wire to engage the malpositioned catheter and draw it back into the right atrium. These techniques are used when the catheter length is deemed appropriate and does not need modification. 

Blood and Urine Collection. As mentioned previously, serial blood samples can be fairly easily collected from the dog. The jugular vein is probably the most commonly used vein because of its size and accessibility. Other veins used less frequently are the cephalic, femoral, brachial, and saphenous. 

Figure 14.3 Integration plot of the initial uptake of [3H]adenosine by the retina after intravenous administration (A) and retinal uptake index (RUI) of [3H]adenosine and [3H]D-mannitol (B). A [3H]Adenosine (10 //.Ci/head) was injected into the femoral vein. B A test compound, [3H]adenosine or [3H]D-mannitol (10 //Ci/head), and a reference compound, [14C]n-butanol (0.1 //Ci/head), were injected into the common carotid artery in the presence or absence of 2 mM inhibitors. p < 0.05, significantly different from the control. Data from Biochimica et Biophysica Acta, 1758, Nagase et al., Functional and molecular characterization of adenosine transport at the rat inner blood-retinal barrier. 13-19, 2006, with permission from Elsevier.

The anatomic location for temporary central venous catheter (CVC) insertion and placement can be dictated by certain patient or disease restrictions, but the most common sites are the internal jugular vein (neck), the femoral vein (groin), and the subclavian position (upper chest). The internal jugular approach is the first choice for placement of a hemodialysis CVC, while femoral placement is favored when rapid insertion is essential (Canaud et al., 2000). Subclavian vein access has fallen from favor because of a higher incidence of thrombosis and stenosis associated with this site, which can ultimately prevent use of the veins in the downstream vascular tree for high-flow applications such as dialysis (Cimochowski et al., 1990 Schillinger et al., 1991). 

After venous access, some consideration should be given to the sequence of lead placement. Some operators prefer to place the RV electrode first for emergency RV pacing, should heart block ensue because the heart failure patients commonly have a left bundle branch block and any trauma to the conduction system or right bundle may result in complete heart block. Other operators choose to place the coronary sinus lead first and, if necessary, depend on heart rate support via a temporary transvenous pacemaker placed via the femoral vein. The issue of failure speaks for placing the coronary sinus lead first. Should the procedure fail with unsuccessful left-sided left ventricular lead placement and the patient has already received right-sided electrodes, a pacing system may be left without an indication unless a future second attempt is considered. As more and more systems are placed for a primary prevention indication like MADIT II, this has become less problematic (153). 

Fig. 12.17. Intrapelvic portion of the iliopsoas muscle. Transverse 12-5 MHz US image obtained over the intrapelvic portion of the iliopsoas (IPs) muscle in a healthy subject. The muscle is seen lying over the anterior surface of the iliac bone. Its tendon (arrow) is located in an anterior and medial position. It appears as a well-defined oval hyperechoic structure embedded within the hypoechoic muscle belly. The femoral nerve (FN) is found in a superficial location, just laterally to the common femoral artery (FA). FV, femoral vein. The photograph and the schematic drawing at the left side of the figure indicate probe positioning...

If the recipient had previous open heart surgery (a situation not uncommon for heart transplant recipients) we usually dissect the common femoral artery and femoral vein for a short distance in one of the groins. Umbilical tapes are placed around the vessels and everything is prepared for emergency femoral cannulation. Cardiopulmonary bypass can be established immediately if there are serious complications during chest reopening or stepwise division of fibrous adhesions. 

Bolus intravenous, intramuscular, or subcutaneous injections can be administered by a single person by securing the animal s arm through the cage bars (Mazue and Richez, 1982). For safety considerations, many investigators prefer to have the animal physically restrained by a second person before the injection is given. Arterial injections (via the femoral artery) as well as limited or continuous intravenous infusion (via catheterization of the femoral or jugular vein) are other less commonly used parenteral routes in the monkey. 

With double-lumen intravenous catheters for acute hemodialysis, hemperfusion, and plasma exchange, the most common complications are bleeding, hematomas, catheter failure, risk of infection, central vein thrombosis and stenoses, and rarely, air embohsm. Femoral placement is the site associated with the fewest non-in-fectious comphcations [16]. Comphcations of treatment will be discussed below. 

Among anatomic variants, duplication of veins, especially at the femoral (20%) and popliteal (35%) level, is common. In this instance, veins are generally smaller than in a single system and may be potential source of error at continuous-wave Doppler analysis. 

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