Femoral Artery Catheterization

Presentation & Cause

Arterial catheterization may occur through the radial, ulnar, axillary, brachial, dorsalis pedis, posterior tibial, or femoral arteries.1 In the case of femoral artery catheterization, the catheter is inserted into the femoral artery, one of the main arteries of the lower limb,2 through a small incision in the groin. This catheter can then be used to measure blood pressure or to inject contrast medium into the artery for angiography.

Arterial catheterization is a medical procedure that typically occurs in the intensive care or surgical setting.1 This procedure requires the insertion of a catheter into an artery to monitor blood pressure, allowing access to frequent blood sampling and evaluation of intravascular volume status.1 Other indications include cardiac catheterization, transfusions, and extracorporeal membrane oxygenation.1

Femoral artery catheterization is commonly used for cardiac catheterization, a procedure that may be used for diagnostic or therapeutic purposes.3 For example, patients may have first-line non-invasive testing for common cardiac complaints such as chest pain or cardiac arrhythmias, and if this initial testing does not yield adequate data, cardiac catheterization via the femoral artery may be used for further evaluation.3

Left heart catheterization is considered the gold standard of coronary artery disease diagnosis; however, the procedure is also used therapeutically in patients with congenital heart defects, arrhythmias, or those requiring cardiac valve replacement.3

Diagnostic Workup/Differential Diagnosis to Identify Appropriateness

The assessment for contraindications to the placement of an arterial catheter is an essential part of the diagnostic workup to identify the appropriateness of the procedure. Important contraindications to catheterization include arterial insufficiency, vascular disease, and infection at the catheterization site.1

To assess for arterial insufficiency, the femoral artery anatomic site should be inspected carefully, and peripheral pulses should be documented.3

Though there are no absolute contraindications to cardiac catheterization, relative contraindications include severe uncontrolled hypertension, unstable arrhythmias, acute cerebrovascular accidents, and severe coagulopathies.3 If radiographic contrast dye is used during the catheterization procedure, history of allergy to radiographic contrast dye, as well as renal function must be assessed.3

In preparation for the femoral artery catheterization procedure, hemoglobin, platelets, creatinine, and coagulation profile should also be analyzed.3

Femoral Artery Catheterization: Device Overview & Selection Options

Equipment for artery catheterization procedures is typically packaged in commercially bundled kits containing catheter-related equipment and infection control materials.1 These kits typically comprise appropriately-sized catheter and search needle, lidocaine, chlorhexidine solution, gauze tissue, sterile gloves, masks and gowns, and a guidewire.1

Equipment required specifically for cardiac catheterization include coronary wires, balloons, stents, and ultrasound.3 Cardiac catheterization is usually performed in a cardiac catheterization laboratory equipped with a fluoroscopy machine and hemodynamic monitors.3

After the femoral artery catheterization procedure, a vascular closure device may be used to achieve hemostasis at the catheterization site.2 Although mechanical compression at the site can be used to achieve hemostasis, this method can be especially challenging in patients who are obese and medically anticoagulated.2 These vascular closure devices may be passive (eg, devices that help healthcare workers with mechanical compression) or active (eg, suture devices, collagen plugs, and clips that expedite hemostasis).2

Patient & Special Populations Considerations

Due to the risk of bleeding associated with femoral artery catheterization, patients with anticoagulation disorders and patients undergoing medical anticoagulation represent an important special population.1 These patients should be considered especially carefully when assessing the appropriateness of the femoral catheterization procedure.1 Although severe coagulopathies represent a relative contraindication to cardiac catheterization, the procedure may still be performed in this patient population after the appropriate risk-benefit analysis.3

For patients who are medically anticoagulated, oral anticoagulants are typically stopped at least 24 hours before the catheterization procedure.3

Due to the relatively small size of arteries, multiple catheter insertion attempts may required; as a result, pediatric patients represent another special population for arterial catheterization procedures.1,4 Previously identified pediatric risk factors for complications related to catheterization procedures include infants and children aged 5 months to 2 years, the presence of systemic infection, and the number of days in hospital.4 Due to the increased likelihood of complications of catheterization procedures in the pediatric population, the risks-benefit analysis of performing the procedure must be carefully considered.1

Patients with burns or surgical interventions at the catheterization site also should be given special consideration.1

Monitoring After Femoral Artery Catheterization

In adult patients, complications related to artery catheterization have been reported in 10 to 13% of cases; therefore, monitoring for complications is especially important.1

Hematomas and active bleeding represent some of the most common complications.5 To prevent bleeding, mechanical compression at the site or a closure device may be used.2 Mechanical compression remains the “gold standard” for achieving hemostasis and involves at least 10 minutes of firm pressure proximal to the puncture site.2 After hemostasis is achieved via mechanical compression or closure device, patients also require bed rest and monitoring for any retroperitoneal bleeding for at least 8 hours.2

Additional complications of primary importance include infection and inflammation at the site, mechanical complications related to the medical equipment used for the procedure, embolic or thrombotic events, and amputation due to ischemic injury.1 To prevent infection, appropriate aseptic techniques should be used.1

Amputation due to ischemic injury can occur due to obstruction of the femoral artery during or after the catheterization procedure, because no other major collateral arterial vessels exist in the lower limb.1

Complications specifically due to cardiac catheterization include myocardial infarction, pericardial effusion, cardiac tamponade, and aortic or coronary artery dissection.3

Finally, if contrast dye is used, additional contrast-related complications may include allergic reaction or renal dysfunction.3

Implementation of ultrasound guidance reduces the risk of cardiovascular complications, and ultrasound-guided catheterization is currently the standard of care.1,6 As previously stated, the use of vascular closure devices may also improve patient outcomes.5

References

  1. Pierre L, Pasrija D, Keenaghan M. Arterial Lines. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022. Updated May 8, 2022. Accessed August 30, 2022.
  2. Rao SS, Agasthi P. Femoral Vascular Closure Devices After Catheterization Procedure. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022. Updated Jun 21, 2022. Accessed August 30, 2022.
  3. Ahmed I, Hajouli S. Left Heart Cardiac Catheterization. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022. Updated 2022 Jul 1. Accessed August 30, 2022.
  4. Hebal F, Sparks HT, Rychlik KL, Bone M, Tran S, Barsness KA. Pediatric arterial catheters: Complications and associated risk factors. J Pediatr Surg. 2018;53(4):794-797. DOI: 10.1016/j.jpedsurg.2017.08.057
  5. Castillo-Sang M, Tsang AW, Almaroof B, et al. Femoral artery complications after cardiac catheterization: a study of patient profile. Ann Vasc Surg. 2010;24(3):328-335. DOI: 10.1016/j.avsg.2009.06.025
  6. Rashid MK, Sahami N, Singh K, Winter J, Sheth T, Jolly SS. Ultrasound Guidance in Femoral Artery Catheterization: A Systematic Review and a Meta-Analysis of Randomized Controlled Trials. J Invasive Cardiol. 2019;31(7):E192-E198.

Author Bio

Anna Courant is a nurse practitioner and writer.