DrMKZ

I am working in a ward where there are at least  8 – 9 patients having difficult IV access. Drug abuse  , renal impaired, liver patients and so on. ‘IT‘ will take sometimes to learn this art. Putting difficult IV lines is a tough thing. I still remember I had to poke Abah more than 5 times to find his IV lines, and in the end Nadiah got it. I called up Nadiah and  asked  for her help when Abah had to receive his antibiotics through IV. She managed to put in a pink branula at the  hand despite all the a sclerosis.

I learn this new trick last week.

If you have a Hep C positive, generalized anarsarca patient, bloating everywhere with an uncorrected INR of 4, bleeding tendencies,  and you are looking for an IV access, and to make thing worst, this patient also is a drug abusers like 10 years ago, where would you put the IV line and how?

What I did was, I didn’t put the line immediately. Incidentally, this patient was cuffed – ‘doing his time in jail’ , and he was in a left lateral lie position. ( I dont know why his cuffed was on the left side of the hand ONLY).  I had tried to put in an IV line at his femoral region the day before  but everything was bloated, and puffed.  So I only poked into the soft tissues, unable to locate the femoral vein.

So the next morning I came, my house officer did managed to put in the line, but it was not secured properly and the IV line got bunked.

The next morning, to my surprise the fluid was all to the left side, his abdomen was assymetrical, the pedal edema was more to the left side, and when I palpated the right femoral gutter I can ‘see’ the femoral artery pulse. Theoretically, the femoral artery is at the ‘question’? Is it the midpoint of the inguinal ligament or the mid-inguinal point?

The answer is the femoral artery is at the midpoint of the inguinal ligament, – halfway for the Anterior superior iliac spine (ASIS) to the pubic symphisis. From medial to lateral, the femoral vein, femoral artery and the femoral nerve. ( Thanks Dr Emad – Anatomy)

My experience, I have done femoral artery cannulation many, many times. The blood is red and it spurts. Even there was a case of ruptured and aneurysmal of the right femoral artery ( <– I didn’t do this)

So with this patient, at the right femoral gutter, the artery was nice, and with the help from a colleague, he managed to put in the IV line.  Dont ask me with what?

The interesting thing is the femoral gutter was dried up, leaving no fluid inside the anterior and medial part of the  femoral region. And, the femoral gutter is not connected to the abdomen, despite the bloated ascites fluid in the abdomen the femoral lata fascia is not connected to the abdomen. ( I learned this when I was a housemen, – when my MO had to clear an abcess from the buttock ). SO in this patient, the fluid retention had all when though to the left side of the body leaving a nice femoral gutter where the artery and the vein can be poked.

And yes we managed to put is the IV line nicely at the right femoral veins.

So he received his, IV meds.