Three-point positioning method for femoral vein puncture

Children, especially newborns, have relatively small blood vessels, and the needles used for blood collection are relatively thick. In addition, children cry and refuse to cooperate, so the amount of blood collected is often insufficient and can easily cause hemolysis, which can easily damage blood vessels, delay the diagnosis and treatment of the disease, and make it impossible to cooperate with the rescue of critically ill children. In recent years, our department has used femoral vein puncture to obtain blood samples from a total of 292 infants and other children with difficulty in venous blood collection. The success rate of one puncture was 90.5%, the success rate of the second puncture was 97.3%, and the success rate of the third puncture was 100%. Practice has shown that the use of femoral vein puncture improves the success rate and reduces the pain of children.

Specific methods

Puncture site

The femoral vein is located in the femoral triangle, inside the femoral sheath, just inside the inguinal ligament and close to the inside of the femoral artery. If a line is drawn between the anterior superior iliac spine and the pubic tubercle, the course of the femoral artery intersects with the midpoint of the line. The femoral vein is 0.5 cm inside the femoral artery.

Items Preparation

Treatment tray, iodine, alcohol, cotton swabs, adhesive tape, a 10ml syringe, test tubes, sterile cotton balls

How to operate

1. The child lies on his back, the buttocks on the puncture side are raised with a small sandbag, and the perineum is wrapped with a diaper to prevent urination from contaminating the puncture point.

2. The assistant restrains the child's trunk and upper limbs so that the hip on the puncture side is abducted 45 degrees and the knee is flexed 90 degrees. The assistant fixes the lower limb and knee joint on the non-puncture side. The child's lower limbs are basically in a "frog-like position", fully exposing the puncture point.

3. The operator used iodine and alcohol to disinfect the left index finger (including the nail groove) and the skin at the puncture site of the child.

4. At the junction of the middle and inner 1/3 of the child's groin, touch the femoral artery fluctuation point with the index finger of the left hand, hold the syringe in the right hand, vertically pierce the femoral artery 0.3-0.5cm inside the fluctuation point, then slowly lift the needle upwards, drawing out blood while lifting it. When blood returns, fix the needle, draw the required amount, and pull out the needle.

5. Press the needle hole with a cotton ball for 5 minutes to prevent bleeding.

6. Make up the bed units.

Precautions

1. This method is contraindicated for those with bleeding tendency or coagulation dysfunction to avoid bleeding.

2. If the puncture fails, it is not advisable to puncture repeatedly on the same side.

3. If bright red blood is drawn out, it means that the puncture has mistakenly entered an artery. Remove the needle immediately and apply pressure for 10 minutes until the bleeding stops.

4. In addition to vertical needle insertion, oblique insertion is also possible, that is, insert the needle 1-3 cm below the groin at a 30-45o angle, pierce toward the inside of the pulsation point, and then slowly withdraw the needle while drawing back blood. When blood is returned, the needle can be fixed to draw blood.

5. After puncture, observe whether there is active bleeding in the local area.

6. The groin area is easily contaminated by urine and feces, so the skin should be thoroughly disinfected before puncture.