ICU Primary PrepQuest: Anatomy of the Femoral Vein

Introduction

• Presenters: Maddy and Swapnil
• Focus: Anatomy of the femoral vein, particularly in relation to central venous cannulation.

Structure of the Anatomy Discussion

1. Origin, Course, and Tributaries
2. Location
3. Anatomical Relations
4. Surface Anatomy

Origin, Course, and Tributaries

• Origin: Begins at the adductor hiatus of the adductor magnus muscle.
• Course:
  • Continuation of the popliteal vein.
  • Extends into the anterior thigh, through the adductor canal into the femoral triangle.
  • Traverses the femoral sheath lateral to the femoral canal.
  • Terminates posterior to the inguinal ligament as the external iliac vein (retroperitoneal region).
• Tributaries:
  • Deep femoral vein: Empties into the femoral vein posteriorly, distal to the inguinal ligament.
  • Great saphenous vein: Joins the femoral vein anteriorly, infralateral to the pubic tubercle.
  • Receives tributaries from deep veins of thigh and leg, external dendral, superficial circumflex iliac, superficial epigastric, accessory saphenous, and lateral/medial circumflex veins.

Location

• Femoral Triangle:
  • Borders: Inguinal ligament (superior), Adductor longus (medial), Sartorius (lateral).
  • Apex: Sartorius crossing the adductor longus.
  • Roof: Skin, subcutaneous tissue, preformed fascia, fascia lata.
  • Floor: Adductor longus, adductor brevis, pectineus, iliopsoas muscle.
  • Contains femoral sheath, divided into compartments:
    • Medial compartment: Femoral canal (lymphatic vessels, fat, deep lymph node).
    • Intermediate compartment: Femoral vein.
    • Lateral compartment: Femoral artery.
  • Femoral nerve: Lateral to femoral sheath and artery.

Anatomical Relations

• Cannulation: Important relation to femoral artery.
• Mnemonics and Acronyms:
  • "NAVY" from lateral to medial: Nerve, Artery, Vein.
  • Position of artery and vein can vary; vein typically medial but varies with proximal/distal location in cannulation.

Surface Anatomy

• Ultrasound Guidance: Commonly used for accuracy.
• Traditional Surface Anatomy Method:
  • Femoral artery pulsation: Midway between ASIS and pubic symphysis along inguinal ligament.
  • Femoral vein: 1-2 cm inferior and medial to femoral artery pulsation.
• Needle Insertion Layers: Skin, subcutaneous tissue, fascia, then femoral vein.

Conclusion

• Importance of understanding anatomical relations and sequence.
• Correct sequencing in real-life application prevents arterial puncture.

Reference in show notes for further information or diagrams.