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Procedural Skills for Medical Students Central Line placement: Femoral Objectives: 1. Learners should be able to verbalize the indications and contraindications of central line placement. 2. Learners should be able to verbalize the ideal anatomical location for placement of a femoral central line. 3. Learners should be able to insert a femoral central line on central line trainer, using sterile technique. Material to review prior to lab: Video on Femoral Venous Catheter (need access to New England Journal of Medicine, available to students through the University of Arizona Health Sciences Library) Indications: 1. Venous access in obese or debilitated patients who have peripheral veins that are inaccessible for peripheral IV cannulation. 2. Emergency venous access after a cardiac arrest 3. Administration of cardiac medication during cardiopulmonary resuscitation 4. Large-volume parenteral fluid administration when peripheral IV cannulation is not readily obtainable 5. Central venous pressure monitoring 6. Administration of certain chemotherapeutic agents, vasopressor medications, or hyperosmolar infusions (i.e. total parenteral nutrition) 7. Performance of right cardiac catheterization and pulmonary angiography 8. Performance of hemodialysis or plasmapheresis Contraindications: 1. 2. 3. 4. 5. 6. 7. Patient refusal Distortion of local anatomy or landmarks Superior vena cava syndrome Uncontrolled coagulopathy Burn or cellulitis over insertion site Venous thrombosis of the proposed site Right-sided endocarditis or mural thrombus Equipment: HPS, central line kit, femoral central line trainer Instructional Procedure & Endpoints: 1. Learners will be oriented to trainer and equipment in ASTEC. 2. ASTEC staff or facilitator will demonstrate instruction on proper sterile technique for insertion of femoral central venous line. 3. Learners will demonstrate one femoral central line insertion on trainer using sterile technique with guidance from ASTEC staff. 1 Procedural Skills for Medical Students References: James, D. (2011). Central venous catheter insertion. In J.L. Pfenninger, & G.C. Fowler (Eds.), Procedures for Primary Care, 3rd Ed (1443-1450). Philadelphia: Elsevier Mosby. Tsui, J.Y., Collins, A.B., White, D.W., Lai, J., & Tabas, J.A. (2008). Placement of a femoral venous catheter. The New England Journal of Medicine, 358(e30). Retrieved from http://www.nejm.org/doi/full/10.1056/NEJMvcm0801006#figure=preview.gif 2