Femoral Artery Sheath. The femoral sheath is formed by a downward prolongation, behind the inguinal ligament, transversalis fascia and the iliac fascia. The sheath is in the form of a short tunnel and it is directed upwards. It is also called the crural sheath. This sheath is strengthened by a band called the deep crural arch.
What does femoral sheath mean?
The femoral sheath, also called the crural sheath, is a continuation of the abdominal fascia that is contained in the femoral triangle. It forms the femoral canal, allowing for the femoral artery and the femoral vein to travel between the abdomen and the thigh. Femoral sheath. Femoral sheath laid open to show its three compartments.
What are the contents of the femoral sheath?
- The lateral compartment contains the femoral artery, and the femoral branch of genitofemoral nerve.
- The intermediate compartment contains the femoral vein.
- The medial (and smallest) compartment is named the femoral canal, and contains some lymphatic vessels and a lymph gland embedded in a small amount of areolar tissue.
What is arterial venous sheath?
Arterial & Venous Sheaths. A sheath is a protective covering or encasement that's used during cardiac procedures to assist with guidewire and catheter insertion and advancement. A sheath can be ...
What is arterial sheath removal?
the arterial sheath from the femoral artery during exhalation. Prevents bleeding. Removing the arterial sheath during the exhalation phase of the respiratory cycle may prevent the patient from “bearing down” during arterial sheath removal. Never withdraw the sheath if resistance is met. Notify the physician or advanced practice nurse. 20.
What is a femoral sheath used for?
Function. The femoral sheath allows for the femoral artery and the femoral vein to pass between the abdomen and the thigh.
What is a arterial sheath?
Background. The radial artery access sheath is used to gain arterial access and facilitate the insertion of catheters or other equipment for diagnostic and vascular interventions.
Where is the femoral sheath?
The femoral sheath is the funnel-shaped fascial space that extends from the abdomen, inferior to the inguinal ligament, into the femoral triangle.
How do you remove arterial sheath?
Take your index, middle and sometimes your ring finger, and place them slightly above the sheath to feel the patient's pulse. This will tell you exactly where the artery is that you are holding. Slowly remove the sheath in a sterile manner, holding occlusive pressure to avoid bleeding.
When should arterial sheath be removed?
Control ACT in the third hour after angioplasty. If ACT was less than or equal to 175 seconds, arterial sheath would be removed by manual compression. Put direct pressure on the arterial sheath insertion site for two to three minutes; so that the dorsalis Pedi's pulse disappears.
When do you remove the femoral sheath?
The anticoagulation time (ACT) should ideally be less than 160 seconds (Grossman and Baim, 2000). In practice, it is time consuming trying to measure the ACT. Therefore it is our local practice to remove femoral sheaths four hours after the procedure unless the cardiologist specifies otherwise.
Is femoral nerve in femoral sheath?
The primary nerve contained within the femoral triangle is the femoral nerve, arising from L2, L3, and L4. It enters the femoral triangle inferior to the inguinal ligament, external to the femoral sheath, and is the most lateral of the significant structures contained within the triangle.
Can you feel the femoral artery?
Femoral Pulse When palpating the femoral pulse, you are feeling for the femoral artery that comes close to the surface in the femoral crease (the line between the end of the abdomen and the beginning of the inside of the thigh) midway between the pubic symphysis and the Anterior Superior Illiac Spine (ASIS).
What do you monitor after sheath removal?
Accurate vascular puncture and effective initial control of bleeding after sheath removal are the best measures to prevent local vascular complications. Early diagnosis and management of local access site complications are essential to reduce morbidity and improve outcome.
What is a sheath after cardiac catheterization?
Once the local anesthetic has taken effect, your doctor inserts a sheath, or introducer into the blood vessel. This is a plastic tube through which the catheter is thread into the blood vessel and advanced into the heart.
What is a sheath in angioplasty?
A sheath is a vascular tube placed into the access artery, such as the femoral artery in the groin. A balloon catheter is a long, thin plastic tube with a tiny balloon at its tip. A stent is a small, metal mesh tube.
What is the femoral sheath?
The femoral sheath, also called the crural sheath, is a continuation of the abdominal fascia that is contained in the femoral triangle. It forms the femoral canal, allowing for the femoral artery and the femoral vein to travel between the abdomen and the thigh. Femoral sheath.
What is the depression in the septum femorale?
The septum femorale is pierced by numerous lymphatic vessels passing from the deep inguinal to the external iliac lymph glands, and the parietal peritoneum immediately above it presents a slight depression named the femoral fossa .
How many partitions are there in a sheath?
The sheath is divided by two vertical partitions which stretch between its anterior and posterior walls:
Which compartment contains lymphatic vessels and a lymph gland?
The medial (and smallest) compartment is named the femoral canal, and contains some lymphatic vessels and a lymph gland embedded in a small amount of areolar tissue.
Where is the spermatic cord located?
The spermatic cord in the male and the round ligament of the uterus in the female lie immediately above the anterior margin of the ring, while the inferior epigastric vessels are close to its upper and lateral angle.
How to identify femoral artery?
First locate the bifurcation of the femoral artery. Once the bifurcation is identified, trace the artery proximally to identify the common femoral artery. Under direct ultrasound guidance advance the 18-gauge needle. As the needle passes through the tissue planes, the indentation on the artery by the advancing needle can be identified on the ultrasound.
How many compartments are there in the femoral sheath?
The femoral sheath has three compartments. The lateral compartment contains the femoral artery, the intermediate compartment contains the femoral vein, and the medial and smallest compartment is called the femoral canal, which contains efferent lymphatic vessels and a lymph node embedded in a small amount of areolar tissue.
What is the CFA in a femoral artery?
Femoral artery anatomy. Knowledge of the normal course of the common femoral artery (C FA) is vital as the majority of arterial access complications are related to the site of femoral arterial puncture. The CFA is a continuation of the external iliac artery and crosses the pelvic brim at the level of the inguinal ligament.
What is the relationship between CFA and femoral vein?
Lateral to the femoral artery and outside the femoral sheath is the femoral nerve. The relationship between CFA, femoral vein, and the femoral nerve can be easily remembered by the mnemonic VAN (Vein, Artery, Nerve) going from medial to lateral.
Where is the ideal site for femoral arterial puncture?
The ideal site of femoral arterial puncture (not skin puncture) is at the CFA at a point approximately 1 cm lateral to the most medial aspect of the femoral head, midway between its superior and inferior borders (Rupp’s rule).
Which artery is used for transcatheter valves?
For many procedures such as transcatheter valves, given the larger size of the femoral artery, this is the routinely used access site, although subclavian artery and direct aortic access are being increasingly used for transcatheter valves.
What interventions are used for peripheral arterial disease?
Prior interventions for peripheral arterial disease, including arterial bypass grafts or stenting (anatomy of the graft and site of stent)
What is the femoral sheath?
The femoral sheath is the funnel-shaped fascial space that extends from the abdomen, inferior to the inguinal ligament, into the femoral triangle. It has variable length and terminates by blending in with the adventitia of the femoral vessels.
Which compartment contains the common femoral vein?
medial compartment: also known as the femoral canal. intermediate compartment: contains the common femoral vein. lateral compartment: contains the common femoral artery.
Where is the sheath placed in a cardiac catheter?
A sheath is often placed in the femoral artery or vein during a cardiac catheterization because these are large vessels. A guide wire helps insert the catheter through the sheath. Joan tells Paul that a sheath will be inserted into his femoral artery after a local anesthetic is applied.
How does a sheath stay in place?
The amount of time that a sheath stays in place is determined by the procedure and type of anticoagulant or thrombolytic medication that the patient received. An anticoagulant and thrombolytic medication thins the blood, placing a patient at risk for bleeding.
How does Joan tell Paul to use a sheath?
Joan tells Paul that a sheath will be inserted into his femoral artery after a local anesthetic is applied. A guide wire is then used to advance the catheter through the sheath and into the femoral artery toward the heart. Paul will hardly feel anything. The catheter is removed immediately, but the sheath often stays in for several hours to minimize bleeding. Paul asks how he will be managed while the sheath is still in his artery.
Why is pressure applied to the sheath site after removal?
Pressure must be applied to the sheath insertion site after removal in order to decrease complications. Pressure is applied using an external compression device, vascular closure device, or manual compression.
What are the signs of a sheath being removed?
Amount of tension to apply to the artery once the sheath is removed. Signs of bleeding, hematoma, or loss of pulse.
What happens when you remove a sheath?
Pressure and pain may be felt during removal of the sheath, which causes a stimulation of the vagus nerve. This can cause the blood pressure and heart rate to decrease, resulting in a vasovagal response or fainting. Bleeding from the sheath site can be arterial or superficial.
What is the term for a clot in the artery that causes paleness and decreased sensation?
An arterial occlusion, or ischemic limb, occurs when a clot forms in the artery, which causes a decreased pulse, paleness, and decreased sensation of the limb. There is a risk for infection any time there is a foreign body inserted into the body.
Overview
The femoral sheath, also called the crural sheath, is a continuation of the abdominal fascia that is contained in the femoral triangle. It forms the femoral canal, allowing for the femoral artery and the femoral vein to travel between the abdomen and the thigh.
Structure
The femoral sheath is formed by a prolongation downward, behind the inguinal ligament, of the abdominal fascia, the transverse fascia being continued down in front of the femoral vessels and the iliac fascia behind them. The femoral sheath is contained in the femoral triangle.
The sheath assumes the form of a short funnel, the wide end of which is directed upward, while the lower, narrow end fuses with the fascial investment of the vessels, about 4 cm. below the ing…
Function
The femoral sheath allows for the femoral artery and the femoral vein to pass between the abdomen and the thigh.
History
The femoral sheath is also known as the crural sheath.
Additional Images
• Femoral sheath
External links
• Photo and overview at gla.ac.uk
• antthigh at The Anatomy Lesson by Wesley Norman (Georgetown University)
• Diagram at washington.edu
General Description of Procedure, Equipment, Technique
- Femoral access is still the most common mode of vascular access for coronary angiography and intervention in the United States, though transradial access is on the rise. The femoral artery, in a nondiseased state, is a larger caliber artery (permitting larger size catheters) and is less prone to spasm when compared with the radial artery. For many ...
Indications and Patient Selection
- Femoral access is commonly used for the following purposes: 1. As an access site for coronary angiography and intervention (preferred over radial for procedures requiring larger sheath size) 2. As an access site for percutaneous structural heart procedures (balloon valvuloplasty, percutaneous valves, etc.) 3. As an access site for peripheral vascular angiography and intervent…
Contraindications
- There is no absolute contraindication for femoral access. However, caution must be exercised and alternative routes considered in the following circumstances: 1. Absent or weak femoral artery pulse (consider contralateral femoral artery, radial access, or use of SMART needle or ultrasound guided femoral access as described below) 2. Recent use of vascular closure device …
Details of How The Procedure Is Performed
- Prior to the procedure, patient should be well informed about the steps of the procedure to ensure adequate understanding and cooperation. A well-informed patient makes for a more cooperative patient.
- Ensure that a written informed consent is obtained prior to the procedure.
- Review basic laboratory values (preferably obtained in the prior 2 weeks).
- Prior to the procedure, patient should be well informed about the steps of the procedure to ensure adequate understanding and cooperation. A well-informed patient makes for a more cooperative patient.
- Ensure that a written informed consent is obtained prior to the procedure.
- Review basic laboratory values (preferably obtained in the prior 2 weeks).
- Ensure that women of child-bearing age have a negative urine/serum beta-hCG test within 2 week prior to the procedure.
Complications and Their Management
- Femoral access site complications are perhaps the most common complications in patients undergoing coronary angiography and interventions. Recognition and early treatment of these complications can prevent more serious complications and death. 1. Arteriovenous (AV) Fistula: The incidence of AV fistula after femoral arterial cannulation is <1.0%. Femoral arteriovenous fis…
What’s The Evidence?
- Bangalore, S, Bhatt, DL. “Femoral arterial access and closure”. Circulation. vol. 124. 2011. pp. e147-56. Rao, SV, Ou, FS, Wang, TY. “Trends in the prevalence and outcomes of radial and femoral approaches to percutaneous coronary intervention: a report from the National Cardiovascular Data Registry”. JACC Cardiovasc Interv. vol. 1. 2008. pp. 379-86. Rupp, SB, Vogelzang, RL, Nemc…