“As the patient was unable to lie flat on bed and multiple attempts for vascular access were already tried in the emergency department, we planned for low approach femoral access. Since RT-PCR report for COVID-19 was pending, after donning PPE kit and taking all aseptic precautions, skin over the thigh was prepared with the patient in reverse Trendelenburg position, leg abducted & external rotation at hip joint. We used ultrasound (M-Turbo, Fujifilm sonosite, Bothell, WA, USA) with a linear transducer to scan the femoral vessel at the level of the groin. Short axis view was used to identify femoral vein and was traced down to 5 cm below the inguinal ligament [Fig. 1]. By keeping the femoral vein in center of the screen, a needle was inserted from the middle of the linear probe at an angle of 30–45 degree [Fig. 2]. After successful puncture of the vein, the transducer was removed and the catheter was introduced by seldinger technique. Position of guidewire inside the femoral vein was confirmed with ultrasound by using a long axis view before threading the catheter over it [Fig. 3]. The cannulation was successful in the first attempt.”

K. Singh, A.K. Bharti and P.K. Dubey, Use of ‘Low approach’ femoral central venous cannulation during COVID 19 pandemic, American Journal of Emergency Medicine (2021), https://doi.org/10.1016/j.ajem.2021.02.010