title: Intravenous access in the critically ill trauma patient: a multicentered, prospective, randomized trial of saphenous cutdown and percutaneous femoral access.
abstract: OBJECTIVE
  To compare the speed of IV access and the rate of infusion for saphenous venous cutdown and percutaneous femoral catheterization.
  
  
  METHODS
  Prospective, randomized, multicentered trial. Patient enrollment occurred from September 1990 through September 1991.
  
  
  METHODS
  Patients were enrolled at three urban Level I trauma centers.
  
  
  METHODS
  Seventy-eight critically ill trauma patients.
  
  
  METHODS
  Participants were randomized to one of two groups: saphenous cutdown or percutaneous femoral line. After successful cannulation of the vein, 1 L of crystalloid was infused by gravity.
  
  
  RESULTS
  The mean procedure time for the cutdown group was 5.63 +/- 2.58 minutes compared with 3.18 +/- 1.19 minutes for the femoral line group (P < .0001). The mean infusion time for the cutdown group was 6.65 +/- 4.29 minutes compared with 4.56 +/- 2.47 minutes for the femoral line group (P < .03). The mean overall time for the cutdown group was 11.76 +/- 4.81 minutes compared with 7.67 +/- 2.78 minutes for the femoral line group (P < .0002).
  
  
  CONCLUSIONS
  Percutaneous femoral catheterization can be performed more rapidly than saphenous cutdown in the critically ill trauma patient with a palpable femoral pulse and allows for more rapid fluid administration. We support the use of a percutaneous femoral line as an acceptable alternative to saphenous venous cutdown in the initial resuscitation of trauma patients.
authors.affiliation: Department of Internal Medicine, Northwestern Memorial Hospital, Chicago, Illinois.
authors.forename: M D
authors.initials: MD
authors.lastname: Westfall
authors.forename: K R
authors.initials: KR
authors.lastname: Price
authors.forename: M
authors.initials: M
authors.lastname: Lambert
authors.forename: R
authors.initials: R
authors.lastname: Himmelman
authors.forename: D
authors.initials: D
authors.lastname: Kacey
authors.forename: S
authors.initials: S
authors.lastname: Dorevitch
authors.forename: J
authors.initials: J
authors.lastname: Mathews
mesh_terms: D000328:Adult; D002405:Catheterization, Central Venous; D002406:Catheterization, Peripheral; D016638:Critical Illness; D005268:Femoral Vein; D005440:Fluid Therapy / Q000379:methods*; D006801:Humans; D007262:Infusions, Intravenous / Q000379:methods*; D011446:Prospective Studies; D012501:Saphenous Vein; D016748:Venous Cutdown; D014947:Wounds and Injuries / Q000628:therapy*