title: Utility of fluoroscopy in teaching trainees groin puncture technique.
abstract: OBJECTIVE
  To assess trainee physicians' ability to puncture at the femoral head and complication rates when obtaining access to the common femoral artery using fluoroscopy.
  
  
  BACKGROUND
  The common femoral artery is the most common artery accessed during cardiac catheterization. Fluoroscopy can be used to visualize the femoral head and estimate the common femoral artery location. Puncture superior or inferior to the femoral head is associated with increased rates of retroperitoneal bleeding or thrombosis, respectively. Adequate training in groin puncture technique is essential in minimizing complications and upholding patient safety.
  
  
  METHODS
  Two consecutive samples of patients were retrospectively analyzed - one from Keck Medical Center (Keck) (n = 45), and one from Los Angeles County-University of Southern California (LAC-USC) (n = 100). An attending interventional cardiologist performed all groin punctures at Keck, and a trainee performed groin puncture at LAC-USC after detailed faculty instruction. A single reviewer retrospectively analyzed all angiograms. Puncture was recorded as occurring above, below, or at the femoral head.
  
  
  RESULTS
  Percentage of punctures at the femoral head between LAC-USC vs Keck was not significantly different (93.0% vs 95.6%; P=.26). There was no significant difference in percentage of punctures below and above the femoral head between both groups, and no difference in complications.
  
  
  CONCLUSIONS
  Femoral artery puncture at the femoral head is associated with improved outcomes. Our data show no significant difference between attending physicians' and trainees' ability to puncture at the level of the femoral head. Groin puncture using fluoroscopy can be taught to a high proficiency level with appropriate instruction.
authors.affiliation: Mayo Clinic Graduate School of Medicine, 200 First St. SW, Rochester, MN 55905 USA. prasad.megha@mayo.edu.
authors.forename: Megha
authors.initials: M
authors.lastname: Prasad
authors.forename: Han
authors.initials: H
authors.lastname: Tun
authors.forename: Ray
authors.initials: R
authors.lastname: Matthews
mesh_terms: D000368:Aged; D006328:Cardiac Catheterization / Q000379:methods*; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging*; D005270:Femur Head / Q000000981:diagnostic imaging*; D005471:Fluoroscopy / Q000706:statistics & numerical data*; D006119:Groin / Q000098:blood supply*; D006282:Health Personnel / Q000193:education*; D006470:Hemorrhage / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D011361:Professional Competence; D012189:Retrospective Studies; D013927:Thrombosis / Q000453:epidemiology; D016896:Treatment Outcome