STANDARDIZED PROCEDURE

FEMORAL VENOUS BLOOD DRAW (Adult, Peds)

I. Definition
The Femoral venous blood draw (FVBD) is the procedure of performing a needle
stick into the femoral vein for the purpose of drawing blood work that will assist
in lab monitoring.

II. Background Information

A. Setting:
The setting (inpatient vs outpatient) and population (adults vs pediatrics) for the
Advanced Health Practitioner (AHP) is determined by the approval of the
privileges requested on the AHP Privilege Request Form. If the procedure is
being done on a Pediatric patient, make sure Child Life is involved and use age
appropriate language and age appropriate developmental needs with care of
children, as appropriate to the situation.

B. Supervision
The necessity of this procedure will be determined by the Advanced Health
Practitioner in collaboration with the supervising physician or his/her designee.
Designee is defined as another attending physician who works directly with the
supervising physician and is authorized to supervise the Advanced Health
Practitioner.

Direct supervision will not be necessary once competency is determined, as

provided for in the procedure. The Advanced Health Practitioner will notify the
physician immediately upon being involved in any emergency or resuscitative
events or under the following circumstances:
1. Patient decompensation or intolerance to the procedure
2. Bleeding that is not resolved
3. Outcome of the procedure other than expected

C. Indications
This procedure is indicated in patients with a history of poor venous access as
assessed by inability to draw blood from antecubital spaces or other peripheral
sites normally used to access veins.

D. Precautions/Contraindications
1. Thrombocytopenia (if platelet count is less than 50,000, consult physician) or
any dyscrasias that can affect clotting time.
2. Patients with coagulation defects or those receiving anticoagulant therapy.

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FEMORAL VENOUS BLOOD DRAW (Adult, Peds)

III. Materials
A. Povidone iodine / Chlorhexadine swabs
B. alcohol swabs
C. Band-Aid and 2x2
D. 18 gauge needle or appropriate size for the size of the patient
E. 10 ml syringes
F. Blood collection tubes
G. Lab requisition filled out with requested labs and diagnosis
IV. Procedure
A. Pre-treatment evaluation

1. Determine if there is a history of pancytopenia, anticoagulation or aspirin use,

renal insufficiency, disseminated intravascular coagulation, or liver
dysfunction. If present, discuss with attending physician if procedure should
be attempted.

2. Review of systems; History of multiple attempts to access usual venous sites

for blood draws.

Patient Evaluation

1. General appearance, vital signs, skin rashes in groin area.

2. Focused skin exam and palpation of femoral artery and vein.

Diagnostic
1. Current CBC with differential, INR, platelets and review of other labs as
indicated.

B. Set up (if applicable)

Assemble above materials from section III.

C. Patient Preparation
1. After providing the purpose, risks and benefits, and steps of the procedure,
obtain informed consent from the patient or appropriate legal designee.
2. Check platelet count and/or presence of coagulopathy. Consult with attending
physician if platelet count is <50,000, or there is a known coagulopathy as to
whether platelet transfusion or other intervention is needed prior to the
procedure.
3. The most important step is positioning the patient. The patient should be lying
on his or her back on the treatment table in a comfortable position with their

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FEMORAL VENOUS BLOOD DRAW (Adult, Peds)
knees flexed with a pillow. The patient should have a hospital gown on for
ease of access to the femoral vein. The patient will need to be draped from the
thighs down with a blanket or sheet.

4. Identify where the femoral vein is and be sure not to access the artery or
nerve. The vein is located medial to the artery. (Remember: NAVEL /
Nerve-Artery-Vein-Empty-Lymphatic)
5. Don gloves, and set up prepared FVBD kit. Perform a time out with all
appropriate steps.

D. Perform Procedure:
1. Using the povidone iodine/Chlorhexadine wipes provided in the FVBD kit,
prepare the area with povidone iodine/Chlorhexadine solution beginning at the
site marked for the needle puncture, working outward; repeat two more times
for a total of three times.
2. Drape the patient.
3. Recheck the landmarks. Identify the pulsation of the femoral artery 1-2 cm
below the inguinal ligament. Insert the needle about 1cm medial to the
pulsation and aim it towards the head and medially at an angle of 20-30° to
the skin. The above measurements are for standard size adults and should be
scaled for pediatric patients. In adults, the vein is normally found 2-4cm from
the skin. In small children reduce the elevation on the needle to 10-15° since
the vein is more superficial.
4. Withdraw adequate amount of blood for ordered tests.
5. Apply pressure to the area for 5 minutes.

E. Post-procedure: assess patient for possible side effects

1. Cleanse procedure area of povidone iodine solution and place dry sterile
dressing.
2. Assess patient for any adverse reaction to procedure.
3. Label specimen tubes and send to lab.
4. Instruct patient to observe FVBD site for any signs of bleeding or infection,
and to call clinic or notify physician/AHP for any problems.
5. Document procedure results, patient response, and patient follow-up
instructions.

F. Follow-up treatment
1. The Advanced Health Practitioner will review all abnormal lab findings with
the supervising physician.

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FEMORAL VENOUS BLOOD DRAW (Adult, Peds)

V. Documentation
A. Documentation is in the electronic medical record
1. Documentation of the pretreatment evaluation and any abnormal physical
findings.
2. Record the time out, indication for the procedure, procedure, size needle used,
site used, patient position, amount of blood drawn, name of labs sent, EBL,
the outcome, how the patient tolerated the procedure, medications (drug, dose,
route, & time) given, complications, and the plan in the note, as well as any
teaching and discharge instructions.
B. All abnormal findings are reviewed with supervising physician.
VI. Competency Assessment
A. Initial competence
1. The Advanced Health Practitioner will be instructed on the efficacy and the
indications of this therapy and demonstrate understanding of such.
2. The Advanced Health Practitioner will demonstrate knowledge of the
following:
a. Medical indication and contraindications of femoral venous blood
draw
b. Risks and benefits of the procedure
c. Related anatomy and physiology
d. Consent process (if applicable)
e. Steps in performing the procedure
f. Documentation of the procedure
g. Ability to interpret results and implications in management.
3. The Advanced Health Practitioner will observe this procedure at least 3 times
in its entirety.
4. The Advanced Health Practitioner will perform three treatments/procedures
under the direct observation of the supervising physician and such additional
procedures as may be necessary to verify clinical competence.
5. The Advanced Health Practitioner will ensure the completion of competency
sign off documents and send them directly to the medical staff office.
B. Continued proficiency
1. The Advanced Health Practitioner will demonstrate competence by
successful completion of the initial competency.
2. Each candidate will be initially proctored and signed off by an attending
physician. Advanced Health Practitioner must perform this procedure at least
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FEMORAL VENOUS BLOOD DRAW (Adult, Peds)
three times per year. In cases where this minimum is not met, the attending,
must again sign off the procedure for the Advanced Health Practitioner. The
Advanced Health Practitioner will be signed off after demonstrating 100%
accuracy in completing the procedure.
3. Demonstration of continued proficiency shall be monitored through the annual
evaluation.
4. A clinical practice outcomes log is to be submitted with each renewal of
credentials. It will include the number of procedures performed per year and
any adverse outcomes. If an adverse outcome occurred, a copy of the
procedure note will be submitted.

VII. RESPONSIBILITY
Questions about this procedure should be directed to the Chief Nursing and Patient Care
Services Officer at 353-4380.

VIII. HISTORY OF POLICY

Revised April 2012 by Subcommittee of the Committee for Interdisciplinary Practice
Reviewed April 2012 by the Committee on Interdisciplinary Practice
Prior revision October 2008
Approved April 2012 by the Executive Medical Board and the Governance Advisory Council.

This procedure is intended for use by UCSF Medical Center staff and personnel and no representations or
warranties are made for outside use. Not for outside production or publication without permission. Direct
inquiries to the Office of Origin or Medical Center Administration at (415) 353-2733.