Chapter 14 ■ Venipuncture 93

4. Enter skin and then vein at point medial to the arterial

pulsation, approximately two-thirds along the line from

inguinal ligament to apex of triangle (Fig. 14.6B).

a. Use relatively steep angle (45 to 60 degrees).

b. After entering skin, advance 1 to 4 mm while applying gentle suction until blood return is achieved.

5. See F, “General Venipuncture.”

External Jugular Vein

1. Position infant in head-down positionwith head extended

and rotated away from selected vessel (Fig. 14.7).

B A

Fig. 14.6. A: Anatomy of the femoral triangle as defined in the text. (Adapted from Plaxico DT,

Bucciarella RL. Greater saphenous vein venipuncture in the neonate. J Pediatr. 1978;93:1025, with permission.) B: Position of the femoral triangle on the abducted thigh.

2. Prepare skin over sternocleidomastoid muscle with

antiseptic.

3. Flick infant’s heel to induce crying and optimize vein

distension.

4. Visualize external jugular vein running from angle of

jaw to posterior border of sternocleidomastoid in its

lower third.

5. Puncture vessel where it runs across the anterior border

of the sternocleidomastoid muscle.

6. See F, “General Venipuncture.”

G. Complications (8–11)

1. Hemorrhage with

a. Coagulation defect

b. Puncture of deep vein

2. Venous thrombosis or embolus, limb ischemia, and

arteriovenous fistula with puncture of large, deep

vein (9)

3. Laceration of adjacent artery

4. During femoral vein puncture

a. Reflex arteriospasm of femoral artery with gangrene

of extremity (10)

b. Penetration of peritoneal cavity

c. Septic arthritis of hip (11)

d. Arteriovenous fistula (9)

5. During internal jugular puncture

a. Laceration of carotid artery

Fig. 14.7. Infant po