Sharing an Idea: Use of Pulse Oximeter on the Toe to Locate and Manually Compress the Common Femoral Artery After Cardiac Catheterization Procedures

Dear Editor,

Recently in the evening after another busy day on the inpatient service, I passed by our cardiac catheterization lab and heard about a patient developing a right groin hematoma at the femoral access site after cardiac catheterization. This was a morbidly obese patient and due to the excessive soft tissue, nurses were unable to palpate the underlying common femoral artery to control the bleeding. I reviewed the femoral angiogram to assess the site of arterial puncture. On examination, no pulse was palpable at the anticipated compression area above the skin puncture site, due to the excessive soft tissue. Distal posterior tibial and dorsalis pulses were palpable. I came up with the idea to use the pulse oximeter on the great toe of the patient’s right leg. An arterial waveform was observed on the monitor. Then, I compressed above the skin puncture site enough to completely dampen the arterial waveform on the monitor. Bleeding was controlled successfully and the patient did not require blood transfusion. This is similar to the technique that we routinely use to perform Allen’s test to check the patency of radial artery.  

This technique served two purposes:

1. Locate the common femoral artery;
2. Provide information regarding the degree of manual compression needed, thus avoiding over-compression, excessive pain, and vasovagal episode.

Sincerely,

Qaiser Shafiq, MD, MMSc, Clinical Fellow (PGY-2), Division of Cardiovascular Medicine, Department of Medicine, University of Toledo, Toledo, Ohio

Email: qaiser.shafiq@utoledo.edu