Using a sacral lift to improve femoral vein size and visibility

Examining the Effect of a Sacral Lift on Femoral Vein Size and Exposure in the Emergency Department

This trial will test whether placing a gel pad under the sacrum (a sacral lift) makes the femoral vein larger and less overlapped by the artery in adult emergency department patients to help with femoral vein cannulation.

Quick facts

• Phase: NA
• Study type: Interventional
• Enrollment: 35 (estimated)
• Ages: 18 Years to 85 Years
• Sex: All
• Sponsor: Allegheny Singer Research Institute (also known as Allegheny Health Network Research Institute) (other)
• Locations: 1 site (Erie, Pennsylvania)
• Trial ID: NCT06916741 on ClinicalTrials.gov

What this trial studies

This single-center, interventional trial uses bedside ultrasound to compare femoral vein diameter and femoral artery overlap with and without a sacral lift in two leg positions (straight and frog-leg). Adult emergency department patients who can safely lie supine and abduct/externally rotate their hips will undergo ultrasound measurements in four conditions: straight leg without lift, straight leg with lift, frog-leg without lift, and frog-leg with lift. The primary measurements are femoral vein size and the degree of arterial overlap, analyzed to see if the sacral lift increases vein diameter or reduces overlap. Patients with prior DVT, vascular surgery, noncompressible veins, or inability to tolerate positioning are excluded, and the procedure uses a linear ultrasound transducer at a single site in Erie, Pennsylvania.

Who should consider this trial

Good fit: Adults (18–85 years) in the emergency department who can safely lie supine and position their hips, have identifiable and compressible femoral vessels on ultrasound, and no history of DVT or relevant lower-extremity vascular surgery.

Not a fit: Patients with prior DVT, noncompressible femoral veins, significant peripheral vascular disease, prior lower-extremity vascular surgery, inability to assume the required positions, or those who are pregnant or otherwise vulnerable are unlikely to benefit from this maneuver.

Why it matters

Potential benefit: If successful, this simple positioning maneuver could make femoral vein cannulation easier and more reliable, potentially increasing first-pass success and reducing complications.

How similar studies have performed: While frog-leg positioning is already known to improve femoral vein exposure, using a sacral lift is a novel, minimally studied maneuver with limited prior data on its effectiveness.

Eligibility criteria

Inclusion Criteria:

* Adult emergency department patients.

Exclusion Criteria:

* \<18 or \>85 years-old
* Anyone with a history of: deep venous thrombosis (DVT), May-Thurner syndrome, lower extremity vein harvesting, arterial or venous surgery of the lower leg (e.g., peripheral arterial stent placement or sclerotherapy of lower extremity varicose veins), or peripheral vascular disease.
* Anyone with a medical condition that could impact their physical ability to lay supine or abduct and externally rotate their hips safely (e.g., hip fracture).
* Anyone whose femoral vessels cannot be clearly identified using a linear transducer
* Anyone whose femoral vein is not compressible on the study ultrasound (indicating a DVT).
* Vulnerable populations such as pregnant women and those who cannot consent.

Where this trial is running

Erie, Pennsylvania

• Saint Vincent Hospital — Erie, Pennsylvania, United States (RECRUITING)

Study contacts

• Principal investigator: Principal Investigator Dhimitri Nikolla, DO, MS, FACEP, FACOEP — Allegheny Health Network
• Study coordinator: Dhimitri Nikolla, DO, MS, FACEP, FACOEP

Conditions: Femoral Artery, Cannulation, femoral artery, ultrasound, femoral vein, sacral lift, cannulation