Q. Describe the procedure of femoral approach?

The catheter is inserted into the femoral sheath and advanced to the level of the left mainstem bronchus over the guidewire. After removal of the guidewire, the catheter is attached to the manifold system which is designed to permit flushing, pressure monitoring and contrast administration through its ports. The catheter is immediately double flushed - blood is withdrawn and discarded and heparinized saline flush is injected through the catheter lumen. Once the catheter has been flushed with saline solution, tip pressure should be displayed on the monitor at all times. Next the catheter is filled with contrast solution. Then the catheter is engaged into the desired coronary ostium for selective coronary angiography. The left and right coronary catheters are engaged in the LAO view. The left Judkins catheter often engages the left coronary ostium with minimal manipulation. The right coronary catheter, however, requires clockwise rotation by almost 180° for engaging the right coronary ostium. If there is trouble with engaging the left or right coronary ostia, other catheters like the Amplatz catheter may be used.