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. 2025 Apr 23;17(4):e82837.
doi: 10.7759/cureus.82837. eCollection 2025 Apr.

The Greater Saphenous Venipuncture Procedure: A Reliable Phlebotomy Method for Neonates

Erik J VerHage  1 , Federico Jimenez Ruiz  2 , Thomas R VerHage  3 , Juan C Roig  1
Affiliations

The Greater Saphenous Venipuncture Procedure: A Reliable Phlebotomy Method for Neonates

Erik J VerHage et al. Cureus. .

Abstract

Clinicians in the neonatal intensive care unit (NICU) face considerable challenges when caring for the most critically ill and smallest patients, particularly when blood collection is required from those whose umbilical lines have been removed. Advances in NICU care have led to improved survival rates for this vulnerable population, but their smaller size and clinical fragility make venipuncture increasingly difficult. This paper outlines a reliable and accurate approach to venipuncture using specific anatomical landmarks. While our team at the University of Florida utilized point-of-care ultrasound (POCUS) to confirm procedural accuracy, the primary aim of this publication is to equip clinicians with a practical, landmark-based method for obtaining blood samples. This approach is particularly valuable in cases where phlebotomy is challenging due to patient size, in the absence of central vascular access, or in developing countries and units without access to POCUS machines.

Keywords: greater saphenous vein; neonatal intensive care unit (nicu); phlebotomy; point-of-care ultrasound (pocus); preterm neonate; venipuncture.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. University of Florida IRB issued approval 202400041. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Illustration of the structures contained within the femoral triangle
Of interest, the GS vein is the last branch of the femoral vein at the level of the femoral triangle, coursing superficially to the adductor longus. GS: greater saphenous Image obtained from Hacking (2019) [5]
Figure 2
Figure 2. Ultrasound images of the vessels in the right femoral triangle in a proximal-to-distal sweep in the axial plane, with an annotated image on the left and original image on the right
(A) Most proximal view demonstrating branching of the GS vein from the common femoral. (B) Middle view of the sweep with the GS separating from the femoral vein superficial to the pectineus muscle. (C) Distal view of the GS separation from the femoral vein, traversing superficial to the pectineus muscle with the adductor longus — medial border of the femoral triangle — coming into view. 1: femoral artery; 2: femoral vein; 3: GS vein GS: greater saphenous
Figure 3
Figure 3. Annotated landmarks during the procedure
(A) The patient’s thigh placed in a “frog leg” position with the landmarks of the femoral triangle marked. Thigh divided into thirds. (B) Insertion site of the needle on the lateral edge of the adductor longus muscle angled at 45 degrees and aimed toward the patient’s umbilicus. Solid lines: borders of the femoral triangle; dashed lines: thigh divided into thirds; star: site of needle introduction where the adductor longus meets the proximal third line
Figure 4
Figure 4. Ultrasound confirmation of needle tip location
(A) Redemonstration of the anatomy of the GS vein in relation to the femoral artery and vein in the axial plane. (B) Needle tip in the GS vein perpendicular to the ultrasound probe in the axial plane. (C) Sagittal plane view of the needle tip in the GS vein. 1: femoral artery; 2: femoral vein; 3: GS vein GS: greater saphenous
See this image and copyright information in PMC

References

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