The sheaths, catheters, wires etc. used for venography are the same as for standard angiography. Similar to the arterial side, the size and selection of equipment are dependent upon the purpose of procedure, e.g., a 5-Fr sheath and catheter are used when performing a diagnostic procedure, while at least a 6-Fr sheath will be required in an intervention.

When anticipating a potential intervention, start with at least a 6-Fr sheath, even if performing a diagnostic procedure.

The technique of gaining access is similar to arterial access using modified Seldinger technique. However, the skin stab incision and vessel puncture are made medial to the arterial pulsations, as the femoral vein lies medial to the femoral artery.

When successfully punctured, dark blood will emanate from the needle at low pressure and without the pulsations characteristic of arterial puncture.

Place sheath in the vein using modified Seldinger technique in the same fashion, as when you catheterize the artery.

Connect the sheath to a continuously running flush of heparinized saline and secure the sheath to adjacent skin using 2-0 silk suture.

Navigate the catheter connected to a continuous heparinized saline flush over a leading wire using fluoroscopy.

The course of inferior vena cava is usually to the right of aorta and leads to right atrium.

The catheter is then advanced over wire into the superior vena cava.