What are the guidelines for removing a femoral catheter to prevent infection?

Guidelines for Removal of Femoral Catheters to Prevent Infection

Femoral catheters should be removed as soon as possible and replaced with catheters at upper extremity sites to minimize infection risk. 1

Key Recommendations for Femoral Catheter Management

Immediate Actions

• Promptly remove any femoral catheter that is no longer essential 1
• Replace a femoral catheter with an upper extremity site catheter as soon as possible in adults 1
• Avoid using the femoral vein for central venous access in adult patients whenever possible 1

Site Selection Hierarchy (for adults)

1. Subclavian site - preferred for non-tunneled central venous catheters to minimize infection risk 1
2. Internal jugular site - second choice when subclavian site is contraindicated
3. Femoral site - avoid when possible due to higher infection risk 1

Special Considerations

• In hemodialysis patients and those with advanced kidney disease, avoid the subclavian site to prevent subclavian vein stenosis 1
• For pediatric patients, both upper and lower extremities can be used as catheter insertion sites 1

Infection Prevention During Catheter Insertion and Maintenance

Sterile Technique

• Use maximal sterile barrier precautions during insertion, including:
  • Cap
  • Mask
  • Sterile gown
  • Sterile gloves
  • Sterile full-body drape 1

Skin Preparation

• Prepare the insertion site with a 0.5% chlorhexidine preparation with alcohol 1
• If chlorhexidine is contraindicated, use tincture of iodine, an iodophor, or 70% alcohol 1

Site Care and Assessment

• Evaluate the catheter insertion site daily for signs of infection 1
• For transparent dressings, inspect visually
• For gauze or opaque dressings, palpate for tenderness 1
• Remove the dressing and inspect visually if the patient has local tenderness or other signs of possible infection 1

Emergency Situations

• When aseptic technique cannot be ensured during insertion (such as during medical emergencies), replace the catheter as soon as possible, within 48 hours 1

Indications for Catheter Removal

• Signs of catheter-related bloodstream infection (CRBSI)
• When the catheter is no longer needed 1
• Development of phlebitis (warmth, tenderness, erythema, or palpable venous cord) 1
• Catheter malfunction 1

Evidence Quality and Considerations

• The recommendation to avoid femoral sites in adults is Category 1A (highest level of evidence) 1
• The preference for subclavian over jugular or femoral sites is Category IB 1
• Recent studies show decreasing differences in infection rates between sites compared to older studies 2
• A 2001 randomized controlled trial found femoral catheterization was associated with significantly higher rates of infectious complications (19.8% vs 4.5%) and thrombotic complications (21.5% vs 1.9%) compared to subclavian sites 3

Common Pitfalls

• Keeping femoral catheters in place longer than necessary
• Failing to evaluate the need for the catheter daily
• Not using maximal sterile barrier precautions during insertion
• Improper skin preparation before insertion
• Delaying replacement of catheters inserted during emergencies

By following these guidelines, healthcare providers can significantly reduce the risk of catheter-related infections associated with femoral venous catheters, ultimately improving patient outcomes by reducing morbidity and mortality associated with catheter-related bloodstream infections.