What are the Infectious Diseases Society of America (IDSA) guidelines for removing femoral catheters to prevent infection?

IDSA Guidelines for Removal of Femoral Catheter to Prevent Infection

According to the Infectious Diseases Society of America (IDSA) guidelines, femoral catheters should be avoided when possible in adults and should be removed as soon as possible and replaced with catheters at upper extremity sites to minimize infection risk. 1

Site Selection Recommendations

The IDSA guidelines provide clear recommendations regarding femoral catheter use:

• Femoral sites carry a higher risk of infection compared to upper extremity sites 2, 1
• In adults, use of radial, brachial, or dorsalis pedis sites is preferred over femoral or axillary sites to reduce infection risk (Category IB recommendation) 2
• For central venous catheters, subclavian sites are preferred over femoral sites to minimize infection risk 1
• Internal jugular sites are considered second choice when subclavian sites are contraindicated 1

Specific Recommendations for Femoral Catheter Management

When femoral catheters must be used:

• Use maximal sterile barrier precautions during insertion, including cap, mask, sterile gown, sterile gloves, and sterile full-body drape 1
• During femoral artery catheter insertion, maximal sterile barrier precautions should be used (Category II recommendation) 2
• Evaluate the catheter insertion site daily for signs of infection 1
• Remove the catheter as soon as it is no longer needed (Category II recommendation) 2

Rationale for Femoral Site Avoidance

The recommendation to avoid femoral sites is based on several factors:

• Higher colonization rates at femoral sites compared to upper extremity sites
• Proximity to perineal area increases contamination risk
• Studies have shown that femoral catheters have a higher risk of infection with non-fermenting gram-negative bacilli (31% vs 4% for non-femoral sites) 3
• Empirical antipseudomonal therapy should be considered if a femoral catheter-related bloodstream infection is suspected 3

Special Considerations

• In pediatric patients, the brachial site should not be used, and the radial, dorsalis pedis, and posterior tibial sites are preferred over femoral sites (Category II recommendation) 2
• For hemodialysis patients and those with advanced kidney disease, avoid the subclavian site to prevent subclavian vein stenosis 1
• If a femoral catheter must be used, subcutaneous tunneling may reduce the risk of infection 4

Catheter Removal Indications

Remove femoral catheters promptly in the following situations:

• When no longer clinically needed 2, 1
• When signs of catheter-related bloodstream infection (CRBSI) are present 2
• When signs of phlebitis develop (warmth, tenderness, erythema, or palpable venous cord) 1
• When catheter malfunction occurs 1

Replacement Strategies

• Replace femoral catheters with upper extremity site catheters as soon as possible 1
• Do not routinely replace catheters solely to prevent catheter-related infections (Category II recommendation) 2
• Replace catheters as soon as possible (within 48 hours) when aseptic technique cannot be ensured during insertion 1

By following these IDSA guidelines for femoral catheter management and removal, clinicians can significantly reduce the risk of catheter-related infections and improve patient outcomes.