Can a central line be placed in the saphenous vein?

Can a Central Line Be Placed in the Saphenous Vein?

No, the saphenous vein is not a standard or recommended site for central venous catheter placement in adults, though it has been used as an alternative access site in select pediatric cases when conventional upper body sites are unavailable.

Standard Central Venous Access Sites

The established first-choice sites for central venous catheter placement are:

• Internal jugular vein (preferred first choice) 1
• Subclavian vein (alternative first choice) 1
• Femoral vein (when upper body access is contraindicated) 1

Access to the upper vena cava via internal jugular or subclavian vein is the first-choice recommendation for CVC placement 1. The catheter tip should be positioned at the junction of the superior vena cava and right atrium to minimize thrombosis risk 1.

Why the Saphenous Vein Is Not Standard

The saphenous vein is not mentioned in any major adult central line placement guidelines 1, 2. The femoral vein—not the saphenous vein—is the recommended lower extremity access site when needed 1.

The femoral vein itself is relatively contraindicated for parenteral nutrition due to high risk of contamination at the groin exit site and increased venous thrombosis risk 1. Given these concerns with the femoral vein, the smaller saphenous vein would carry even greater risks.

Limited Pediatric Experience

The saphenous vein has been used in select pediatric populations as an alternative when conventional sites are unavailable:

• A retrospective study of 27 pediatric patients showed saphenous vein catheters had similar complication rates to jugular vein catheters, though this was in children with malignancy requiring alternative access 3
• Another pediatric series demonstrated 78% successful placement via saphenous vein in 86 children (mean age 1.8 years, 76% weighing <10 kg), primarily when upper body access was challenging 4
• Saphenous vein peripherally inserted central catheters have been described in small case series of adults with end-stage renal failure or malignancy when other sites were exhausted 5

Clinical Algorithm for Access Site Selection

When planning central venous access, follow this hierarchy:

1. First choice: Internal jugular or subclavian vein (right-sided preferred over left) 1
2. Second choice: Contralateral internal jugular or subclavian if first side unavailable 6
3. Third choice: Femoral vein (accept higher infection/thrombosis risk) 1
4. Last resort: Consider saphenous vein only in pediatric patients or when all conventional sites are exhausted and patient has specific contraindications to upper body access 7, 3, 4

Critical Caveats

• Always use real-time ultrasound guidance for all central line insertions to reduce complications and improve success rates 1, 2
• For long-term access (>3 months), tunneled catheters or totally implantable devices are required 1
• PICCs are not recommended for long-term use due to higher thrombosis risk 1
• The saphenous approach would require fluoroscopic guidance to ensure proper central tip positioning, as the catheter must traverse the femoral and iliac veins to reach the inferior vena cava 4