Femoral Quinton Catheter Sizing for Adults
For femoral hemodialysis catheters in adults, use an 11.5 French dual-lumen catheter with a minimum length of 19.5 cm (approximately 20 cm), with the catheter tip positioned above the renal veins at the first lumbar vertebra level. 1
Catheter Size Specifications
- French size: 11.5 French dual-lumen catheters are standard for temporary femoral hemodialysis access 2
- Length requirements: Minimum 19.5 cm for adequate blood flow and reduced recirculation 2
- For tunneled femoral catheters with exit site at mid-thigh, catheters of at least 50 cm length are needed to reach proper tip position 3
Critical Length Considerations
Shorter femoral catheters have significantly worse performance. Blood recirculation rates are dramatically higher with 13.5 cm femoral catheters (22.8%) compared to 19.5 cm catheters (12.6%), resulting in reduced dialysis efficiency 2. This translates to clinically meaningful differences in urea reduction ratios: 54.5% for femoral versus 62.5% for subclavian catheters 2.
Tip Positioning Requirements
- The catheter tip must lie above the renal veins at the first lumbar vertebra level 1
- For tunneled femoral catheters, the tip should be positioned in the inferior vena cava or at the IVC-right atrium junction 3
- Proper tip positioning is essential to minimize recirculation and maximize blood flow rates 2
Clinical Context and Limitations
Femoral access should be reserved for specific situations where other sites are unavailable or contraindicated 1:
- Emergency situations with severe coagulopathy where hemostasis is easier to achieve 1
- Patients with exhausted thoracic venous access 4
- Short-term use (≤5 days) in bed-bound patients 1
Key contraindications: Avoid femoral catheters in patients with aortobifemoral bypass grafts or femoral-distal bypass grafts due to infection risk 1. The CDC advises against femoral vein use in adult patients for routine central venous access due to higher colonization rates compared to subclavian sites 1.
Practical Insertion Considerations
- Tunneling the catheter onto the anterior abdominal wall with exit site at mid-thigh reduces groin contamination risk and facilitates nursing care 1, 3
- Ultrasound guidance should be used to reduce complications 1
- Expected blood flow rates with properly functioning femoral catheters are approximately 220 mL/min 4
- Anticoagulation with aspirin or clopidogrel may be considered to prevent catheter thrombosis 4
Common Pitfalls
- Using catheters that are too short (13.5 cm) results in excessive recirculation (>22%) and inadequate dialysis 2
- Prolonged femoral catheter use increases infection risk; femoral catheters should not remain longer than 5 days for non-tunneled access 5
- Inadequate tip positioning below the renal veins increases thrombosis risk 1