What is the term for a catheter used for hemodialysis (HD) placed in the femoral vein in a patient with end-stage renal disease (ESRD) or acute kidney injury (AKI)?

Terminology for Femoral Hemodialysis Catheters

A hemodialysis catheter placed in the femoral vein is called a "femoral dialysis catheter" or "femoral hemodialysis catheter," and it can be either nontunneled (uncuffed) or tunneled (cuffed) depending on the anticipated duration of use.

Catheter Classification by Duration

Short-Term Access (≤5 days to 1 week)

• Nontunneled (uncuffed) femoral catheter is the appropriate term for temporary access in acute kidney injury or urgent dialysis initiation 1.
• These catheters should be limited to hospitalized, bed-bound patients and used for less than 1 week 2.
• The femoral vein is the second-choice insertion site after the right internal jugular vein for acute temporary access 1, 2.

Longer-Term Access (>1 week to months)

• Tunneled cuffed femoral catheter is the correct terminology when femoral access is needed for more than 1 week 1, 2.
• The KDOQI guidelines state that a tunneled cuffed femoral catheter may be acceptable in urgent dialysis initiation (e.g., <1 month) until arteriovenous access is created and usable 1.
• This approach preserves upper extremity vasculature for pending arteriovenous access creation 1.

Technical Specifications

Catheter Length Requirements

• Femoral catheters must be at least 19 cm long to minimize recirculation and reach the inferior vena cava 3, 2.
• Longer catheters (24-31 cm) are more likely to reach the desired position for optimal flow and adequate blood delivery 3, 2.

Insertion Technique

• Ultrasound guidance is strongly recommended for all dialysis catheter insertions to reduce complications 1, 3.
• The catheter tip should be positioned in the inferior vena cava and confirmed by fluoroscopy or radiography 3, 2.

Clinical Context and Limitations

When Femoral Access is Appropriate

• The femoral vein is acceptable when upper extremity options are limited or contraindicated 1, 3.
• Right nephrectomy does not affect the patency or function of the right femoral vein, as these are separate venous systems 3.
• Femoral access is often preferred in emergency or high-risk situations due to lower insertion complications and easier hemostasis achievement 3.

Important Caveats

• Avoid femoral vein access in adult patients for general central venous access when other sites are available 1.
• Noncuffed femoral catheters should only be used in bed-bound patients and for ≤5 days 3, 2.
• For ambulatory patients requiring longer access, tunneling the catheter moves the exit site away from the groin to reduce infection risk 3, 4, 5.

Infection and Thrombosis Monitoring

• Monitor closely for signs of infection and femoral vein thrombosis 3.
• Research shows that with proper care, tunneled femoral catheters can function for extended periods (mean 166 days) with acceptable infection rates when strict aseptic technique is maintained 5, 6.