Femoral Sheath Misplaced in Saphenous Vein: Remove Immediately
A femoral sheath inadvertently placed in the saphenous vein must be removed and cannot be used for central venous access. The saphenous vein is a superficial peripheral vein that does not provide central venous access, and attempting to use it as such creates significant risks without any therapeutic benefit.
Why This Catheter Cannot Be Used
Anatomical and Functional Problems
The saphenous vein is not a central vein - it is a superficial peripheral vein that drains into the femoral vein at the saphenofemoral junction, meaning the catheter tip will not reach the inferior vena cava or right atrium where central venous catheters must terminate 1, 2.
Inadequate flow rates - the saphenous vein has significantly smaller diameter than the femoral vein and cannot accommodate the flow rates required for most indications requiring femoral access (resuscitation, hemodialysis, high-volume infusions) 3.
Wrong vessel for intended purpose - all guidelines specify that femoral central venous access requires cannulation of the femoral vein itself, not its tributaries 4.
Serious Complication Risks
Thrombosis risk is unacceptably high - even properly placed femoral catheters carry elevated thrombosis risk compared to other sites 4. A catheter in the smaller saphenous vein would have dramatically higher thrombosis rates due to vessel size mismatch 5.
Venous insufficiency - the saphenous vein is critical for lower extremity venous drainage, and thrombosis from catheter placement could cause chronic venous insufficiency 6.
No established safety data - there are no studies evaluating safety or efficacy of using the saphenous vein for central venous access because this is not an appropriate site 4.
Immediate Management Algorithm
Step 1: Confirm Misplacement
- Obtain immediate imaging (chest/abdominal X-ray or ultrasound) to confirm catheter tip location - it will be in the saphenous vein rather than tracking to the IVC 4, 2.
- Do not infuse medications or fluids through this catheter until proper placement is confirmed 4.
Step 2: Remove the Catheter
- Remove the misplaced catheter immediately using standard sterile technique 4.
- Apply direct pressure to the puncture site for adequate hemostasis 4.
Step 3: Establish Proper Access
Reassess the need for femoral access - femoral veins should only be used when upper body sites are contraindicated due to higher infection and thrombosis risks 4, 1.
If femoral access is still required, re-attempt cannulation of the actual femoral vein using ultrasound guidance to visualize the correct vessel 4, 5.
Consider alternative sites - the right internal jugular vein is the preferred site for central venous access due to lower complication rates 1, 2. Subclavian access has the lowest infection risk but higher pneumothorax risk 4, 2.
Critical Pitfalls to Avoid
Do not attempt to "make it work" - there is no scenario where a saphenous vein catheter can substitute for proper central venous access 4.
Do not leave it in place "temporarily" - even short-term use creates thrombosis risk without providing functional central access 7, 5, 8.
Always use ultrasound guidance for femoral vein cannulation to prevent misplacement into adjacent structures including the saphenous vein 4, 5.
Verify catheter tip position after any central line placement with imaging before use 4, 2.