How long should a femoral central venous catheter remain in place before it needs to be exchanged?

Femoral Vein Catheter Duration Limits

Noncuffed femoral catheters must be removed or exchanged within 5 days maximum and should only be used in bed-bound hospitalized patients with excellent exit-site care. 1

Duration-Based Recommendations by Catheter Type

Noncuffed Femoral Catheters (Short-Term)

• Maximum duration: 5 days for noncuffed femoral catheters, with use restricted to bed-bound patients only 1
• Infection rates are nearly 7 times higher with femoral noncuffed catheters compared to internal jugular tunneled cuffed catheters 2
• Any short-term catheter should have a definitive plan within 1 week to either: (i) discontinue, or (ii) convert to a tunneled cuffed catheter 1
• The femoral site carries the highest infection risk compared to all other central venous access sites 3, 2

Internal Jugular Catheters (Comparison Standard)

• Noncuffed internal jugular catheters should be used for no more than 1 week before infection rates increase exponentially 1
• Beyond 1 week, infection rates with noncuffed catheters increase dramatically, with actuarial analysis showing infection rates per 1,000 days at risk for noncuffed catheters are more than 5 times greater than tunneled cuffed catheters 1

Tunneled Cuffed Catheters (Long-Term Alternative)

• For access needs exceeding 1 week, tunneled cuffed catheters are strongly preferred over noncuffed catheters due to significantly lower infection rates 1, 4
• Tunneled catheters are designed for continuous access exceeding 3 months and provide catheter fixation that inhibits organism migration 4

Critical Technical Requirements for Femoral Catheters

Catheter Length

• Femoral catheters must be at least 19-20 cm long to reach the inferior vena cava (IVC) and minimize recirculation 1, 2
• Catheters shorter than 20 cm demonstrate significantly higher recirculation rates (26.3%) compared to those longer than 20 cm (8.3%; P=0.007) 2
• If dialysis blood flow is less than 300 mL/min from a properly placed femoral catheter, guidewire exchange to a longer catheter (24-31 cm) should be considered 1, 2

Blood Flow Optimization

• One femoral catheter that does not reach the IVC frequently cannot deliver 300 mL/min 1
• Although increased catheter length increases resistance, this is offset by reaching anatomic sites with greater IVC flow 1, 2
• Femoral catheters have inherently higher recirculation rates (13.1%) compared to internal jugular catheters (0.4%; P<0.001), making adequate length even more critical 2

Absolute Contraindications

Transplant Candidates

• Never use femoral catheters in patients who are transplant candidates, as iliac vein stenosis can permanently compromise the anastomosis site for kidney transplantation 1, 3, 2
• Any patient with the option of undergoing kidney transplantation should not have a femoral catheter placed to avoid stenosis of the iliac vein 1

Site Selection Hierarchy

• The right internal jugular vein remains the preferred site for both short-term and long-term hemodialysis catheters due to lower complication rates, better blood flow, and reduced recirculation 2
• Femoral access should be reserved for situations where upper body sites are unavailable or contraindicated 3, 2
• Subclavian routes are preferable to femoral routes in short-term catheterization because femoral routes are associated with higher risks of catheter colonization (RR 6.43,95% CI 1.95-21.21) and thrombotic complications (RR 11.53,95% CI 2.80-47.52) 5

Common Pitfalls to Avoid

• Do not discharge patients with noncuffed catheters due to risks of infection, inadvertent removal, hemorrhage, and patient discomfort 1
• Do not use routine scheduled replacement of catheters as a strategy to prevent infection, as the daily risk of catheter infection remains constant regardless of catheter age 4
• Do not place femoral catheters on the same side as a maturing arteriovenous access when possible 1
• Do not use femoral catheters in ambulatory patients - they should only be used in bed-bound patients with excellent exit-site care 1