From the Guidelines
A femoral temporary dialysis catheter should not be kept in place for more than 5 days due to the high risk of infection and dislodgment, especially in non-bed-bound patients or those with poor exit-site care 1.
Key Considerations
- The catheter should be at least 19 cm long to minimize recirculation and reach the inferior vena cava 1.
- Bed-bound patients with good exit-site care may be able to use femoral catheters for the recommended duration, but careful monitoring is necessary to prevent complications 1.
- The use of tunneled cuffed catheters is preferred for longer durations of hemodialysis due to lower infection rates and higher blood flow rates 1.
- Antimicrobial lock solutions and anticoagulant medications may help reduce the risk of infection and catheter occlusion, but do not extend the recommended duration of use 1.
Clinical Implications
- Femoral temporary dialysis catheters should be removed or replaced within the recommended timeframe to minimize complications, such as infection and thrombosis 1.
- Patients with femoral catheters should be closely monitored for signs of infection, dislodgment, or other complications, and the catheter should be removed promptly if any issues arise 1.
From the Research
Duration of Femoral Temporary Dialysis Catheter Use
- The duration for which a femoral temporary dialysis catheter can be kept in place varies based on several factors including the risk of bacteremia and catheter-related complications.
- A study published in 2000 2 found that the incidence of bacteremia was 10.7% after one week in femoral vein, suggesting that femoral catheters in bed-bound patients should be removed after one week.
- Another study from 2005 3 observed significantly higher percentage catheter survival rates at 7,14, and 28 days for femoral catheters when using a cefotaxime-heparin lock solution, but did not specify a maximum duration for catheter use.
- A 2008 study 4 identified femoral localization as a negative predictor for catheter malfunction, but did not provide a specific duration for catheter use.
Factors Affecting Catheter Longevity
- The risk of catheter-related bloodstream infections (CRBSI) and catheter thrombosis are significant factors affecting the longevity of temporary dialysis catheters.
- A 2014 systematic review and meta-analysis 5 found that citrate locks, particularly those containing antimicrobial agents, were effective in reducing CRBSI incidence compared to heparin locks.
- The concentration of heparin used for locking the catheter canals did not influence the time of catheter functioning, according to a 2008 study 4.
- Higher ultrafiltration rates during hemodialysis were also found to be a predictor of catheter malfunction 4.
Catheter-Related Complications
- Femoral tunneled dialysis catheters are associated with poor patency rates and high complication rates, including catheter-related infections and deep vein thrombosis 6.
- The risk of bacteremia and catheter-related complications increases with the duration of catheter use, particularly for femoral catheters 2.