From the Guidelines
The femoral line should not be changed and continued on the same side for dialysis after 10 days, as this increases the risk of catheter-related complications, such as infection and thrombosis 1.
Recommended Approach
- Use a different site for the new femoral line to minimize the risk of complications, as recommended by the guidelines for the prevention of intravascular catheter-related infections 1.
- If a new femoral line is placed on the same side, administer prophylactic antibiotics, such as cefazolin 1g IV, 30 minutes prior to the procedure, and use a different insertion site, at least 2 cm away from the previous site 1.
- Consider using antimicrobial locks, such as taurolidine 1.35% and citrate 4%, for a duration of 14 days, to reduce the risk of catheter-related bloodstream infections 1.
Key Considerations
- The guidelines recommend avoiding the use of the femoral vein for central venous access in adult patients, due to the increased risk of infectious complications 1.
- The use of a subclavian site is recommended instead, to minimize infection risk for nontunneled CVC placement 1.
- However, in patients with advanced kidney disease, the subclavian site should be avoided to prevent subclavian vein stenosis 1.
- In cases where catheter removal is not possible, guidewire exchange or antibiotic lock therapy may be considered as alternative options 1.
From the Research
Catheter-Related Complications
- The risk of catheter-related bloodstream infections with femoral venous catheters is a significant concern, with studies suggesting a higher risk compared to internal jugular access 2.
- A systematic review of the literature found no significant difference in the risk of catheter-related bloodstream infections between femoral and subclavian/internal jugular sites, but the internal jugular site was associated with a lower risk of catheter-related bloodstream infections compared to the femoral site 3.
- Another study found that femoral tunneled dialysis catheters are associated with poor patency rates and high complication rates, and reusing femoral veins for TDCs should be avoided where possible 4.
Catheter Patency and Survival
- A study on tunneled femoral vein catheterization for long-term hemodialysis found low catheter survival and significant complications, including catheter-related deep venous thrombosis and malfunction/occlusion 5.
- Another study found that the overall catheter survival rate was 84% at 34 days, and catheter insertion was easy to perform with no serious complications 6.
Site Selection for Catheter Placement
- The choice of site for catheter placement is crucial, with internal jugular access associated with a lower risk of catheter-related bloodstream infections compared to femoral access 2.
- A study found that the risk of catheter-related bloodstream infections was higher with femoral access compared to internal jugular access, and the absence of both CRBSI and CC was significantly associated with a lower duration of catheterization 2.
Recommendations for Catheter Management
- Regular monitoring and observation of the microbiological spectrum in patients receiving care in intensive care units is essential to adopt preventative measures for infection prevention and control 2.
- Staff education, strict hygiene standards, and a higher nurse-to-patient ratio may help reduce the risk of catheter-related complications 2.