Vascular access devices inserted via the femoral vein have always been controversial, but necessary in some patients. The 2014 SHEA Compendium states, “Avoid using the femoral vein for central venous access in obese adult patients when the catheter is placed under planned and controlled conditions.” The 2011 CDC Guidelines states, “Avoid using the femoral vein for central venous access in adult patients.” The percutaneous insertion site may lead to a greater risk of complications, especially if the patient is ambulatory.
Another issue is tip location and confirmation of that location. Many have the mistaken idea that this aspect is not as important for a CVAD inserted through the femoral vein, but why would it be less important than those inserted through veins of the upper extremity or thorax?
The 2011 INS Standards of Practice addresses these issues in many standards.
Here is one case report of a femoral catheter entering the left ascending lumbar vein, but there are other case reports like this in the literature.
The INS Standards of Practice state, “Tip location of a CVAD shall be determined radiographically or by other approved technologies prior to initiation of infusion therapy.” This would apply to CVADs inserted via all veins including femoral vein insertions.
Author: Lynn Hadaway
Lynn Hadaway has more than 35 years experience in infusion nursing and adult education. Her experience comes from multiple acute care settings, healthcare manufacturing, continuing professional education.