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.
- Standard #32, VAD Selection states, “femoral tip location should be the IVC (inferior vena cava)”.
- Standard #35, VAD Site Preparation and Device Placement states, “CVADs shall have the tip dwelling within the superior vena cava (SVC) near its junction with the right atrium or, if placed via the femoral vein, shall have the tip dwell in the inferior vena cava (IVC) above the level of the diaphragm.”
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.