Cannulation of the superficial femoral vein at mid-thigh when catheterization of the superior vena cava system is contraindicated

Abstract

Purpose: Patients needing medium- to long-term infusion therapy with limited catheterization via the superior vena cava system is a challenging condition. The conventional catheterization via the femoral vein in the groin has a high complication rate, discomfort, and short indwelling time. Since changing the insertion site can avoid the disadvantage of conventional catheterization via the femoral vein in the groin, the present study aimed to investigate the effects of femoral inserted central catheters insertion via the superficial femoral vein at the mid-thigh to resolve the issue of limited superior vena cava system catheterization. Methods: Based on the symptoms and signs, enhanced computed tomography findings, and insertion history, in 121 patients, limited catheterization via the superior vena cava system was identified. Subsequently, the femoral inserted central catheters were inserted via the superficial femoral vein at the mid-thigh under the guidance of ultrasound, and the tip of femoral inserted central catheters was in the inferior vena cava. Results: A total of 121 patients underwent femoral inserted central catheters insertion via a superficial femoral vein at the mid-thigh from August 2017 to December 2018. The success rate of insertion was 100%, and the indwelling time was 3–472 days. The complications of femoral inserted central catheters in the thigh were similar to that of peripherally inserted central catheters in the arm. The incidence of primary malposition was 1.65%, the incidence of catheter-related thrombosis was 0.83%, and the central line associated bloodstream infection rate was 0.83%. Subsequently, 116 lines (95.87%) were removed at the end of the treatment, one line (0.83%) was accidentally removed by the patient, and four lines (3.31%) were unplanned removed due to complications. Conclusion: The technique of femoral inserted central catheters insertion via the superficial femoral vein at the mid-thigh has a high success rate, low complication rate, and less impact on activities, and is easy to maintain. This phenomenon resolves the patient’s needs of medium- to long-term infusion therapy with limited catheterization of superior vena cava system.

Ultrasound-guided cannulation of the superficial femoral vein for central venous access

“…Other indications-such as the presence of dialysis catheter in the right jugular vein and pacemaker in the left subclavian vein (two patients of our study) and dialysis fistulas in chronic renal failure patients (two patients)has already been described by Zhao et al 14 Severe vasculopathy and no possibility of PICC or CICC insertion because of repeated previous venous cannulations and very small veins in a patient with both legs amputated (mid-thigh in the right leg and below the knee on the left side: the SFV was obviously cannulated on the left thigh) was another peculiar indication in our experience.…”

“…This technique consists in creating a long subcutaneous tunnel from the puncture site in the groin zone to the mid-thigh or up to the abdomen. [7][8][9][10][11][12] In the last years, the direct cannulation of the superficial femoral vein in oncologic patients has been described by Wan et al 13 and by Zhao et al 14 The superficial femoral vein has been considered in the last decade for formation of fistulas for hemodialysis, 23,24 but its cannulation for infusion purposes had never been described before.…”

“…5,6 To overcome these complications, in the last decade, many centers have adopted the technique of tunneling the catheter so to move the exit site from the groin downward to mid-thigh, or upward to the abdomen. [7][8][9][10][11][12] Another interesting strategy to achieve an exit site at mid-thigh, without tunneling, is the direct puncture/cannulation of the superficial femoral vein (SFV), recently described by Wan et al 13 and by Zhao et al 14 These two recent clinical studies suggest that such technique is feasible and safe, being associated with a rate of complications similar to PICCs with exit site at midarm.…”

“…Another interesting strategy to achieve an exit site at mid-thigh, without tunneling, is the direct puncture/cannulation of the superficial femoral vein (SFV), recently described by Wan et al 13 and by Zhao et al 14 These two recent clinical studies suggest that such technique is feasible and safe, being associated with a rate of complications similar to PICCs with exit site at midarm.…”

Alternative exit sites for central venous access: Back tunneling to the scapular region and distal tunneling to the patellar region

“…According to some authors, FICC-related thrombosis may be more common on the left side than on the right side. 23,24 However, we believe that the most important factors in preventing thrombosis after FICC insertion are the choice of a vein properly matched with the catheter size and the adoption of ultrasound-guided venipuncture. Tunneling the catheter from the common femoral vein to a region proximal to the patella may require a double tunnel.…”