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.

Keywords

Catheterization central venous complication femoral vein inferior vena cava superior vena cava

Get full access to this article

View all access options for this article.

References

Gorski

Hadaway

Hagle

, et al. Infusion therapy standards of practice. J Infus 2016; 39(1s): 1–132.

Lin

Yang

, et al. Comparison of four methods of deep vein catheter insertion in lung cancer patients. Chinese J Clin Nutr 2014; 22(6): 381–386.

Zhang

, et al. The feasibility of ultrasound-guided PICC insertion by the middle-thigh femoral vein in lung cancer patients with superior vena cava obstruction. Chin J Nurs 2015; 50(6): 692–696.

Aria

Vatsky

Kaye

, et al. Greater saphenous venous access as an alternative in children. Pediatr Radiol 2014; 44(2): 187–192.

Robert

PICC Zone Insertion Method (ZIM): a systematic approach to determine the ideal insertion site for PICCs in the upper arm. JAVA 2011; 3(16): 156–165.

Wan

Chu

Qiu

, et al. The feasibility and safety of PICCs accessed via the superficial femoral vein in patients with superior vena cava syndrome. Vasc Access 2018; 19(1): 34–39.

Zhang

The clinical effect and safety evaluation of femoral vein PICC catheterization in malignant tumor patients with obstruction of superior vena cava. J Nurses Train 2017; 32(1): 72–75.

Fragou

Gravvanis

Dimitriou

, et al. Real-time ultrasound-guided subclavian vein cannulation versus the landmark method in critical care patients: a prospective randomized study. Crit Care 2011; 39: 1607–1612.

Frykholm

Pikwer

Hammarskjöld

, et al. Clinical guidelines on central venous catheterization. Acta Anaesthesiol Scand 2014; 58(5): 508–524.