A modified guidewire-assisted technique to facilitate advancement of long femoral central catheters into the inferior vena cava and prevent malposition

Abstract

Advancement of long femorally inserted central catheters (FICCs), particularly 4–5 Fr, 55 cm devices introduced via the superficial femoral vein at mid-thigh, may be limited by the presence of venous valves, bifurcations, or inadvertent diversion into collateral pathways such as the ascending lumbar vein. Smaller-caliber, more flexible catheters appear especially prone to primary maldirection along the iliac–caval axis. We describe a simple technical modification aimed at facilitating catheter progression toward the inferior vena cava and potentially reducing the risk of primary malposition. In this approach, the original internal stylet of a 4–5 Fr single-lumen, 55 cm catheter is replaced with a 0.035″ × 70 cm J-tip metallic guidewire. During the initial phase of insertion, the guidewire is kept entirely within the catheter lumen, thereby increasing the overall longitudinal stiffness of the system and improving pushability. After ~20–25 cm of advancement—corresponding to the expected position within the common femoral or iliac vein—the guidewire is advanced slightly, allowing the J-tip to protrude about 2 cm beyond the catheter tip. This configuration enables the guidewire to lead navigation toward the inferior vena cava. The increased shaft rigidity reduces the tendency to buckle and limits tip deflection during progression through the iliac segment. Furthermore, the minimally protruding, atraumatic J-tip, characterized by a wide curvature, appears less likely to engage narrow or posterior collateral pathways, such as the ascending lumbar vein, thereby favoring alignment with the larger-caliber inferior vena cava and promoting smoother advancement along the main venous axis. This guidewire-assisted maneuver is simple, reproducible, and compatible with ultrasound-based tip location protocols. Further prospective studies are warranted to assess its impact on technical success rates and on the reduction of catheter malposition.