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

Abstract

Background: In some clinical conditions, central venous access is preferably or necessarily achieved by threading the catheter into the inferior vena cava. This can be obtained not only by puncture of the common femoral vein at the groin, but also—as suggested by few recent studies—by puncture of the superficial femoral vein at mid-thigh. Methods: We have retrospectively reviewed our experience with central catheters inserted by ultrasound-guided puncture and cannulation of the superficial femoral vein, focusing mainly on indications, technique of venipuncture, and incidence of immediate/early complications. Results: From June 2020 to December 2020, we have inserted 98 non-tunneled central venous catheters (tip in inferior vena cava or right atrium) by ultrasound-guided puncture of the superficial femoral vein at mid-thigh or in the lower third of the thigh, all of them secured by subcutaneous anchorage. The success of the maneuver was 100% and immediate/early complications were negligible. Follow-up of hospitalized patients (72.5% of all cases) showed only one episode of catheter dislodgment, no episode of infection and no episode of catheter related thrombosis. Conclusions: The ultrasound approach to the superficial femoral vein is an absolutely safe technique of central venous access. In our experience, it was not associated with any risk of severe insertion-related complications, even in patients with low platelet count or coagulation disorders. Also, the exit site of the catheter at mid-thigh may have advantages if compare to the exit site in the inguinal area.

Management of antithrombotic treatment and bleeding disorders in patients requiring venous access devices: A systematic review and a GAVeCeLT consensus statement

“…The benefits of both real time ultrasound guidance and adequate training of the operator have been discussed in a few studies. [44][45][46] Some of these studies 3,4,46 have also recommended the use of micro-puncture kits (21G needles and 0.018″ nitinol guidewires) with the purpose of reducing puncture-related trauma to the tissues. Though this strategy may not be available in every hospital and/or in every Country, the panel suggested to consider this option in most cases, and especially in patients with increased risk of bleeding.…”

“…Old guidelines recommended that insertion of a central VAD other than a Peripherally Inserted Central Catheter (PICC)-in a nonemergent situation-should be carried out only if platelet count is >50 × 10 9 /L and the international normalized ratio of prothrombin time (PT/INR) is below 1.5. 1 In the last decade, many novelties have changed the clinical scenery: the diffusion of ultrasound guided venipuncture and the introduction of micro-puncture kits with very small needles (21G) have reduced the risk of bleeding associated with VAD insertion 2,3 ; central VADs with low risk of bleeding complications, such as PICCs in veins of the arm or Femorally Inserted Central Catheters (FICCs) in the superficial femoral vein 4 have become more popular; new ultrasound-guided peripheral VADs have been introduced in clinical practice 5 ; traditional Vitamin K antagonists (VKAs) have been partially replaced by a new generation of direct oral anticoagulants (DOACs) that are becoming the cornerstone of antithrombotic therapy. 6 These novelties call for a revision of the current recommendations.…”

The SIF protocol: A seven-step strategy to minimize complications potentially related to the insertion of femorally inserted central catheters

“…6 Some cases of venipuncture of the SFV, especially in patients with high BMI, when the vein is located at a depth of 5-6 cm, may require long needles and long micro-introducer-dilators. 25 Soon after the US-guided venipuncture, ultrasound should also be used for assessing the correct direction of the guidewire while it progresses into the vascular system (US-based "tip navigation"). This maneuver can be performed with the same linear probe used for venipuncture, usually visualizing the CFV in long axis.…”

“…When the catheter tip is in RA or at IVC/RAJ, the FICC can be additionally used for hemodynamic monitoring. 25 When the tip of the FICC is expected to be in the IVC, length estimation by anthropometric measurement is useful. In adult patients, 25 cm from the inguinal sulcus corresponds to the location in IVC.…”

ECHOTIP: A structured protocol for ultrasound-based tip navigation and tip location during placement of central venous access devices in adult patients

“…As regards tip location, please also note the tip of a FICC is not necessarily located in the RA or at the junction between IVC and RA: if the FICC is not to be used for hemodynamic monitoring, the tip is usually left in the mid-portion of the IVC, above the confluence of the iliac veins and below the renal veins. 45 In this latter case, it is easy to locate the catheter tip in the RA by the bubble test (as described above) and then withdraw it.…”