Experience with tunneled femoral hemodialysis catheters

OBJECTIVE. The purpose of this study was to evaluate the use and complication rate of tunneled femoral hemodialysis catheters placed in patients with no remaining thoracic venous access sites. MATERIALS AND METHODS. Over a 3-year period, 41 tunneled femoral vein catheters (35 right, six left) were placed in 21 patients (15 women, six men; 21-89 years old; mean, 52 years). Catheters ranged in length from 40 to 60 cm. Tips were positioned immediately above the iliac bifurcation, at the mid inferior vena cava (IVC), or at the junction of the IVC and right atrium. Catheters were exchanged through the existing tract if the flow rate decreased to less than 200 ml/min. Catheters were removed if an episode of bacteremia did not resolve with antibiotics or if the insertion site became infected. RESULTS. Technical success of placement was 100%. The 30-, 60-, and 180-day primary patency rates were 78%, 71%, and 55%, respectively. The 30-, 60-, and 180-day secondary patency rates were 95%, 83%, and 61%, respectively. Average time of function per intervention was 61 days. Infections requiring catheter removal occurred at a rate of 2.4 per 1000 catheter days. One episode of partial IVC thrombosis occurred after a catheter infection developed 78 days after initial catheter placement. No episodes of symptomatic pulmonary embolism occurred. Total length of follow-up was 2506 catheter days. CONCLUSION. Femoral vein catheters require more frequent interventions than do thoracic catheters and are more susceptible to infection. However, in patients with difficult central venous access, the common femoral vein may be successfully used for permanent tunneled hemodialysis access.