A PROSPECTIVE EVALUATION OF THE USE OF FEMORAL VENOUS CATHETERS IN CRITICALLY ILL ADULTS

Objective: To determine the rate of complications following the use of femoral catheters in adults. Design: Prospective survey of major and minor complications. Setting: A mixed medical/surgical intensive care unit (ICU) in a university hospital. Patients: Eighty consecutive pati ents admitted to the ICU who underwent right femoral venous catheteriz ation over a 13-month period. interventions: Patients were carefully m onitored for mechanical, infectious, and thrombotic complications. On catheter removal, a lower extremity bilateral phlebographic examinatio n was performed in each patient. Measurements and Main Results: There were 80 polyurethrane catheters inserted for a mean duration of 8.8 +/ - 4.4 (so) days. Catheters were inserted by interns or residents (75%) or by critical care fellows (25%). Minor complications consisted of a rterial puncture (15%), local hematoma (4.4%), local bleeding (3%), an d local inflammation (5%). After insertion, 17% of catheter tips were in the right atrium, 13% in the abdominal vena cava, 63% in the thorac ic inferior vena cava (correct position), and 8% in aberrant abdominal intravascular positions. After repositioning, 80% of catheter tips we re in the thoracic inferior vena cava. One patient developed a cathete r-related bacteremia. Catheter-related sepsis were seen in three (3.7% ) patients and catheter colonization in 11 (13.7%) patients. No patien t had clinical signs of deep vein thrombosis or pulmonary embolism. Bi lateral phlebography was performed in 70 patients at the time of cathe ter removal and was normal in 45 (64%) patients. Fibrin sleeves were s een in 11 (15.7%) patients. Lower extremity deep vein thrombosis devel oped in 24 (34%) patients. Six (8.5%) patients had femoral vein thromb osis (common femoral vein in two patients, and superficial femoral vei n in four patients). Eighteen (25.7%) patients developed popliteal vei n or posterior tibial vein thrombosis that was either bilateral (n = 1 6) or homolateral (n = 2) to the femoral catheter. Conclusions: Based on the data from this study, we conclude that femoral vein catheteriza tion with a polyurethane catheter is associated with an 8.5% frequency rate of femoral vein thrombosis. Thrombosis in the popliteal vein or posterior tibial vein is higher (25.7%), but is homolateral to the cat heter with only a 2.8% frequency rate. Infectious complications are lo w and similar to those of other central venous routes. Given the accep table rate of clinically important complications, femoral venous cathe terization offers an attractive alternate site of insertion to the jug ular and subclavian veins for central venous access in the critically ill.