Optimal Catheter Site Selection with Avoidance of the Femoral Vein for Central Venous Access in Adult Patients

Traditionally the first site of choice for CVC placement tunneled or nontunneled in an adult patient would be Subclavian (SC); due to the proximity to the airway, comfort of site, ability to maintain occlusive dressings and the known lowest site infection rate. With the emphasis on ultrasound guided insertions, utilization of the modified subclavian approach using the axillary vein should be considered. Second would be internal jugular (IJ), which would be the first site of choice for temporary hemodialysis catheters and tunneled catheters, followed by the femoral site. Tunneled catheters terminate in the SVC via the subclavian vein or internal jugular vein, yet exit the skin in the subclavian region on the chest. Right-sided approaches are more direct and allow the catheter to track more efficiently into the optimal tip position.

The femoral site has a known increased bacterial colony count and should be avoided when possible. Clinical situation will warrant femoral placement such as a code arrest or severe coagulation disorder. Reassessment and replacement of femoral catheters should be considered within 24 hours. You should consider antimicrobial dressings at all femoral sites (9).