Review and Case Studies of Midthigh Femoral Central Venous Catheter Placement

Ostroff, M., Moureau, N., & Ismail, M. (2018). Review and Case Studies of Midthigh Femoral Central Venous Catheter Placement. JAVA 23 (3) 167-175.


Background: Bedside vascular access options have been limited to the short peripheral intravenous, midline catheter, peripherally inserted central catheter, and central venous catheter (CVC) insertion sites such as the jugular, subclavian, and femoral vein. Many patients with limited options for upper extremity, subclavicular, supraclavicular, and cervical limitations have traditionally received a femoral CVC in the inguinal region. This insertion site is considered a high risk for infection because of its location in the inguinal region and associated difficulties with maintaining the dressing integrity. An alternative location was selected for the insertion of a femoral vein central venous catheter in the midthigh to reduce the risk of infection.

Methods: After a multiple-year implementation process, midthigh femoral (MTF) insertions were performed on a select group of patients. The case studies that are included in this report outline the indications, procedures, and other pertinent aspects of the MTF placement. Patients at this institution with contraindications to upper extremity and thoracic catheter insertion received a MTF vein CVC in place of a traditional common femoral vein catheter insertion in the inguinal area. All procedural consents include permission for photography of procedure sites.

Results: All but a single patient completed their therapy without complication; 1 intentional dislodgement by a patient was recorded. There were no MTF catheter-related bloodstream infections and 2 confirmed central line associated bloodstream infections (n = 2 of 100) with the second noted as probable contaminated specimen. Outcomes reflected no procedural complications (eg, expanding hematoma or femoral nerve injury or any other femoral artery or vein injuries) and 1 nonocclusive deep vein thrombosis (n = 1 of 100).

Conclusions: The MTF CVC provides an alternative to traditional common femoral vein catheter placement for nonemergent patients with upper extremity and thoracic contraindications to central line placement.

1 thought on “Review and Case Studies of Midthigh Femoral Central Venous Catheter Placement”

  1. Hello Dawn,
    Mid-thigh femoral placement is for a very select group of patients who require venous access, but do not have the upper extremity or chest veins to adequately accommodate catheters. Also patients with chronic kidney disease who should not have catheters in the upper extremities.

    The functional limitation of patients with MTF catheters is mainly no ambulation, which may promote thrombosis, more common in femoral catheters. These patients are generally very sick and bedbound. Sitting is not a limitation, but with increasing activity in the legs more difficulties may occur. As with any femoral catheter, or intravenous device, it should be removed as soon as no longer needed, effectively reducing the risk of complications.

    I have attached Matthew Ostroff on this email, who may have more to add since he is the real expert on this type of insertion and catheter.

    Glad to help anytime,

    Nancy Moureau, PhD, RN, CRNI, CPUI, VA-BC
    PICC Excellence, Inc
    Office 706-377-3360
    Cell 706-614-8021

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