Has anyone seen a femoral picc line placed?  Is this a common practice?  If so, where should the tip reside?  A/C junction or IVC...We have a patient with SVC syndrome and IR placed a femoral picc line and we have not seen that before.  Any input is appreciated!

 

femoral PICC use

Molly,

 

I applaud your physicians for placing a femoral catheter in a patient with SVC syndrome.  This tells me you are working with someone who is willing to take the time to assess the patient AND his need.

Unfortuntely in my past travels to other facilities plus my own, I hear, "the primary ordered a PICC so I placed a PICC".  Physicians thread the catheter as far as they can, which is usually into the subclavian vein or axillary vein and leave it there.  So then the nurses have to deal with it again in several days when the subclavian clots off and we begin to see leakage around the insertion siite.   This eliminates that whole side and extrimity should we be able to correct the SVC syndrome. 

If I had to use the femoral area I would want the smallest possible catheter used since we know that we have a higher thrombus rate there.  We also have experience with placing PICCs in areas that

receive lots of movement (axillary) and do well with that movement with minimal side effects.  We want the same for the femoral area.  We want the patient to be able to move his legs/hips etc with the minimal amount risk.  The femoral area is not an area I like to use but sometimes we find we have no choice after a good assessment. 

Margy Galloway

M Galloway, RN, BSN, VA-BC, CRNI

Power Line

Your IR departmet may have placed a Power Line and not a Power PICC.  Look at the line to see what it actually says as they are both similiar in look however one has a cuff.

PICC line use in the femoral is off label.

Kathy Kokotis

Bard Access Systems

Molly, did you ask why they

Molly, did you ask why they would place a PICC in in the femoral as compared to a CVC? This particular location may be an opportunity for an antimicrobial CVC......as Lynn stated--any placement of a PICC in this area (just as in the IJ) is an off label use.

Cheryl Kelley RN BSN, VA-BC
Independent Vascular Access Consultant

Although not intended for

Although not intended for this insertion site, femoral insertion could be done as an off-label use. For any catheter inserted via the femoral vein, the tip should reside in the IVC above the level of the diaphragm to be considered a central venous catheter. See Infusion Nursing Standard 35. Also see the SHEA and CDC guidelines as femoral catheter use is greatly discouraged due to their high infection risk. This catheter should be removed as soon as the patient is stable with a better site chosen. Femoral catheters in adults should only be used in bedridden patients as there are numerous complications in published case reports and studies. So I would hope this is only a very short-term temporary need. If this is a long term need, I would recommend referring the patient to a radiologist for insertion into the IVC via the hepatic or lumbar veins.  Lynn

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861