Does anyone have a policy regarding how long femoral lines are recommended to stay in place?
Every professional organization (APIC, SHEA, IDSA, CDC, INS, etc) states that femoral sites should not be used for CVAD placement. So there is no recommendation on the length of time they should remain in place. The answer is the absolute shortest length of time possible, if at all. At the first point of a stable patient, another site should be chosen and the femoral line removed. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Office Phone 770-358-7861
If you go to IHI website you wiill find hospitals who state emergent use is femoral and hospitals who have 12 and 24 hour policies for line substitution
I believe Alleghany policy is on IHI and it is 12 hours
kathy Kokotis RN BS MBA
We recently had a patient admitted who had RA and was severely contracted. He got around using an electric chair and had an accident on it. Broke his neck. He was going to have a halo placed the next day. He had a peripheral site when I went in to assess him. Knew he was going to need some other type of device, and knew right away that he was not going to be a PICC candidate. I could barely pull his arms out! No Way! I placed a note in his chart letting the physicians know of my findings and recommended a different type of central line other than a PICC due to his severe contractures. He had a femoral line placed the next day. The hospitalist later wanted it changed out for a PICC. Another PICC nurse attempted and his humurus was fractured in the process. He kept his femoral line. We kept the dressing changed and clean and kept it for his entire stay, even transferring to a Swing Bed facility with it! We NEVER do that! but we had no choice. We documented extensively on his line. Even getting Risk Management involved.
We usually do all we can to have femoral lines out, but once in a while you will have an exception.
Thank you for your input! I needed additional information for our policy and wanted to make sure I wasn't missing anything after reading the CDC and INS guidelines. We have had a "run" of patients coming to the floors from ER with femoral lines. The nurses weren't sure about the policy, and I told all that no femoral line should be in place for more than 24 hours without a doctor's order. One ER doctor challenged me on this and I gave all evidence-based data I could gather. Now I am able to re-word the policy to state this!
And yes, we all have exceptions, which is why we allow for the doctors to write orders allowing the line to stay in place. We just take extra precautions and so far, so good.
I'm shocked that the pt has a humeral fracture while getting a PICC line placed. All the more reason I don't PICC on anyone that cannot straighten their arm more than 90 degrees.