1003745

research-article2021
JVA0010.1177/11297298211003745The Journal of Vascular AccessAnnetta et al.

Techniques in vascular access

JVA The Journal of
Vascular Access

The Journal of Vascular Access

Ultrasound-guided cannulation of the

1­–8
© The Author(s) 2021
Article reuse guidelines:
superficial femoral vein for central sagepub.com/journals-permissions
https://doi.org/10.1177/11297298211003745
DOI: 10.1177/11297298211003745

venous access journals.sagepub.com/home/jva

Maria Giuseppina Annetta, Bruno Marche, Laura Dolcetti,

Cristina Taraschi, Antonio La Greca, Andrea Musarò,
Alessandro Emoli, Giancarlo Scoppettuolo
and Mauro Pittiruti

Abstract
Background: In some clinical conditions, central venous access is preferably or necessarily achieved by threading the
catheter into the inferior vena cava. This can be obtained not only by puncture of the common femoral vein at the groin,
but also—as suggested by few recent studies—by puncture of the superficial femoral vein at mid-thigh.
Methods: We have retrospectively reviewed our experience with central catheters inserted by ultrasound-guided
puncture and cannulation of the superficial femoral vein, focusing mainly on indications, technique of venipuncture, and
incidence of immediate/early complications.
Results: From June 2020 to December 2020, we have inserted 98 non-tunneled central venous catheters (tip in inferior
vena cava or right atrium) by ultrasound-guided puncture of the superficial femoral vein at mid-thigh or in the lower third
of the thigh, all of them secured by subcutaneous anchorage. The success of the maneuver was 100% and immediate/
early complications were negligible. Follow-up of hospitalized patients (72.5% of all cases) showed only one episode of
catheter dislodgment, no episode of infection and no episode of catheter related thrombosis.
Conclusions: The ultrasound approach to the superficial femoral vein is an absolutely safe technique of central venous
access. In our experience, it was not associated with any risk of severe insertion-related complications, even in patients
with low platelet count or coagulation disorders. Also, the exit site of the catheter at mid-thigh may have advantages if
compare to the exit site in the inguinal area.

Keywords
Femoral, central venous access, superficial femoral vein, ultrasound guidance, central venous catheters

Date received: 17 February 2021; accepted: 19 February 2021

Introduction large mediastinal tumors, bilateral breast cancers, lung or

Central venous access is usually achieved by ultrasound-
guided puncture/cannulation of deep veins of the cervico-
thoracic area (CICC = centrally inserted central catheters)
or of the arm (PICC = peripherally inserted central cathe-
ters), and the tip is located either in the superior vena cava
(SVC) or in the right atrium (RA), or more precisely—as
recommended by most recent guidelines1,2—in proximity
of the SVC/RA junction.
There are some patients, though, in whom a cervico-
thoracic or brachial approach may be not feasible or even
contraindicated. Compression or infiltration of SVC,
esophageal cancer with mediastinal infiltration, etc., are
well known clinical conditions potentially associated
with difficult or impossible progression of the catheter
into the SVC. In these situations, central venous access
can alternatively be obtained by cannulation of
Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
Corresponding author:
Mauro Pittiruti, Catholic University Hospital, Largo Francesco Vito 1,
Rome 00168, Italy.
Email: mauropittiruti@me.com
2 The Journal of Vascular Access 00(0)
the femoral vein and placement of the catheter tip in the
inferior vena cava (IVC) or at the IVC/RA3,4: such type
of central access may be defined as FICC (femorally
inserted central catheter).
Until recently, FICCs have been inserted almost exclu-
sively by puncture/cannulation of the common femoral
vein (CFV) in the inguinal groove, with the exit site at the
groin. This approach is burdened with a high risk of
catheter-related infection (mainly due to the high bacterial
contamination of this skin area) and of catheter-related
venous thrombosis (due to many factors, but mainly to the
instability of the catheter when the exit site is in a flexion
area).5,6 To overcome these complications, in the last dec-
ade, many centers have adopted the technique of tunneling
the catheter so to move the exit site from the groin down-
ward to mid-thigh, or upward to the abdomen.7–12
Another interesting strategy to achieve an exit site at
mid-thigh, without tunneling, is the direct puncture/can-
nulation of the superficial femoral vein (SFV), recently
described by Wan et al.13 and by Zhao et al.14 These two
recent clinical studies suggest that such technique is feasi-
ble and safe, being associated with a rate of complications
similar to PICCs with exit site at midarm.
In these clinical studies, the superficial femoral vein
(SFV) is defined (as in most anatomy textbooks)15 as that
portion of femoral vein which begins after the popliteal
vein, in the adductor canal (Hunter’s canal), and ends
below the inguinal groove, merging with the deep femoral
vein into the common femoral vein (CFV). As such, it is
the main vein of the thigh. This definition is still main-
tained in some textbooks and articles of ultrasound anat-
omy,16 while some textbooks of phlebology and vascular
surgery name it simply “femoral vein.” We will keep the
term ‘superficial femoral vein’ so to differentiate clearly
this venipuncture from the traditional venipuncture of the
common femoral vein (CFV). Still, one must consider that
the “superficial” femoral vein is actually a deep vein, since
it is located at more than 1 cm (typically, 3–6 cm) from the
skin surface.
In this study, we report our 6-month experience of non-
tunneled FICCs inserted by direct ultrasound-guided punc-
ture/cannulation of the SFV.
Methods
We have reviewed retrospectively all the FICCs recently
inserted via SFV puncture by our Vascular Access Team,
a multi-professional, multi-disciplinary team which
inserts approximately 7000 central lines per year (includ-
ing short, medium, and long term central venous access
devices) in our University Hospital. Though our experi-
ence with SFV puncture started approximately 1 year
ago, we have considered only the catheters inserted in the
last 6 months (from June 1st, 2020 to December 31st,
2020).
According to our hospital policies, all central line inser-
tions, both in outpatients and in hospitalized patients, are
recorded in a computer-based archive; all relevant
catheter-related complications are also reported to our
Team and managed by our Team. The technique of central
venous access device insertion is standardized and
described in appropriate insertion bundles, recommended
by our hospital policies.
In particular, our insertion bundle for FICC placement
includes the following steps: systematic pre-procedural
assessment of the deep veins of the groin and the thigh,
according to the RaFeVA protocol (Rapid Femoral Vein
Assessment),16 for an appropriate choice of the best venous
approach and a proper planning of the exit site; aseptic tech-
nique (hand hygiene, skin antisepsis with 2% chlorhexidine
in alcohol, maximal barrier precautions); ultrasound-guided
puncture/cannulation; ultrasound-based tip navigation;
ultrasound-based or ECG-based tip location (if tip location
is planned at the IVC/RA junction); sutureless stabilization
of the catheter; protection of the exit site with cyanoacrylate
glue and semipermeable transparent membrane.
All FICC insertions via the SFV were performed by six
different operators of our team, using the same technique.
All catheters were inserted at bedside, using either a
wireless portable ultrasound device (Cerbero, ATL; linear
transducer: 7.5–10 MHz) or a standard ultrasound device
(Edge II or NanoMaxx, SonoSite-Fuji; linear transducer,
6–13 MHz). Most patients were in supine position or in a
half-sitting position; the leg was preferably placed in slight
abduction, though this was not always possible, consider-
ing that some patients had obligatory postures due to pare-
sis or muscle spasticity.
After obtaining informed consent, we assessed the
patency and the caliber of the CFV and of the SFV, using
the RaFeVA protocol. The best site for cannulation of the
SFV was identified at mid-thigh or in the distal third of the
thigh (Figure 1), as long as its inner diameter was appro-
priate for the catheter size (4 Fr or 5 Fr catheters requiring
respectively 4 or 5 mm veins). In all patients, pressure
injectable polyurethane non-valved catheters (4 Fr single
lumen or 5 Fr double lumen, 50–60 cm long) were used.
Different catheter brands were adopted (Synergy CT,
Healthline; ProPICC, Medcomp; Celsite PICC, BBraun).
According to our hospital policies, the puncture/cannu-
lation was performed after skin antisepsis with 2% chlo-
rhexidine in 70% iso-propylic alcohol, using maximal
barrier precautions (beret, mask, sterile gowns, and gloves,
wide sterile drapes over the patient, sterile cover for the
probe) (Figure 2). All procedures were performed using a
specific and dedicated insertion pack. After skin infiltra-
tion with few ml of local anesthesia (7.5% ropivacaine)
(Figure 3), the SFV was cannulated using real-time ultra-
sound guidance and micro-introducer technique (21G nee-
dle, floppy straight tip 0.018″ nitinol guide wire and
micro-introducer-dilator) (Figure 4).
Annetta et al.
Figure 1. Ultrasound visualization of right superficial femoral
artery and right superficial femoral vein at mid-thigh, in short
axis: the vein is placed below the artery, slightly lateral.
Figure 2. Operative field before puncture/cannulation of
superficial femoral vein.
When the SFV was located laterally or medially to the
superficial femoral artery (SFA), a short axis visualization
with “out-of-plane” puncture was adopted; when the SFV
was located below the SFA, an oblique axis visualization
with “in-plane” puncture was preferred.
After venipuncture, the vein was cannulated by the
modified Seldinger technique (introduction of the guide
wire into the needle, removal of the needle, placement of
the micro-introducer-dilator over the guide wire, removal
of the guide wire and of the dilator, insertion of the cathe-
ter inside the micro-introducer).
If the tip had to be located in the mid-portion of the IVC,
the catheter was trimmed according to a length estimation
based on surface landmarks (from puncture site to the
navel), so to have the tip approximately placed above the
confluence of the iliac veins and below the renal veins. If
hemodynamic monitoring was required, the tip of catheter
3
Figure 3. Visualization of the vein in short axis, using wireless
probe.
Figure 4. Venipuncture with 21G needle.
was placed precisely in RA or at the IVC/RA junction using
the intracavitary ECG method (IC-ECG) of tip location; in
such cases, the catheter was trimmed according to a length
estimation based on the distance between the puncture site
and the third intercostal space on the parasternal border. At
IC-ECG, the biphasic P wave corresponds to the midportion
of the RA and the maximal negative P wave corresponds to
the IVC/RA junction.17–19 An additional 2–2.5 cm of cathe-
ter length were added to the landmark-based length estima-
tion considering that all FICCs were secured by a
subcutaneously anchorage device (SecurAcath, Interrad).20,21
According to our hospital policies, after subcutaneously
anchored securement, the exit site was sealed with cyano-
acrylate glue and protected with a semipermeable trans-
parent dressing (Figure 5).
All relevant data related to the insertion procedure
were recorded, according to our hospital policies, and
retrieved for this retrospective analysis. We have also
retrieved information about relevant catheter-related
4 The Journal of Vascular Access 00(0)
Figure 5. Securement by subcutaneous anchorage + sealing
with cyanoacrylate glue + protection with semipermeable
transparent membrane.
complications from the database of our Team. In fact, all
major catheter-related complications occurring during
hospitalization (infection, venous thrombosis, catheter
dislodgment, irreversible lumen occlusion) are reported
and recorded. The diagnosis of catheter-related blood
stream infection was based on paired cultures (from the
lumen of the catheter and from the peripheral blood),
according to the method of delayed time to positivity
(DTP)22; the diagnosis of catheter-related venous throm-
bosis was based on ultrasound examination of the veins,
performed only in case of local signs or symptoms sug-
gestive of venous thrombosis.
This retrospective study was carried out according the
STROBE checklist for retrospective cohort studies.
Results
Between June 1st, 2020, and December 31st, 2020, we
inserted 98 non-tunneled FICCs using an ultrasound-
guided approach to the superficial femoral vein (SFV).
Indications to FICC insertion included patients requir-
ing central venous access but with absolute or relative con-
traindications to both CICC and PICC insertion:
- non-collaborative patients at high risk of dislodg-
ment of the central line due to delirium and agitation
(n = 40, 41%); many patients of this group had previ-
ous history of accidental removal of PICCs and
CICCs;
- bedridden patients with abnormal postures due to
physical disability and/or spasticity of the limbs
(n = 27, 27.5%), candidate to extra-hospital treat-
ment in long term health care facilities;
- obstruction/infiltration of SVC due to mediastinal
malignancy (n = 19, 19.3%) (patients with lym-
phoma, thyroid cancer, ENT cancer);
- four patients with liver failure and severe coagulop-
athy (less than 5000 platelets), thus with contraindi-
cation to CICC insertion, and no arm veins available
for PICC insertion (4%);
- two septic patients with helmet for non-invasive
ventilation, secured by underarm straps (2%);
- two chronic renal failure patients with dialysis cath-
eters in the right supraclavicular area and concomi-
tant pacemaker on the left side (2%);
- 
two chronic renal failure patients with arterio-
venous fistulas, who did not give their consent to
CICC insertion (2%);
- one patient with severe vasculopathy and no evident
accessible deep vein for PICC or CICC insertion
(the patient had had previous leg amputations on
both sides: below the knee on the left site and above
the knee on the right side);
- one patient with paralysis of both arms due to amyo-
trophic lateral sclerosis, who did not consent to
CICC insertion but only to SFV cannulation.
Most patients were adults (n = 96) (mean age 70 years old,
age range 40–90; 51 females and 45 males), while two patients
were less than 18 years old (15 and 17 years old, both males).
We inserted 50 double lumen 5 Fr catheters (Figure 6),
mainly in patients who were scheduled to stay in our hos-
pital, and 48 single lumen 4 Fr catheters (Figure 7), mostly
in patients candidate to long term facilities or candidate to
chemotherapy.
All 5 Fr catheters were inserted in SFV with inner diam-
eter equal or superior to 5 mm, and all 4 Fr catheters in
SFV with inner diameter equal or superior to 4 mm. The
mean diameter of SFV was 6 (range 4–8 mm), and the
mean depth was 4 cm from the skin (range 3–6 cm).
As regards to the venipuncture, the short axis out of
plane technique was most commonly used (52 pts); the
oblique axis in plane technique was adopted in 46 pts.
The vast majority of insertion were on the right thigh
(81%): the left SFV was accessed mainly in patients with
paresis or previous femoral venous thrombosis of the right
lower limb.
Annetta et al. 5

Figure 6. Double lumen 5 Fr catheter in a hospitalized patient. Figure 7. Single lumen 4 Fr catheter in a patient to be
referred to nursing home.

In 94 patients, the tip of the FICC was located in the

midportion of the IVC; in two adult patients and in two Table 1. Patients and catheters.
pediatrics, hemodynamic monitoring was required, so that
Intra-hospital use Extra-hospital use
the tip was located in RA, or at the IVC/RA junction using
IC-ECG. Number of patients 52 46
At the end of the procedure, the exit site of catheter was Sex
in the middle third of the thigh in 52 pts and in the distal - Male > 18 years old 25 20
third of the thigh in 46 pts. - Male < 18 years old 2 –
Table 1 summarized the main characteristics of the - Female 25 26
FICCs inserted in our patients. Catheter size/lumens
All procedures were successful. Most veins (95%) were - 5 Fr double lumen 44 6
punctured at the first attempt. No major immediate/early - 4 Fr single lumen 8 40
Tip position
complication was recorded. There were three minor imme-
- Right atrium 4 –
diate/early complications:
- Mid-portion of IVC 48 46
Exit site location
- one accidental puncture of SFA (followed by suc-
- Thigh, middle third 32 20
cessful SFV puncture at cannulation during the sec- - Thigh, distal third 20 26
ond attempt); no significant local hematoma was
detected at the ultrasound examination of the soft
tissues at the end of the procedure and in the subse- over-the-guide replacement was performed: we found
quent days; out that the catheter was kinked in the intravascular
- one catheter was not properly functioning soon after tract, at about 8 cm from the exit site.
insertion, probably due to kinking of the tip inside
the veins; the catheter function was restored by jet The long-term follow-up was not possible in all cases,
lavage with normal saline; as late complications potentially occurring in the patients
referred to nursing facilities (n = 27, 27.5%) were not con-
- one catheter was not functioning properly the day after sistently reported to our team. Though, in the patients who
insertion (inability to both aspiration and infusion); an stayed hospitalized (n = 71, 72.5% of cases), no major late
6 The Journal of Vascular Access 00(0)
catheter-related complications were reported: in particular,
we had no catheter-related blood stream infection, no irre-
versible lumen occlusion, and no catheter-related venous
thrombosis. There was only one case of accidental dis-
lodgment, in an agitated, non-collaborative patient (though
the catheter was secured by subcutaneous anchorage). In
one patient, there was a suspect of asymptomatic catheter-
related venous thrombosis, which was finally diagnosed as
a fibroblastic sleeve at closer ultrasound examination. In
one patient with suspected catheter-related infection,
paired blood cultures showed a catheter colonization
(peripheral blood culture was negative, while a Staph.
hominis was isolated by the catheter blood sample).
In this group of 71 hospitalized patients, the mean dura-
tion of the central line was 35 days (range 1–123 days),
with only three unscheduled removals, as described above
(one guide-wire replacement at day 1 because of malfunc-
tion; one catheter removed because colonized; one cathe-
ter lost for accidental dislodgment).
Discussion
Femoral Inserted Central Catheters (FICC) are a useful
alternative when the SVC is not accessible. The use of
FICCs was first described in patients with mediastinal
tumors, bilateral breast cancer, lung cancer with mediasti-
nal infiltration, or lymphoma with SVC compression.3,4,7
Traditionally, the inferior vena cava approach is performed
through common femoral vein cannulation at the groin
site. However, this approach, because of the exit site in the
groin area, has an elevated risk of late catheter-related
complications, in particular infection and thrombosis.5,6
In the last decade, for the purpose of reducing the risk of
catheter related blood stream infection (CRBSI), the tun-
neling technique has been introduced to move the exit site
away from the groin zone. This technique consists in creat-
ing a long subcutaneous tunnel from the puncture site in the
groin zone to the mid-thigh or up to the abdomen.7–12
In the last years, the direct cannulation of the superficial
femoral vein in oncologic patients has been described by
Wan et al.13 and by Zhao et al.14 The superficial femoral
vein has been considered in the last decade for formation
of fistulas for hemodialysis,23,24 but its cannulation for
infusion purposes had never been described before.
The cannulation technique described by Wan and by Zhao
consists in the ultrasound-guided puncture (short axis, out of
plane) of the superficial femoral vein at mid-thigh, so that the
exit site is 10–20 cm away from the groin. In both studies, the
procedure was performed mostly in patients with superior
vena cava syndrome, mediastinal tumors, bilateral breast
cancer, or renal failure. In a non-randomized comparison
with PICCs, both studies reported less risk of dislodgment,
of primary malposition and of infection, a similar duration of
the line, as well a similar risk of thrombosis, bleeding, and
skin problems. Ostroff et al.25 have reported seven cases of
cannulation of the superficial femoral vein in hospitalized
non-oncologic patients, for a duration of less than 4 weeks,
with no major complication (no catheter-related infection
and no catheter-related thrombosis).
To our knowledge, our study is the first to describe SFV
cannulation also in agitated, delirious patients and in
patients with severe physical disabilities candidate to long
term facilities. Furthermore, it is the first study to describe
the ultrasound-guided approach to SFV with visualization
in oblique axis and in-plane puncture.
In our cohort of patients, 41% were delirious, agitated
patients with previous loss of PICCs and CICCs. Delirium
is frequent in aged hospitalized patients and is associated
with high morbidity and mortality.26,27 Causes of delirium
in our patients were posttraumatic syndromes, metabolic
disorders (hyponatremia) and cerebral ischemic syn-
dromes. Agitated patients may pull away every indwelling
device they can reach (such as nasogastric or jejunal tubes,
urinary, and intravenous catheters), sometimes even if
restrained.9 Subcutaneous anchored securement20,21 may
reduce but not completely avoid the risk of accidental dis-
lodgment in this population of patients. We decided to use
the SFV approach in confused, agitated patients after
repeated episodes of removal of CICCs and PICCs, even if
such catheters were secured by subcutaneous anchorage.
In such patients, we assumed that the exit site in the infe-
rior third of the thigh—sometimes very close to the knee
and covered with elastic band—would make more difficult
for the patients to reach the catheter and pull it away
(Figure 7). In this area of the thigh, the SFV is particularly
deep and typically located below the artery, so that we had
to use an oblique axis/in-plane approach and a longer
micro-introducer-dilator (7 cm rather than 5 cm).
Prevision of hospital discharge for referral to a long-
term health care facility is a frequent indication to venous
access: 27.5% of the patients included in our study needed
a central line because candidate to long term facilities.
Many of these patients had physical disabilities such as
mono-lateral paresis, tetraplegia spastic, or progressive
paresis due to amyotrophic lateral sclerosis. SFV cannula-
tion was preferred because of the presence of tracheostomy,
and/or inaccessibility of arm veins, and/or high risk of con-
tamination of the infraclavicular skin area by oral or tra-
cheal secretions. One patient with amyotrophic lateral
sclerosis had bilateral arms paralysis but was still autono-
mous in walking; though, he was very afraid of cervico-
thoracic puncture and he preferred a femoral approach.
As previously described in other studies,13 superior
vena cava syndrome, hematologic malignancy and thyroid
cancers with mediastinal infiltration were indication to
SFV cannulation also in our study (in 19.3% of patients).
Most of these cancer patients requires a venous access for
chemotherapy and many of them had coagulation and
platelet disorders, which might have contraindicated the
maneuver of tunneling the catheter.
Annetta et al.
Other indications—such as the presence of dialysis
catheter in the right jugular vein and pacemaker in the left
subclavian vein (two patients of our study) and dialysis
fistulas in chronic renal failure patients (two patients)—
has already been described by Zhao et al.14
Severe vasculopathy and no possibility of PICC or CICC
insertion because of repeated previous venous cannulations
and very small veins in a patient with both legs amputated
(mid-thigh in the right leg and below the knee on the left
side: the SFV was obviously cannulated on the left thigh)
was another peculiar indication in our experience.
Liver failure with severe low platelet count (<5000
per microliter) and coagulopathy (INR > 3) in four
patients (5%) with small arm veins (<4 mm) was another
indication to SFV approach. Low platelet count and
severe coagulopathy may be relative contraindications to
cannulation of cervical/thoracic central veins for CICC
insertion.28
Another indication to SFV was respiratory failure in
two septic patients with helmet, both with severe coagu-
lopathy. The presence of the rubber collar of the helmet is
associated with difficult CICC insertion and the underarm
straps tight around the axilla may increase the risk of
thrombosis, in particular after cannulation of arm veins.29
The use of FICC has been advocated in COVID patients
with helmet for non-invasive ventilation,30 but to our
knowledge we are the first to report a SFV approach in
patients with helmet.
As regards the choice of the device, since the caliber of
SFV ranges typically between 5 and 8 mm, it was possible
to use either single lumen 4 Fr or double lumen 5 Fr cath-
eters without increasing the risk of thrombosis; 4 Fr cath-
eters were preferred, and double lumen 5 Fr catheters were
used only if necessary, mostly in hospitalized patients with
multiple simultaneous infusions.
At mid-thigh, the SFV usually lies in a slight medial
position to the artery, and the depth of the vein is approxi-
mately 3–5 cm from the skin: therefore, the easiest
approach is a short axis visualization with out-of-plane
puncture. More distally, in the inferior third of the thigh, at
5–10 cm from the knee, the SFV is usually located below
the artery, and in a deeper position (>5 cm): thus, in this
zone we preferred an oblique axis visualization with in-
plane puncture, and we were forced to use a longer micro-
introducer-dilator (7 cm).
In our retrospective analysis, the incidence of immedi-
ate, early and late complications was very low, and all
complications were mild and not associated with any mor-
bidity and mortality. It is interesting to note that CRBSI
and symptomatic catheter-related thrombosis did not
occur, at least in those patients (n = 71; 72.5%) who used
the device during hospitalization. This might confirm that
the location of the exit site plays an important role in deter-
mining the risk of both infection and thrombosis: in the
hospitalized, bedridden patient the exit site at mid-thigh or
7
in the lower third of the thigh may be associated with less
risk of bacterial contamination and of catheter instability,
if compared to the exit site at the groin or at the neck.
The limitations of our study are the following:
- 
first, this is a small, non-controlled retrospective
study; to assess the safety of the approach to the SFV
and to classify more precisely its clinical indications,
a larger controlled prospective study is warranted;
- being a retrospective study, a complete follow-up of
all catheters was not possible; in particular, those
patients who had a FICC inserted for extra-hospital
treatment at home or in nursing homes (27.5%) were
lost at follow-up;
- last, the maneuver of SFV cannulation was performed
by a small group of highly trained professionals with
extensive experience in the field of ultrasound guided
venous cannulation; we cannot predict at which
extent this technique may become popular, and we
cannot currently define the training needed to achieve
consistently good clinical results.
In conclusion, our experience suggests that the approach
to the superficial femoral vein may open new perspectives
in the area of femorally inserted central catheters (FICC):
it is a completely safe technique, which is not associated
with any potential risk of severe insertion-related compli-
cation (in this, it is similar to PICC insertion).
If compared to non-tunneled FICCs inserted in the
CFV, FICCs inserted in the SFV have the great advantage
of a better exit site; also, contrary to tunneled FICCs, they
can be inserted also in patients with low platelet count or
coagulation disorders, without any risk of relevant local
complications.
Declaration of conflicting interests
The author(s) declared no potential conflicts of interest with
respect to the research, authorship, and/or publication of this
article.
Funding
The author(s) received no financial support for the research,
authorship, and/or publication of this article.
ORCID iD
Mauro Pittiruti https://orcid.org/0000-0002-2225-7654
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