Femoral venous catheterization is a popular form of vascular access in the ED, as these lines are usually easier to place than subclavian or internal jugular catheters and obviously carry no risk of pneumothorax. The findings of Mian and colleagues in this study, however, make it clear that femoral catheters carry their own serious risks that need to be weighed against their convenience.
Adult patients receiving triple-lumen femoral vein catheters over a 15-month period were enrolled in this study. Patients were eligible regardless of the indication for femoral line placement, although patients admitted for trauma were excluded. Within seven days following catheter removal, all study patients had venous duplex imaging performed on both the catheterized extremity as well as the contralateral leg, which served as the control.
Forty-two patients were analyzed. No control sites demonstrated femoral deep venous thrombus (DVT) formation, while 11 (26%) of the catheterized sites were positive for femoral DVT. The presence of DVT was not associated with the usual risk factors or the use of DVT prophylaxis. Mian and colleagues conclude that there is a high incidence of DVT associated with femoral venous catheter use. (Mian NZ, et al. Incidence of deep venous thrombosis associated with femoral venous catheterization. Acad Emerg Med 1997;4:1118-1121.)
COMMENT BY DAVID KARRAS, MD, FACEP
This study is valuable in drawing our attention to the fact that seemingly benign procedures performed routinely in the ED may have serious consequences long after the patient is out of our care. DVT formation may, of course, be an acceptable risk of femoral vein catheterization when no alternatives exist or when the procedure is life-saving, but we need to be aware that we are creating an additional risk of pulmonary embolism and consider (and document) any alternative carefully.
This study has very important limitations, most of which are addressed by Mian et al. It is not reported whether any of these DVTs were clinically apparent; indeed, no attempt was made to study clinical outcomes. The extent of the thrombi is not disclosed, and the rate of pulmonary embolism is not reported. The contralateral leg may not be an appropriate control. Interestingly, the rate of upper extremity DVT associated with subclavian catheters has been reported to be even higher than that revealed by this study.1
Reference
1. Horattas MC, et al. Changing concepts of DVT of the upper extremity. Surgery 1988;104:561-567.
According to the paper by Mian et al, femoral venous catheterization is:
a. associated with an increased rate of DVT formation.
b. associated with an increased rate of pulmonary embolism.
c. more likely to cause pseudoaneurysm in females than males.
d. likely to cause DVT only in patients with other risk factors for DVT.
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