Femoral catheters increase risk of infection in total parenteral nutrition patients

Central venous access for the administration of total parenteral nutrition is usually achieved via the subclavian or internal jugular veins. Although a high incidence of complications has been reported with the use of femoral catheters for central venous access, this route has been used when traditional central venous access is contraindicated. We retrospectively reviewed 171 patients who received total parenteral nutrition via a central venous triple-lumen catheter and compared the rates of infections in femoral vs nonfemoral access. A literature review was performed to identify associated complications of and appropriate indications for femoral catheter use. In the 171 patients studied, 355 triple-lumen catheters were placed; these included 331 nonfemoral catheters and 24 femoral catheters. Femoral catheters were placed in nine patients. Femoral catheters had a greater incidence of positive tips (42% vs 6.9%, p < .001) and related bacteremia (16.7% vs 1.8%, p = .002) than did nonfemoral catheters. The organisms most commonly isolated from the blood and catheter tips of both catheter access sites were methicillin-resistant Staphylococcus epidermidis and Candida. The use of femoral catheters for central venous access for total parenteral nutrition administration results in an increased risk of infectious complications.