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Central lines....the bottom line

In article published recently in critical care medicine Paul Marik, Mark Flemmer, and Wendy Harrison argued against the IDSA and CDC recommendation against the femoral line placement and they mentioned that there are no RCTs that support the CDC and IDSA claim of femoral line higher risk of infection..and below are the bottom lines...
  • The chosen site should depend on the expertise and skill of the operator and the risks associated with placement.
  • In emergencies or in high-risk patients (like a demented, agitated patient) femoral placement may be best.
  • All catheters that are placed under non-sterile or emergency circumstances should be removed and resited within 2 days.
  • Ultrasound should be used for catheters placed in the internal jugular and femoral site to reduce the risk of complications from placement.
  • Avoid the subclavian site in patients with advanced renal failure to preserve the arm veins and subclavian vein for future fistula placement. Avoid the femoral veins in renal transplant patients.
  • One unequivocal downside of the femoral site is its interference with early mobilization, particularly in the case of patients with dialysis catheters.
  • There may be a higher risk of CRBI with femoral placement in massively obese patients and IJ or subclavian should be used instead, if possible.

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