We have a patient with a femoral TLC (exit site about an inch from the crease between the leg and lower body.) Unable to obtain other sites for a central line. The patient is edematous on the lower body and thus there is constant oozing of fluid from poke sites around the exit site of the catheter. Skin breakdown is occuring in the crease between the leg and lower body, constantly doing dressing changes. Any suggestions?
First, I would want to know why no one can insert a CVC in a more appropriate location. What sites have been tried, and by which professionals? I would want to exhaust all attempts at placing a PICC, or subclavian or jugular site. The main reason is that femoral sites are dangerous and this one sounds like it should be removed ASAP. This patient may be on the way, if not already there, to a massive bloodstream infection from this catheter. All standards, recommendations, and guidelines from all organizations (SHEA, IDSA, etc) recommend always avoiding the femoral due to their great risk for infection. So it is clear to me from the limited information that this one should be removed. If all other sites have been exhausted, then I would work with an interventional radiologist to insert a CVC into an unconventional site such as translumbar vein. IR may be your best choice for any attempt due to their use of fluoroscopy. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861