So, what about the risk of poor function associated with femoral catheters? In order to determine whether catheter site had any influence over dialysis performance, a paper was recently published in which the authors performed a secondary analysis of the data in the Cathedia trial. The primary endpoints were catheter dysfunction – defined as an inability to achieve adequate blood flow requiring catheter replacement, dialysis sessions delivered, URR and CRRT downtime. Overall, catheter dysfunction occurred in 10.3% of the femoral group and 11.1% of the jugular group. Comparing LIJ to RIJ, the risk of dysfunction was 6.6% on the right as opposed to 19.5% on the left, significantly higher then in the femoral group. There was no difference in URR, number of sessions or CRRT downtime between the two groups. The authors suggested that when choosing a site for vascular access, you should think – RIJ → Femoral → LIJ.
Nate in his previous post came to the conclusion that the original study would not necessarily change his practice although it made it easier to justify the use of femoral lines. This new paper seems like one more piece of evidence that might make me change mine