Previous posts have discussed various iterations of the cathedia study, a study comparing femoral and jugular placement of dialysis catheters in patients in the ICU. As mentioned before, the femoral route was not associated with a higher rate of infection than the jugular route, except in patients with a BMI>28.5, and catheter dysfunction rates were lower in the femoral and R jugular sites compared to the L jugular. The same group has published another follow-up paper, this time in CJASN, analyzing patients who crossed over from a jugular to a femoral line or vice versa. 134 patients were included in total and again, using the patients as their own controls, there was no increased incidence of infections and no change in catheter dysfunction in the femoral group compared to the jugular. One major limitation of this study was that they did not use ultrasound to insert the lines which must be standard practice in most institutions these days. It should also be said that all three of these papers are from the same database, which adds a significant bias, and it has not yet been replicated. Still, for a fellow planning on inserting a line late at night and wondering what the best practice is, it provides further evidence that the femoral route is safe in most cases and that at least you are not doing any harm by utilizing this route for access.