title: Femoral tunneled central venous catheters for terminally ill patients with cancer.
abstract: BACKGROUND
  Oral administration of medication is often difficult in terminally ill patients with cancer. These patients require intravenous routes for high-dose opioid administration and/or parenteral nutrition. When the superior vena cava (SVC) is unsuitable for central vein catheter insertion (i.e., in patients with mediastinal masses involving the SVC), alternative access routes are needed. Of these, the femoral vein is most utilized. In our experience, the femoral tunneled catheter (FTC) is easy and safe to use. We retrospectively studied FTC outcomes in terminally ill patients with cancer.
  
  
  METHODS
  Charts of consecutive patients admitted to the palliative care unit between April 2008 and December 2011 were reviewed. FTC is inserted into the vein by the single-puncture method using a 16-gauge catheter with a 14-gauge peel-away introducer.
  
  
  RESULTS
  Eleven patients underwent FTC insertion. In total, there were 207 days of FTC placement; the mean period in place was 19±15 days. Eight patients received parenteral opioid therapy, high doses in four cases, via FTCs. Complications were incidental arterial puncture and poor infusion rate due to hip joint bending in one case each. Neither catheter-related infection nor clinical venous thrombosis occurred.
  
  
  CONCLUSIONS
  FTCs were successfully inserted, with a low complication rate. FTC, a simple technique, might be an acceptable alternative in selected terminally ill patients with cancer, when SVC insertion is difficult or contraindicated.
authors.affiliation: Department of Palliative Care, Saitama Cancer Center, Ina-machi, Kitaadachigun, Saitama, Japan. machon0112@yahoo.co.jp
authors.forename: Naoki
authors.initials: N
authors.lastname: Matsuo
authors.forename: Kyoko
authors.initials: K
authors.lastname: Nakanishi
authors.forename: Hisashi
authors.initials: H
authors.lastname: Kurosawa
authors.forename: Mayumi
authors.initials: M
authors.lastname: Karino
authors.forename: Kinomi
authors.initials: K
authors.lastname: Yomiya
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Fujii
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000008:administration & dosage; D002173:Cancer Care Facilities; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005268:Femoral Vein; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000473:pathology / Q000628:therapy*; D059408:Pain Management / Q000379:methods; D010166:Palliative Care / Q000379:methods*; D010288:Parenteral Nutrition / Q000379:methods; D012189:Retrospective Studies; D019452:Terminally Ill
chemical_list: D000701:Analgesics, Opioid