title: Femoral Vein Cannulation in the Treatment of Osteomyelitis.
abstract: OBJECTIVE
  The main objective was to investigate the feasibil- ity of using the femoral vein for long-term venous access. This was accomplished in the course of treating osteomyelitis patients, using a combination of long-term (6 weeks), outpatient, intravenous (IV) an- tibiotics administered through a femoral central line. This was com- bined subsequently with the use of hyperbaric oxygen (HBO) therapy. Using the femoral vein for central venous access means there is no risk of creating an iatrogenic pneumothorax, which would prohibit the subsequent use of HBO therapy. In addition, the propitious nature of the groin skin flora, Propionibacteriaceae, seems less inclined to par- ticipate in biofilm production, the root cause of central line infections.
  
  
  METHODS
  The femoral central lines were all inserted in the operating room (OR) and handled like a regular outpatient surgery with a me- ticulous skin prep completed by experienced OR nurses. Experienced technicians assisted with the surgery. After insertion, the lines were then specially secured to prevent sliding. Vancomycin was adminis- tered preoperatively.
  
  
  RESULTS
  Surprisingly, femoral lines placed in this way remained free of infection for up to 70 days. Eight patients with Wagner stage 2 ulcers and underlying osteomyelitis were treated with a course of 6 weeks of vancomycin, followed by HBO therapy. A cure rate of 75% was achieved.
  
  
  CONCLUSIONS
  Femoral vein cannulation for antibi- otic administration is safe and effective in treating patients with osteo- myelitis. The lines should be placed in the OR with the help of skilled personnel. Femoral cannulation avoids the risk of pneumothorax, and the lines can be used for up to 70 days. By avoiding pneumothorax, the patients remain candidates for HBO therapy.
authors.affiliation: Sandhills Center for Wound Healing and Hyperbaric Medicine.
authors.forename: Alan
authors.initials: A
authors.lastname: Coulson
authors.affiliation: Sandhills Center for Wound Healing and Hyperbaric Medicine.
authors.forename: Angela
authors.initials: A
authors.lastname: Peek
authors.affiliation: Health Information Department, Sandhills Regional Medical Center, Hamlet, NC.
authors.forename: Dianne
authors.initials: D
authors.lastname: Haugen
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002404:Catheterization / Q000379:methods*; D062905:Central Venous Catheters; D003131:Combined Modality Therapy; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D005240:Feasibility Studies; D005260:Female; D005268:Femoral Vein; D006801:Humans; D006931:Hyperbaric Oxygenation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000628:therapy*; D011030:Pneumothorax / Q000517:prevention & control; D014640:Vancomycin / Q000008:administration & dosage*
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin