“FIDLINE”: a femorally inserted peripheral venous catheter.

A last resort catheter: our experience.

 

Introduction

Venous access device (VAD) placement is essential for inpatient care but may be challenging when upper extremity veins are unavailable. Although femorally inserted central catheters are frequently used, a central device is not always required. Femorally inserted Midline catheters with a peripheral tip represent a feasible alternative in selected patients (1,2). Given the absence of standardized nomenclature (3), the term Fidline was introduced as a fusion of “femorally inserted peripheral catheter” and “Midline”.

This retrospective study evaluates indications, feasibility, and complications associated with this device.

Methods

A retrospective case series was conducted using the institutional database to identify all Fidline catheters (FCs) inserted over a 12-month period.

A total of 30 FCs in 30 patients were included. Clinical records were reviewed to collect data on catheter-related thrombosis (CRT) and Catheter-Associated Bloodstream Infection (CABSI). All FCs (Midline, 25 cm length, four FR single lumen) were implanted in the superficial femoral vein at mid-thigh according to the SIF protocol (4).

 

Results

Thirty patients were included (median age 84 years; IQR 70–88.5), with a female predominance (67%). Most patients were admitted to medical wards (73%). The right femoral side was used in 63% of cases, and 50% had a previously placed VAD. Median catheter dwell time was 8 days (IQR 2–11.8), with a median of 6.5 days from admission to catheter placement.

During 257 catheter-days, one symptomatic CRT occurred (3.9/1000 catheter-days), with no CABSI observed. Most patients received low-molecular-weight heparin (80%); 20% were on direct oral anticoagulants. Cognitive impairment was common (67%), with frequent respiratory comorbidities (47%) and oncologic disease (20%). Overall, 53% of patients were discharged to palliative care or died during hospitalization.

 

Conclusions

FC represents a safe and viable VAD, particularly when upper limb veins are unavailable, central access is clearly unnecessary, and the patient has a low life expectancy.

 

Bibliography

 

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(2)  Ostroff M, Aberger K, Moureau N. Case report: End of life care via a mid-thigh femoral midline catheter. J Vasc Access. 2023 Jul;24(4):809-812. doi: 10.1177/11297298211043410. Epub 2021 Aug 31. PMID: 34463188.

(3)  van Rens MR, van der Lee R, Spencer TR, van Boxtel T, Barone G, Crocoli A, Pinelli F, Pittiruti M; WoCoVA Foundation (World Conference on Vascular Access) and of the Global Vascular Access Network (GloVANet). The NAVIGATE project: A GloVANet-WoCoVA position statement on the nomenclature for vascular access devices. J Vasc Access. 2025 Sep;26(5):1439-1446. doi: 10.1177/11297298241291248. Epub 2024 Oct 24. PMID: 39446461.

(4)  Brescia F, Pittiruti M, Dawson RB, et al. The SIF protocol: A seven-step strategy to minimize complications potentially related to the insertion of femorally inserted central catheters. J Vasc Access. 2023;24(4) doi:10.1177/11297298211041442