Every critical care physician scoffs at the idea of placing a femoral central line, but are they correct? Do femoral central lines actually cause more infections than other sites?

We take this to be set in stone, when in fact, it is very likely not to be. Reviewing the data over the past 15 years shows only 1 study that supports this, and it is from 2001 – during the time before checklists, critical care bundles and ultrasounds. The other study supported this “dirty femoral line” claim by showing that when you take a central line catheter tip from the fem site vs subclavian, the line is more often than not colonized with some form of bacteria. However, when reviewing patient outcomes, there was no difference in clinically significant infection-rates.

The next time to reach for that TLC kit, consider using the dirty femoral site. What actually seems to matter most is teaching people good TLC care, proper placement, critical care bundles, and hand hygiene.


Hamilton HC, Foxcroft DR. Central venous access sites for the prevention of venous thrombosis, stenosis and infection in patients requiring long-term intravenous therapy. Cochrane Database Syst Rev. 2007 Jul 18;(3):CD004084

Merrer J et al. Complications of femoral and subclavian venous catheterizaiton in critically ill patients: a randomized controlled trial. JAMA. 2001 Aug 8;286(6):700-7

Rosenthal VD. Central line-assocaited bloodstream infections in limited-resource countries: a review of the literature. Clin Infect Dis. 2009 Dec 15;49(12):1899-907. doi: 10.1086/648439.
Shuman EK, Washer LL, Arndt JL et al. Analysis of central line-associated bloodstream infections in the intensive care unit after implementation of central line bundles. Infect Control Hosp Epidemiol. 2010 May; 31(5):551-3

Subclavian vs. Femoral Central Line Placement