The insertion of a catheter via ultrasound-guided cannulation of the common or superificial femoral vein (FICC) is an appropriate alternative option, if other central VADs (PICC and CICC) are controindicated.
If the device is to be used as a medium-term central venous access, the FICC must be tunneled. Tunneling as an appropriate and powerful tool for reducing the risk of infection, since (a) it avoids the exit site at the groin (which is an area heavily contaminated by bacteria) and (b) creates a protection from extraluminal bacterial contamination, by putting a distance between the exit site and the site where the catheter enters the vein. It is possible to tunnel FICCs either towards the abdoment (exit site in the iliac fussa or at the flank) or downward (exit site in the lower part of the thigh, close to the knee). The latter technique is particularly appropriate in the chronically bedridden patient.