Long-term FICCs can be inserted by ultrasound-guided puncture and cannulation of the common or the superficial femoral vein; they should be tunneled towards the knee (in the bedridden patients) or towards the abdomen (in walking patients)
A tunneled FICC secured to the skin with a subcutaneously anchored system (SAS) can be considered as long-term central VAD. In most cases, the SAS will remain in place for many months, until the catheter is removed.
The catheter should be power injectable, in latest generation polyurethane, open-ended, non-valved. Catheters of this type are associated with minimal risk of malfunction and mechanical complications. For this purpose, we recommend the off-label use of catheters marketed as PICCs, which have the advantage of considerable length (50 cm and more) and insertion with modified Seldinger technique (which simplifies the tunneling maneuver).