In particular cases, a FICC can be inserted, by ultrasound-guided puncture and cannulation of the femoral vein.
A FICC is a secondary option compared to the CICC, since in most newborns the femoral venipuncture is more difficult than puncture of the brachio-cephalic vein (especially because of the caliber of the two veins: the femoral vein is always much smaller). If the caliber of the femoral vein is 3 mm or more, a 3Fr power injectable polyurethane catheters can be inserted. In smaller veins (2mm) it is possible to use 2Fr catheters, although currently this caliber is only available for limited lengths (6 cm)..
Insertion must be performed according to the SICA-Ped protocol developed by GAVeCeLT: ultrasound evaluation of the central veins (RaCeVA); maximum barrier precautions; skin antisepsis with chlorhexidine 2% in alcohol; ultrasound-guided venipuncture; tip navigation using ultrasound; tip location using intracavitary ECG technique and/or echocardiography; sutureless securement; coverage of the emergency site with cyanoacrylate glue and transparent semi-permeable dressing with high transpirability. It is possible (and desirable) to tunnel the catheter downwards to the mid-thigh, so as to obtain an exit site far from the inguinal fold.
It is important to distinguish between two types of FICC:
- those with the tip in the inferior vena cava (as verified by ultrasound), usable for infusions of any type and for blood sampling;
- those with the tip in the right atrium tip (as verified with intracavitary ECG or echocardiography), which can be used not only for infusion and sampling, but also for hemodynamic monitoring.
For best tunneling, we recommend the off-label use of central catheters marketed as PICC (3Fr single lumen or 4Fr bi-lumen): these catheters are in power injectable polyurethane, high flow, and they are inserted by modified Seldinger technique (which makes the tunneling easier).