The safety of cuffed, tunneled central venous catheters across access sites in pediatric patients: a single institution’s experience

• Patients undergoing ctCVC placement in the internal jugular vein were 29.5 times more likely to receive general anesthesia and fluoroscopic guidance compared to femoral access (OR = 29.5, p < 0.001). • Despite being less likely to undergo general anesthesia, the femoral group showed no statistically significant differences in immediate complications compared to IJ or subclavian groups. • Propensity-matched femoral placements had significantly lower CLABSI rates (0% vs. 20.59%; p=0.0156) compared to IJ or subclavian placements. Few studies exist comparing immediate and late complication rates between internal jugular (IJ), subclavian, and femoral vein placement of cuffed, tunneled central venous catheters (ctCVCs). Our recent systematic review showed that IJ placement is performed 96.9% of the time, however, at our institution, femoral placement is performed at a higher rate. The purpose of this study is to investigate the safety and efficacy of femoral placement of ctCVCs in pediatric patients. We hypothesized that femoral access would demonstrate fewer immediate complications related to insertion without increased rates of late complications. A retrospective review of 202 pediatric patients with ctCVCs placed at our institution between 2019 and 2024 was performed. Variables included patient demographics, location of line, type of line, size of lumen, number of lumens, line duration, and anesthesia type. Primary outcomes included immediate complications, central line associated bloodstream infection (CLABSI), and late mechanical complications. Immediate, CLABSI, and mechanical complication rates were 2.5%, 10.9%, and 18.8%, respectively. Patients undergoing ctCVC placement in the IJ vein were 29.5 times more likely to receive general anesthesia and fluoroscopic guidance compared to femoral access (OR = 29.5, p < 0.001) with no significant difference in immediate complications. Propensity-matched femoral placements had significantly lower CLABSI rates (0% vs. 20.59%; p=0.0156) compared to IJ and subclavian. Our findings suggest that femoral placement of ctCVCs may be a safe and effective alternative to IJ and subclavian placements, with a decreased risk of CLABSI as well as a decreased need for general anesthesia and fluoroscopic guidance, particularly for younger or lower weight pediatric patients.