Lumbar vein malposition of femorally inserted central venous catheters: Report of three cases and review of the literature

The placement of central venous catheters by ultrasound-guided venipuncture of the superficial or common femoral vein has become an increasingly adopted technique in recent years, particularly in patients for whom upper-body venous access is difficult or contraindicated. Ultrasound-based tip location using transhepatic or subcostal views provides an accurate and intra-procedural assessment of the catheter inside the inferior vena cava, reducing the risk of primary malpositions of the tip. Malposition of a femorally inserted catheter into the ascending lumbar vein represents a rare but serious complication potentially associated with pain at infusion, vascular injury, retroperitoneal hemorrhage, and neurological complications. This paper reports a narrative review of this rare complication and the discussion of three clinical cases of femoral catheters inadvertently inserted into the ascending lumbar veins. This clinical experience suggests that ultrasound-based tip location should be implemented during femoral catheter insertion, since it is a rapid, easy, and safe method for ruling out this malposition.