Survival of tunneled femoral dialysis catheters: a single center retrospective study

For millions of people around the world, kidneys that no longer function means a life dependent on a machine to clean their blood. This process, known as hemodialysis, requires a reliable gateway into the body's circulatory system, a place where a needle can be inserted repeatedly to draw blood out, filter it, and return it. The gold standard for this gateway is a connection created between an artery and a vein, usually in the arm, which strengthens over time to handle the high flow of blood. However, not every patient can have this connection made. Sometimes the veins are too damaged, the anatomy is unfavorable, or the patient arrives at the hospital too late for the connection to mature before treatment must begin. In these difficult situations, doctors must use a tube, called a catheter, to access the deep veins of the body. While the preferred route is through the neck, some patients have exhausted all options in their upper body. For them, the only remaining path is through the groin, using a special tube that is tunneled under the skin to reach the large femoral vein.

For years, medical guidelines have treated these groin catheters as a last resort, often assuming they would fail quickly or cause serious infections. The prevailing belief was that they were a temporary bridge at best, destined to be removed soon after insertion. But in a large medical center in Cluj-Napoca, Romania, a team of researchers decided to look closer at the real-world performance of these devices. They wanted to know if the old assumptions held true when doctors used them carefully in patients who had no other choice. By reviewing the records of every such catheter placed over a seven-year period, they sought to uncover the actual lifespan of these life-saving tubes and the specific reasons they might stop working.

The researchers examined the records of 126 catheters inserted into 74 different patients between 2018 and 2025. Because some patients required more than one tube over time, and because a few patients could not be tracked after leaving the hospital, the final analysis focused on 116 catheters from 65 patients. The team followed each tube from the moment it was placed until it was removed or the patient passed away. They looked for two main reasons a tube might fail: a blockage or mechanical issue that stopped the blood from flowing, or an infection that made the tube unsafe to keep in place. They also tracked whether the tube was removed because the patient needed a different kind of access, or simply because the patient no longer needed dialysis.

The results challenged the idea that these catheters are destined for early failure. The study found that the typical tube lasted for 459 days, which is more than a year and a quarter of continuous use. When the researchers calculated the survival rate over time, they saw that nearly 95 percent of the tubes were still working after the first month. Even after a full year, more than half of the catheters remained functional. This durability suggests that for patients with no other options, a tunneled femoral catheter can provide a stable, long-term solution rather than just a short-term fix. The researchers also looked to see if factors like the patient's age, their gender, or the specific size and shape of the tube made a difference. They found no evidence that any of these variables influenced how long the catheter lasted. Whether the tube was placed on the left or right side, or whether it was a standard length or a custom size, the outcome remained the same.

When the catheters did fail, the reasons were clear. The most common cause was dysfunction, where the tube simply stopped working properly due to clots or other mechanical issues, accounting for nearly 38 percent of the removals. Infections were the second most common cause, leading to removal or death in about 10 percent of cases. The rate of serious infections was relatively low, occurring in roughly 0.34 instances for every 1,000 days a catheter was in use. The team noted that while they could not track every minor infection that was treated with antibiotics without removing the tube, the data they did have showed that serious complications were manageable. They also observed that the order in which a patient received a catheter did not significantly change the outcome; a second or third tube lasted just as long as the first one.

This study does not claim that groin catheters are better than the preferred arm connections, nor does it suggest they should be used when other options exist. Instead, it provides a clearer picture of what happens when those other options are gone. The data indicates that with careful management, these devices can serve patients for a significant amount of time, offering a viable path forward when the veins in the arms are no longer usable. While the study was limited by its retrospective nature, meaning the researchers looked back at existing records rather than controlling the treatment in real time, the findings offer a measure of hope for a difficult group of patients. It suggests that the fear of immediate failure may be overstated, and that with the right care, a tunneled femoral catheter can be a durable part of a patient's life for years.