Femoral lines for red cell exchange

A femoral line is a flexible tube that is put into a large vein in your groin. It is used for giving fluids or medicine into your bloodstream, or for red cell exchange. A femoral line used for red cell exchange has two ‘lumens’ or ports – one for withdrawing blood and the other one for returning blood.

A femoral line is only suitable for short-term use. Specialist nurses from the apheresis team will carry out your red cell exchange. When the treatment is finished, the line will be removed.

A femoral line is useful for a red cell exchange if the veins in your arms are difficult to access.

If you are not sure why you are being offered a femoral line, please speak to one of the apheresis or central venous access nurses.

We are a team of nurses who specialise in intravenous lines (lines situated within a vein), including femoral lines. We will put in your femoral line and provide expert advice before and after the line insertion. Please feel free to ring us on 020 3447 7491 if you have any questions.

One alternative is to use the veins in both of your arms. Another alternative is a Vortex® port, which is a more long-term device used for red cell exchanges.

Your doctor or nurse may have suggested a femoral line for you but if you would like more information about Vortex® ports, please talk to the team looking after you or one of the central venous access nurses.

The apheresis team will arrange for you to have any blood tests you may need before the femoral line is inserted.

On the day of your appointment please wear elasticated underwear, such as briefs rather than boxer shorts. If possible, try to drink plenty of fluids before you come for your appointment. This makes your veins easier to access.

If you take tablets or injections to thin your blood, these may need to be stopped for a short time. This is to prevent any bleeding during the femoral line insertion. If you are an outpatient, you should discuss this with the doctor who prescribes your blood-thinning medicine. One of the central venous access or apheresis nurses will also talk through the plan with you.

If you have ever had an infection called MRSA, please let your doctor or nurse know. You may need to have a nose swab to see if the infection is still present before your femoral line can be put in.

We want to involve you in all the decisions about your care and treatment. The team looking after you will answer any questions you may have so please ask if anything is unclear. If you decide to go ahead, we will ask you to sign a consent form. This confirms that you agree to have the procedure and understand what it involves.

One of the central venous access nurses will usually insert your line. To reduce the risk of infection, the nurse will wear a surgical gown with a hat and mask.

We will ask you to put on a hospital gown and remove your trousers or skirt. You won’t need to take off your underwear.

The nurse will find a vein in your groin using ultrasound and inject local anaesthetic into the skin to numb it. This will cause some temporary discomfort which will wear off within a few seconds. Once the skin is numb the line insertion is usually pain-free, although you may feel a pushing sensation at times.

The nurse will put a dressing over the insertion site to hold the line securely in place. No stitches are needed.

It usually takes about 20 minutes to put the line in.

Your femoral line can be used straight away.

An apheresis or a ward nurse will usually remove the femoral line as soon as your red cell exchange is finished.

You may briefly experience some discomfort when the line is removed. After a dressing is applied, you should press on the site for five to 10 minutes, or until any bleeding has stopped. The nurse will then ask you to stay lying down for 10 minutes.

If you are an outpatient you will be asked to walk around for a few minutes before you leave. This is to check for any bleeding. You can remove the dressing after 24 hours.

Risks during insertion

Most femoral line insertions go smoothly. There is a very small risk of puncturing a blood vessel in the abdomen or air entering your bloodstream. These complications can be serious but we take every precaution to prevent them and they are very unlikely to happen.

There is also a small risk of puncturing an artery in your groin which could cause bruising.

Bleeding

After the line is removed there could be some bleeding from the groin. We can usually prevent this by pressing on the site and by checking for bleeding before you leave.

However, on rare occasions bleeding can start again some time later. As the femoral vein is large, there may seem to be a lot of blood. If this happens, please press on the site until the bleeding stops and lie down if possible. If you are an inpatient, call for assistance. If you are an outpatient, please return to the Apheresis Unit as soon as you are sure the bleeding has stopped to have your dressing changed.

Infection

Femoral lines used for red cell exchanges usually only stay in for a few hours. This means that they are very unlikely to become infected.

If you notice any of the symptoms listed below, either while the line is in or after it has been removed, tell your doctor or nurse straight away:

• a high temperature (over 38°C)
• feeling shivery
• pain, redness or swelling around the insertion site.

If you have an infection, you will need to take a course of antibiotics.

Blood clot

Although rare, it is possible for a blood clot (thrombosis) to form in the vein used for the line. If you notice swelling or pain in the leg or foot, either while the line is in or after it has been removed, let us know straight away. If you have a clot, you will need medication to dissolve it.

There is also a small risk of a blood clot on the lungs. This is very rare. If you experience chest pain or sudden shortness of breath, either while the line is in or in the days after it has been removed, go to your local Emergency Department (A&E) or call an ambulance.

Malfunction

In a very small number of patients a femoral line may fail to function properly. If this happens, the line will need to be removed and replaced.

Blockage

Femoral lines can sometimes become blocked. We can usually unblock them by using a special flushing solution.

Scarring

After the line has been removed you will probably have a small scar in your groin (less than half a centimetre long).

If you have repeated femoral lines, you can also develop scar tissue under the skin. This is not visible and will not affect your life but it can make it difficult to use the vein for future femoral lines. If you have regular red cell exchanges, you may be offered a more long-term line called a Vortex® port to avoid having to use the femoral veins.

You should discuss your options with your doctor or nurse, or contact the central venous access team on 020 3447 7491 if you have any concerns.

It’s important that you contact us if you notice any of the following:

• a high temperature (over 38°C)
• feeling shivery
• any pain or swelling.

Central venous access team (Monday to Friday, 9am to 5pm)

Telephone: 020 3447 7491

Haemoglobinopathy clinical nurse specialist (Monday to Friday, 9am to 5pm)

Telephone: 020 3447 9456

Apheresis team (Monday to Friday, 9am to 5pm)

Telephone: 020 3447 1803

Supportive Care Unit (Monday to Friday, 8am to 8pm)

Telephone: 020 3447 1808

Out of hours

Telephone: 07852 220 900