I recently learned that, in the adult ICU in our hospital, if the patient has a CVL placed in the femoral site, it has to be changed within 24 hours. This is due to the increased rate of infection of the femoral site. Our PICU has an excellent infection rate, and it's never been our policy to put in a new CVL if their current femoral line was inserted using proper technique. I can't quite understand the rational of even placing a femoral line in the first place, much less exposing the patient to another chance of infection (not to mention the sedation and discomfort) of another central line insertion, just because of the site of their line.
I'll mention that femoral lines are often our last resort for CVL insertions. If we have to place a femoral, it's usually because there isn't a better option. We even choose IJ's over the femoral site. Some of our kiddos have horrible venous access- even centrally.
Our hospital is surveying central line documentation in an effort to reduce infection rates. (Like I said, the PICU hasn't had a CLABSI in over two years.) The surveyor, a nurse from infection disease, was adamant that the CDC guidelines stated that femoral lines had to be changed to another site within 24 hours. (She also wanted us to use bio-patches, like the adult's do, which also isn't in our policy- but that's another story.) The particular patient who had a femoral line was one of our sickest, most chronic kids. It had taken hours to get that line in the first place- and he had coded during the attempts. There was no way any of our intensivists would have agreed to attempt another line placement.
So, my real question- do you change the site of your femoral line CVLs within 24 hours?