Central Venous Access Device and Site Selection

Variant: 1 Device selection: Acutely ill patient requiring infusion of an irritant medication, hemodynamic monitoring, and frequent blood draws for 2 weeks or shorter.

Procedure	Appropriateness Category
Nontunneled central venous catheter	Usually Appropriate
PICC	Usually Appropriate
Midline catheter	May Be Appropriate
Tunneled central venous catheter	May Be Appropriate
Arm port	Usually Not Appropriate
Chest port	Usually Not Appropriate

Variant: 2 Device selection: Patient with acute renal failure requiring central venous access for renal replacement therapy, anticipated duration of therapy for 2 weeks or shorter.

Procedure	Appropriateness Category
Nontunneled dialysis catheter	Usually Appropriate
Tunneled dialysis catheter	Usually Appropriate
Arm port	Usually Not Appropriate
Chest port	Usually Not Appropriate
PICC	Usually Not Appropriate

Variant: 3 Device selection: Patient with renal failure requiring central venous access for renal replacement therapy, anticipated duration of therapy for more than 2 weeks.

Procedure	Appropriateness Category
Tunneled dialysis catheter	Usually Appropriate
Nontunneled dialysis catheter	May Be Appropriate
Arm port	Usually Not Appropriate
Chest port	Usually Not Appropriate
PICC	Usually Not Appropriate

Variant: 4 Device selection: Patient with cancer diagnosis requiring central venous access for weekly chemotherapy infusion for more than 2 weeks.

Procedure	Appropriateness Category
Chest port	Usually Appropriate
Arm port	Usually Appropriate
PICC	May Be Appropriate
Tunneled central venous catheter	May Be Appropriate
Nontunneled central venous catheter	Usually Not Appropriate

Variant: 5 Device selection: Patient requiring continuous or very frequent intravenous administration of intravenous medications (excluding total parenteral nutrition) for more than 2 weeks.

Procedure	Appropriateness Category
PICC	Usually Appropriate
Tunneled central venous catheter	Usually Appropriate
Chest port	May Be Appropriate
Arm port	May Be Appropriate
Nontunneled central venous catheter	Usually Not Appropriate

Variant: 6 Device selection: Patient requiring long-term total parenteral nutrition and another indication for central access.

Procedure	Appropriateness Category
Tunneled central venous catheter double lumen	Usually Appropriate
Double lumen PICC	Usually Appropriate
Single lumen PICC	May Be Appropriate
Tunneled central venous catheter single lumen	May Be Appropriate
Chest port	May Be Appropriate
Arm port	Usually Not Appropriate

Variant: 7 Device selection: Patient with chronic kidney disease requiring central venous catheter IV infusions for more than 2 weeks.

Procedure	Appropriateness Category
Tunneled central venous catheter single lumen	Usually Appropriate
Tunneled central venous catheter double lumen	Usually Appropriate
Chest port via internal jugular vein	May Be Appropriate
Chest port via subclavian vein	Usually Not Appropriate
Arm port	Usually Not Appropriate
PICC	Usually Not Appropriate

Variant: 8 Site selection: Patient with acute illness requiring central venous catheter for anticipated therapy for 2 weeks or shorter.

Procedure	Appropriateness Category
Right or left internal jugular vein	Usually Appropriate
Right or left subclavian vein	Usually Appropriate
Upper extremity vein	Usually Appropriate
Right or left external jugular vein	May Be Appropriate
Right or left femoral vein	May Be Appropriate
Hepatic vein	Usually Not Appropriate
Inferior vena cava	Usually Not Appropriate

Variant: 9 Site selection: Patient with chronic kidney disease or end-stage renal disease requiring central venous catheter.

Procedure	Appropriateness Category
Right or left internal jugular vein	Usually Appropriate
Right or left external jugular vein	May Be Appropriate
Right or left femoral vein	May Be Appropriate
Inferior vena cava	May Be Appropriate
Right or left subclavian vein	May Be Appropriate
Hepatic vein	Usually Not Appropriate
Upper extremity vein	Usually Not Appropriate

Panel Members

Sharon W. Kwan, MD, MS^a; Alan Massouh, MD^b; Nicholas Fidelman, MD^c; Mikhail C.S.S. Higgins, MD, MPH^d; Hani Abujudeh, MD, MBA^e; Resmi Charalel, ^f; Marcelo S. Guimaraes, MD^g; Amit Gupta, MD^h; Alexander Lam, MDⁱ; Bill S. Majdalany, MD^j; Parag J. Patel, MD^k; Kevin S. Stadtlander, MD^l; Terri Stillwell, MD, MPH^m; Elrond Y. L. Teo, MDⁿ; Ricky T. Tong, MD, PhD^o; Baljendra S. Kapoor, MD^p.

Summary of Literature Review

Introduction/Background

Discussion of Procedures by Variant

Variant 1: Device selection: Acutely ill patient requiring infusion of an irritant medication, hemodynamic monitoring, and frequent blood draws for 2 weeks or shorter.

Variant 1: Device selection: Acutely ill patient requiring infusion of an irritant medication, hemodynamic monitoring, and frequent blood draws for 2 weeks or shorter.
A. Arm port

Variant 1: Device selection: Acutely ill patient requiring infusion of an irritant medication, hemodynamic monitoring, and frequent blood draws for 2 weeks or shorter.
B. Chest port

Variant 1: Device selection: Acutely ill patient requiring infusion of an irritant medication, hemodynamic monitoring, and frequent blood draws for 2 weeks or shorter.
C. Midline catheter

Variant 1: Device selection: Acutely ill patient requiring infusion of an irritant medication, hemodynamic monitoring, and frequent blood draws for 2 weeks or shorter.
D. Nontunneled central venous catheter

Variant 1: Device selection: Acutely ill patient requiring infusion of an irritant medication, hemodynamic monitoring, and frequent blood draws for 2 weeks or shorter.
E. PICC

Variant 2: Device selection: Patient with acute renal failure requiring central venous access for renal replacement therapy, anticipated duration of therapy for 2 weeks or shorter.

Variant 2: Device selection: Patient with acute renal failure requiring central venous access for renal replacement therapy, anticipated duration of therapy for 2 weeks or shorter.
A. Arm port

Variant 2: Device selection: Patient with acute renal failure requiring central venous access for renal replacement therapy, anticipated duration of therapy for 2 weeks or shorter.
D. PICC

Variant 3: Device selection: Patient with renal failure requiring central venous access for renal replacement therapy, anticipated duration of therapy for more than 2 weeks.

Variant 3: Device selection: Patient with renal failure requiring central venous access for renal replacement therapy, anticipated duration of therapy for more than 2 weeks.
A. Arm port

Variant 3: Device selection: Patient with renal failure requiring central venous access for renal replacement therapy, anticipated duration of therapy for more than 2 weeks.
B. Chest port

Variant 3: Device selection: Patient with renal failure requiring central venous access for renal replacement therapy, anticipated duration of therapy for more than 2 weeks.
C. Nontunneled dialysis catheter

Variant 3: Device selection: Patient with renal failure requiring central venous access for renal replacement therapy, anticipated duration of therapy for more than 2 weeks.
D. PICC

Variant 4: Device selection: Patient with cancer diagnosis requiring central venous access for weekly chemotherapy infusion for more than 2 weeks.

Variant 4: Device selection: Patient with cancer diagnosis requiring central venous access for weekly chemotherapy infusion for more than 2 weeks.
A. Arm port

Variant 4: Device selection: Patient with cancer diagnosis requiring central venous access for weekly chemotherapy infusion for more than 2 weeks.
B. Chest port

Variant 4: Device selection: Patient with cancer diagnosis requiring central venous access for weekly chemotherapy infusion for more than 2 weeks.
C. Nontunneled central venous catheter

Variant 4: Device selection: Patient with cancer diagnosis requiring central venous access for weekly chemotherapy infusion for more than 2 weeks.
D. PICC

Variant 4: Device selection: Patient with cancer diagnosis requiring central venous access for weekly chemotherapy infusion for more than 2 weeks.
E. Tunneled central venous catheter

Variant 5: Device selection: Patient requiring continuous or very frequent intravenous administration of intravenous medications (excluding total parenteral nutrition) for more than 2 weeks.

Variant 5: Device selection: Patient requiring continuous or very frequent intravenous administration of intravenous medications (excluding total parenteral nutrition) for more than 2 weeks.
A. Arm port

Variant 6: Device selection: Patient requiring long-term total parenteral nutrition and another indication for central access.

Variant 6: Device selection: Patient requiring long-term total parenteral nutrition and another indication for central access.
A. Arm port

Variant 6: Device selection: Patient requiring long-term total parenteral nutrition and another indication for central access.
B. Chest port

Variant 6: Device selection: Patient requiring long-term total parenteral nutrition and another indication for central access.
C. Double lumen PICC

Variant 6: Device selection: Patient requiring long-term total parenteral nutrition and another indication for central access.
D. Single lumen PICC

Variant 6: Device selection: Patient requiring long-term total parenteral nutrition and another indication for central access.
E. Tunneled central venous catheter double lumen

Variant 6: Device selection: Patient requiring long-term total parenteral nutrition and another indication for central access.
F. Tunneled central venous catheter single lumen

Variant 7: Device selection: Patient with chronic kidney disease requiring central venous catheter IV infusions for more than 2 weeks.

Variant 7: Device selection: Patient with chronic kidney disease requiring central venous catheter IV infusions for more than 2 weeks.
A. Arm port

Variant 7: Device selection: Patient with chronic kidney disease requiring central venous catheter IV infusions for more than 2 weeks.
B. Chest port via internal jugular vein

Variant 7: Device selection: Patient with chronic kidney disease requiring central venous catheter IV infusions for more than 2 weeks.
C. Chest port via subclavian vein

Variant 7: Device selection: Patient with chronic kidney disease requiring central venous catheter IV infusions for more than 2 weeks.
D. PICC

Variant 7: Device selection: Patient with chronic kidney disease requiring central venous catheter IV infusions for more than 2 weeks.
E. Tunneled central venous catheter double lumen

Variant 7: Device selection: Patient with chronic kidney disease requiring central venous catheter IV infusions for more than 2 weeks.
F. Tunneled central venous catheter single lumen

Variant 8: Site selection: Patient with acute illness requiring central venous catheter for anticipated therapy for 2 weeks or shorter.

Variant 8: Site selection: Patient with acute illness requiring central venous catheter for anticipated therapy for 2 weeks or shorter.
A. Hepatic vein

Variant 8: Site selection: Patient with acute illness requiring central venous catheter for anticipated therapy for 2 weeks or shorter.
B. Inferior vena cava

Variant 8: Site selection: Patient with acute illness requiring central venous catheter for anticipated therapy for 2 weeks or shorter.
C. Right or left external jugular vein

Variant 8: Site selection: Patient with acute illness requiring central venous catheter for anticipated therapy for 2 weeks or shorter.
D. Right or left femoral vein

Variant 8: Site selection: Patient with acute illness requiring central venous catheter for anticipated therapy for 2 weeks or shorter.
E. Right or left internal jugular vein

Variant 8: Site selection: Patient with acute illness requiring central venous catheter for anticipated therapy for 2 weeks or shorter.
F. Right or left subclavian vein

Variant 8: Site selection: Patient with acute illness requiring central venous catheter for anticipated therapy for 2 weeks or shorter.
G. Upper extremity vein

Variant 9: Site selection: Patient with chronic kidney disease or end-stage renal disease requiring central venous catheter.

Variant 9: Site selection: Patient with chronic kidney disease or end-stage renal disease requiring central venous catheter.
A. Hepatic vein

Variant 9: Site selection: Patient with chronic kidney disease or end-stage renal disease requiring central venous catheter.
B. Inferior vena cava

Variant 9: Site selection: Patient with chronic kidney disease or end-stage renal disease requiring central venous catheter.
C. Right or left external jugular vein

Variant 9: Site selection: Patient with chronic kidney disease or end-stage renal disease requiring central venous catheter.
D. Right or left femoral vein

Variant 9: Site selection: Patient with chronic kidney disease or end-stage renal disease requiring central venous catheter.
E. Right or left internal jugular vein

Variant 9: Site selection: Patient with chronic kidney disease or end-stage renal disease requiring central venous catheter.
F. Right or left subclavian vein

Variant 9: Site selection: Patient with chronic kidney disease or end-stage renal disease requiring central venous catheter.
G. Upper extremity vein

Summary of Highlights

Supporting Documents

The evidence table, literature search, and appendix for this topic are available at https://acsearch.acr.org/list. The appendix includes the strength of evidence assessment and the final rating round tabulations for each recommendation.

For additional information on the Appropriateness Criteria methodology and other supporting documents, please go to the ACR website at https://www.acr.org/Clinical-Resources/Clinical-Tools-and-Reference/Appropriateness-Criteria.

Gender Equality and Inclusivity Clause

The ACR acknowledges the limitations in applying inclusive language when citing research studies that predates the use of the current understanding of language inclusive of diversity in sex, intersex, gender, and gender-diverse people. The data variables regarding sex and gender used in the cited literature will not be changed. However, this guideline will use the terminology and definitions as proposed by the National Institutes of Health.

Appropriateness Category Names and Definitions

Appropriateness Category Name	Appropriateness Rating	Appropriateness Category Definition
Usually Appropriate	7, 8, or 9	The imaging procedure or treatment is indicated in the specified clinical scenarios at a favorable risk-benefit ratio for patients.
May Be Appropriate	4, 5, or 6	The imaging procedure or treatment may be indicated in the specified clinical scenarios as an alternative to imaging procedures or treatments with a more favorable risk-benefit ratio, or the risk-benefit ratio for patients is equivocal.
May Be Appropriate (Disagreement)	5	The individual ratings are too dispersed from the panel median. The different label provides transparency regarding the panel’s recommendation. “May be appropriate” is the rating category and a rating of 5 is assigned.
Usually Not Appropriate	1, 2, or 3	The imaging procedure or treatment is unlikely to be indicated in the specified clinical scenarios, or the risk-benefit ratio for patients is likely to be unfavorable.

References

1.	Dariushnia SR, Wallace MJ, Siddiqi NH, et al. Quality improvement guidelines for central venous access. J Vasc Interv Radiol 2010;21:976-81.
2.	Basford TJ, Poenaru D, Silva M. Comparison of delayed complications of central venous catheters placed surgically or radiologically in pediatric oncology patients. J Pediatr Surg 2003;38:788-92.
3.	Busch JD, Herrmann J, Heller F, et al. Follow-up of radiologically totally implanted central venous access ports of the upper arm: long-term complications in 127,750 catheter-days. AJR Am J Roentgenol 2012;199:447-52.
4.	Koroglu M, Demir M, Koroglu BK, et al. Percutaneous placement of central venous catheters: comparing the anatomical landmark method with the radiologically guided technique for central venous catheterization through the internal jugular vein in emergent hemodialysis patients. Acta Radiol 2006;47:43-7.
5.	McBride KD, Fisher R, Warnock N, Winfield DA, Reed MW, Gaines PA. A comparative analysis of radiological and surgical placement of central venous catheters. Cardiovasc Intervent Radiol 1997;20:17-22.
6.	Reeves AR, Seshadri R, Trerotola SO. Recent trends in central venous catheter placement: a comparison of interventional radiology with other specialties. J Vasc Interv Radiol 2001;12:1211-4.
7.	Teichgraber UK, Kausche S, Nagel SN, Gebauer B. Outcome analysis in 3,160 implantations of radiologically guided placements of totally implantable central venous port systems. Eur Radiol 2011;21:1224-32.
8.	Freire MP, Pierrotti LC, Zerati AE, et al. Infection related to implantable central venous access devices in cancer patients: epidemiology and risk factors. Infect Control Hosp Epidemiol 2013;34:671-7.
9.	Caparas JV, Hu JP. Safe administration of vancomycin through a novel midline catheter: a randomized, prospective clinical trial. J. vasc. access. 15(4):251-6, 2014 Jul-Aug.
10.	Tomas-Lopez MA, Cristobal-Dominguez E, Baez-Gurruchaga O, et al. Experience in the use of midclavicular catheters: An inception cohort study. J Clin Nurs 2021.
11.	Takashima M, Schults J, Mihala G, Corley A, Ullman A. Complication and Failures of Central Vascular Access Device in Adult Critical Care Settings. Crit Care Med. 46(12):1998-2009, 2018 12.
12.	Maki DG, Kluger DM, Crnich CJ. The risk of bloodstream infection in adults with different intravascular devices: a systematic review of 200 published prospective studies. Mayo Clin Proc 2006;81:1159-71.
13.	Safdar N, Maki DG. Risk of catheter-related bloodstream infection with peripherally inserted central venous catheters used in hospitalized patients. Chest 2005;128:489-95.
14.	Turcotte S, Dube S, Beauchamp G. Peripherally inserted central venous catheters are not superior to central venous catheters in the acute care of surgical patients on the ward. World J Surg 2006;30:1605-19.
15.	Bonizzoli M, Batacchi S, Cianchi G, et al. Peripherally inserted central venous catheters and central venous catheters related thrombosis in post-critical patients. Intensive Care Med 2011;37:284-9.
16.	Trerotola SO, Stavropoulos SW, Mondschein JI, et al. Triple-lumen peripherally inserted central catheter in patients in the critical care unit: prospective evaluation. Radiology 2010;256:312-20.
17.	Sanfilippo F, Noto A, Martucci G, Farbo M, Burgio G, Biasucci DG. Central venous pressure monitoring via peripherally or centrally inserted central catheters: a systematic review and meta-analysis. [Review]. J. vasc. access. 18(4):273-278, 2017 Jul 14.
18.	Mendu ML, May MF, Kaze AD, et al. Non-tunneled versus tunneled dialysis catheters for acute kidney injury requiring renal replacement therapy: a prospective cohort study. BMC Nephrol. 18(1):351, 2017 Dec 04.
19.	van Oevelen M, Abrahams AC, Weijmer MC, et al. Precurved non-tunnelled catheters for haemodialysis are comparable in terms of infections and malfunction as compared to tunnelled catheters: A retrospective cohort study. J. vasc. access. 20(3):307-312, 2019 May.
20.	Patel GS, Jain K, Kumar R, et al. Comparison of peripherally inserted central venous catheters (PICC) versus subcutaneously implanted port-chamber catheters by complication and cost for patients receiving chemotherapy for non-haematological malignancies. Support Care Cancer 2014;22:121-8.
21.	Pu YL, Li ZS, Zhi XX, et al. Complications and Costs of Peripherally Inserted Central Venous Catheters Compared With Implantable Port Catheters for Cancer Patients: A Meta-analysis. Cancer Nurs. 43(6):455-467, 2020 Nov/Dec.
22.	Taxbro K, Hammarskjold F, Thelin B, et al. Clinical impact of peripherally inserted central catheters vs implanted port catheters in patients with cancer: an open-label, randomised, two-centre trial. Br J Anaesth. 122(6):734-741, 2019 Jun.
23.	Biffi R, Orsi F, Pozzi S, et al. Best choice of central venous insertion site for the prevention of catheter-related complications in adult patients who need cancer therapy: a randomized trial. Ann Oncol 2009;20:935-40.
24.	Furuhashi S, Morita Y, Ida S, et al. Risk Factors for Totally Implantable Central Venous Access Port-related Infection in Patients With Malignancy. Anticancer Res. 41(3):1547-1553, 2021 Mar.
25.	Jiang M, Li CL, Pan CQ, Cui XW, Dietrich CF. Risk of venous thromboembolism associated with totally implantable venous access ports in cancer patients: A systematic review and meta-analysis. J Thromb Haemost. 18(9):2253-2273, 2020 09.
26.	Jiang M, Li CL, Pan CQ, Yu L. The risk of bloodstream infection associated with totally implantable venous access ports in cancer patient: a systematic review and meta-analysis. Support Care Cancer. 28(1):361-372, 2020 Jan.
27.	Kulkarni S, Wu O, Kasthuri R, Moss JG. Centrally inserted external catheters and totally implantable ports for the delivery of chemotherapy: a systematic review and meta-analysis of device-related complications. Cardiovasc Intervent Radiol 2014;37:990-1008.
28.	Yoshida J, Ishimaru T, Kikuchi T, Matsubara N, Asano I. Association between risk of bloodstream infection and duration of use of totally implantable access ports and central lines: a 24-month study. Am J Infect Control 2011;39:e39-43.
29.	Sriskandarajah P, Webb K, Chisholm D, et al. Retrospective cohort analysis comparing the incidence of deep vein thromboses between peripherally-inserted and long-term skin tunneled venous catheters in hemato-oncology patients. Thromb J 2015;13:21.
30.	Carde P, Cosset-Delaigue MF, Laplanche A, Chareau I. Classical external indwelling central venous catheter versus totally implanted venous access systems for chemotherapy administration: a randomized trial in 100 patients with solid tumors. Eur J Cancer Clin Oncol 1989;25:939-44.
31.	Cotogni P, Mussa B, Degiorgis C, De Francesco A, Pittiruti M. Comparative Complication Rates of 854 Central Venous Access Devices for Home Parenteral Nutrition in Cancer Patients: A Prospective Study of Over 169,000 Catheter-Days. JPEN J Parenter Enteral Nutr 2021;45:768-76.
32.	Vashi PG, Virginkar N, Popiel B, Edwin P, Gupta D. Incidence of and factors associated with catheter-related bloodstream infection in patients with advanced solid tumors on home parenteral nutrition managed using a standardized catheter care protocol. BMC Infect Dis. 17(1):372, 2017 05 30.
33.	Pittiruti M, Hamilton H, Biffi R, MacFie J, Pertkiewicz M, Espen. ESPEN Guidelines on Parenteral Nutrition: central venous catheters (access, care, diagnosis and therapy of complications). Clin Nutr 2009;28:365-77.
34.	Gavin NC, Button E, Castillo MI, et al. Does a Dedicated Lumen for Parenteral Nutrition Administration Reduce the Risk of Catheter-Related Bloodstream Infections? A Systematic Literature Review. [Review]. J Infus Nurs. 41(2):122-130, 2018 Mar/Apr.
35.	Cho CH, Schlattmann P, Nagel S, Schmittbuttner N, Hartung F, Teichgraber UK. Cephalad dislocation of PICCs under different upper limb positions: influence of age, gender, BMI, number of lumens. J. vasc. access. 19(2):141-145, 2018 Mar.
36.	Gonsalves CF, Eschelman DJ, Sullivan KL, DuBois N, Bonn J. Incidence of central vein stenosis and occlusion following upper extremity PICC and port placement. Cardiovasc Intervent Radiol 2003;26:123-7.
37.	Aljarrah Q, Allouh M, Hallak AH, et al. Lesion Type Analysis of Hemodialysis Patients Who Underwent Endovascular Management for Symptomatic Central Venous Disease. Vasc Health Risk Manag. 16:419-427, 2020.
38.	Cimochowski GE, Worley E, Rutherford WE, Sartain J, Blondin J, Harter H. Superiority of the internal jugular over the subclavian access for temporary dialysis. Nephron 1990;54:154-61.
39.	Schillinger F, Schillinger D, Montagnac R, Milcent T. Post catheterisation vein stenosis in haemodialysis: comparative angiographic study of 50 subclavian and 50 internal jugular accesses. Nephrol Dial Transplant 1991;6:722-4.
40.	Abdullah BJ, Mohammad N, Sangkar JV, et al. Incidence of upper limb venous thrombosis associated with peripherally inserted central catheters (PICC). Br J Radiol. 2005;78(931):596-600.
41.	Allen AW, Megargell JL, Brown DB, et al. Venous thrombosis associated with the placement of peripherally inserted central catheters. J Vasc Interv Radiol 2000;11:1309-14.
42.	Poletti F, Coccino C, Monolo D, et al. Efficacy and safety of peripherally inserted central venous catheters in acute cardiac care management. J. vasc. access. 19(5):455-460, 2018 Sep.
43.	El Ters M, Schears GJ, Taler SJ, et al. Association between prior peripherally inserted central catheters and lack of functioning arteriovenous fistulas: a case-control study in hemodialysis patients. Am J Kidney Dis 2012;60:601-8.
44.	Lok CE, Huber TS, Lee T, et al. KDOQI Clinical Practice Guideline for Vascular Access: 2019 Update. Am J Kidney Dis 2020;75:S1-S164.
45.	Choosing Wisely® An initiative of the ABIM Foundation. American Society of Nephrology. Five Things Physicans and Patients Should Question. Available at: https://www.choosingwisely.org/societies/american-society-of-nephrology/.
46.	Bhutani G, El Ters M, Kremers WK, et al. Evaluating safety of tunneled small bore central venous catheters in chronic kidney disease population: A quality improvement initiative. Hemodial. int.. 21(2):284-293, 2017 04.
47.	Stavropoulos SW, Pan JJ, Clark TW, et al. Percutaneous transhepatic venous access for hemodialysis. J Vasc Interv Radiol 2003;14:1187-90.
48.	Kade G, Les J, Buczkowska M, Labus M, Niemczyk S, Wankowicz Z. Percutaneous translumbar catheterization of the inferior vena cava as an emergency access for hemodialysis - 5 years of experience. J Vasc Access 2014;15:306-10.
49.	Lund GB, Trerotola SO, Scheel PJ, Jr. Percutaneous translumbar inferior vena cava cannulation for hemodialysis. Am J Kidney Dis 1995;25:732-7.
50.	Moura F, Guedes FL, Dantas Y, Maia AH, Oliveira RA, Quintiliano A. Translumbar hemodialysis long-term catheters: an alternative for vascular access failure. Jornal Brasileiro de Nefrologia. 41(1):89-94, 2019 Jan-Mar.
51.	Wan Y, Chu Y, Qiu Y, Chen Q, Zhou W, Song Q. The feasibility and safety of PICCs accessed via the superficial femoral vein in patients with superior vena cava syndrome. Journal of Vascular Access. 19(1):34-39, 2018 Jan.
52.	Bjorkander M, Bentzer P, Schott U, Broman ME, Kander T. Mechanical complications of central venous catheter insertions: A retrospective multicenter study of incidence and risks. Acta Anaesthesiol Scand. 63(1):61-68, 2019 01.
53.	Iorio O, Cavallaro G. External jugular vein approach for TIVAD implantation: first choice or only an alternative? A review of the literature. J Vasc Access 2015;16:1-4.
54.	Kato K, Taniguchi M, Iwasaki Y, et al. Computed tomography (CT) venography using a multidetector CT prior to the percutaneous external jugular vein approach for an implantable venous-access port. Ann Surg Oncol 2014;21:1391-7.
55.	Goetz AM, Wagener MM, Miller JM, Muder RR. Risk of infection due to central venous catheters: effect of site of placement and catheter type. Infect Control Hosp Epidemiol 1998;19:842-5.
56.	Lorente L, Henry C, Martin MM, Jimenez A, Mora ML. Central venous catheter-related infection in a prospective and observational study of 2,595 catheters. Crit Care 2005;9:R631-5.
57.	Merrer J, De Jonghe B, Golliot F, et al. Complications of femoral and subclavian venous catheterization in critically ill patients: a randomized controlled trial. JAMA 2001;286:700-7.
58.	Parienti JJ, Mongardon N, Megarbane B, et al. Intravascular Complications of Central Venous Catheterization by Insertion Site. N Engl J Med 2015;373:1220-9.
59.	Schwanke AA, Danski MTR, Pontes L, Kusma SZ, Lind J. Central venous catheter for hemodialysis: incidence of infection and risk factors. [Portuguese, English]. Rev Bras Enferm. 71(3):1115-1121, 2018 May.
60.	Trottier SJ, Veremakis C, O'Brien J, Auer AI. Femoral deep vein thrombosis associated with central venous catheterization: results from a prospective, randomized trial. Crit Care Med 1995;23:52-9.
61.	Ge X, Cavallazzi R, Li C, Pan SM, Wang YW, Wang FL. Central venous access sites for the prevention of venous thrombosis, stenosis and infection. Cochrane Database Syst Rev 2012;3:CD004084.
62.	Bell J, Goyal M, Long S, et al. Anatomic Site-Specific Complication Rates for Central Venous Catheter Insertions. J Intensive Care Med. 35(9):869-874, 2020 Sep.
63.	Jonszta T, Czerny D, Prochazka V, Vrtkova A, Chovanec V, Krajina A. Computed Tomography (CT)-Navigated Translumbar Hemodialysis Catheters: A 10-Year Single-Center Experience. Med Sci Monit. 26:e927723, 2020 Dec 15.
64.	Guillermo-Corpus G, Ramos-Gordillo JM, Pena-Rodriguez JC. Survival and Clinical Outcomes of Tunneled Central Jugular and Femoral Catheters in Prevalent Hemodialysis Patients. Blood Purif. 47(1-3):132-139, 2019.

Disclaimer

The ACR Committee on Appropriateness Criteria and its expert panels have developed criteria for determining appropriate imaging examinations for diagnosis and treatment of specified medical condition(s). These criteria are intended to guide radiologists, radiation oncologists and referring physicians in making decisions regarding radiologic imaging and treatment. Generally, the complexity and severity of a patient’s clinical condition should dictate the selection of appropriate imaging procedures or treatments. Only those examinations generally used for evaluation of the patient’s condition are ranked. Other imaging studies necessary to evaluate other co-existent diseases or other medical consequences of this condition are not considered in this document. The availability of equipment or personnel may influence the selection of appropriate imaging procedures or treatments. Imaging techniques classified as investigational by the FDA have not been considered in developing these criteria; however, study of new equipment and applications should be encouraged. The ultimate decision regarding the appropriateness of any specific radiologic examination or treatment must be made by the referring physician and radiologist in light of all the circumstances presented in an individual examination