In the presence of documented obstruction of the superior vena cava, placement of a PICC or a CICC may be difficult or impossible: in this situation, long-term central venous access will be obtained by catheters inserted via ultrasound-guided puncture and cannulation of the common or superficial femoral vein, with the tip in the inferior vena cava, properly tunneled.
As with all long-term external VADs, long-term protection from extraluminal bacterial contamination will be obtained by tunneling, while long-term protection from the risk of dislocation will be obtained either using a cuffed catheter or by securing a non-cuffed catheter to the skin with a subcutaneously anchored system (SAS).