A tunneled cuffed FICC can be used as long-term central VAD, provided it has been properly inserted (important point: the cuff must be inside the tunnel, at 2 cm or more from the exit site).
FICC can be inserted by ultrasound-guided puncture and cannulation of the common or the superficial femoral vein; they can be tunneled towards the abdomen (in walking patients) or towards the knee (in bedridden patients).
We recommend power injectable cuffed catheters, in polyurethane, open-ended, non-valved, appropriately long. These catheters are associated with minimal risk of malfunction and mechanical complications. They are available in various sizes (5Fr, 6Fr, etc.), both single and double lumen. The silicone cuffed CVCs used in the past (cuffed Groshong, Hickman, Broviac, Leonard) are now to be considered obsolete and they should be abandoned, since they do not have any advantage in terms of biocompatibility but instead they have many disadvantages (difficulty in securement, low flow, fragility, tendency to dislocation and to tip migration, high incidence of lumen occlusion, difficult disobstruction if occluded, impossibility of use at high pressures).
Interestingly, the cuff becomes efficient for stabilization purposes only two to three weeks after implantation (i.e. only after the development of adhesions between the cuff and the subcutaneous tissue); in this first weeks after implantation, the catheter must be temporarily stabilized with a sutureless system with skin adhesiveness (or even with a SAS, as recently described in the literature).