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Rationale: The use of the femoral vein for parenteral nutrition (PN) is relatively contraindicated, because of common believe it’s associated with a high risk of contamination at the exit site at the groin, leading to sepsis and a high risk of venous thrombosis. When veins of upper part of the body became occluded, the femoral access is the first choice for long term PN, but such situation is now recognised as indication for intestinal transplantation. The aim was to evaluate safety of modified femoral venous access for HPN. Methods: 20 from 962 HPN patients suffered from intestinal failure presented complete occlusion of upper vena cava on admission (n = 8) or during HPN (n = 12 ), confirmed by phlebography and/or CT scan. 6.6 F Broviac catheter tunnelised to abdominal wall up for over 15 20 cm and then reversed, putting the cuff 5 cm down and exit site 2 cm lower, was inserted under fluoroscopy through femoral vein into right atrium. Exit site infection and central catheter related blood stream infection (CRBSI) rate was retrospectively analysed and compared with observed in the same patients when tunnelised upper vein access was used before occlusion of upper veins or after theirs recanalization. Results: HPN was provided for total of 31 206 days through femoral and 20422 days through subclavian or jugular vein. The CRBSI rate was 1.66/1000 HPN days for upper access and 0.27/1000 HPN days for femoral vein and exit site infection 0.09/1000 HPN days for both. Thrombosis of both femoral veins has occurred in 2 patients, upper veins recanalised after 3 12 years in 4 patients. Conclusion: Modified femoral access is safe. The risk of thrombosis is low with systemic anticoagulation. The reason for lower complications rate may be due to better catheter care performance with growing experience but also due to easier handling by the patients.