Early Mobility and Walking for Patients with Femoral Arterial Catheters in Intensive Care Unit: a Case Series.
Perme, Christiane ; Lettvin, Colleen ; Throckmorton, Terry A ; Mitchell, Katy ; Masud, Faisal. Early Mobility and Walking for Patients with Femoral Arterial Catheters in
Intensive Care Unit: a Case Series. Journal of Acute Care Physical Therapy. 2011. Vol.2 No.1: 32-36
Abstract: Background: Patients with femoral arterial catheters
for hemodynamic monitoring are sometimes placed on bed rest
because of the anatomical location and perceived risk of
catheter-related complications associated with mobility. This
practice subjects these patients to the well known adverse
effects of inactivity on functional mobility and functional
outcomes. Because of limited evidence to link mobility with
femoral artery displacement or damage, this practice may be
unwarranted and may add to the treatment burden of the
patient in the intensive care unit. Objective: The purpose of
this study was to explore whether physical therapy-directed
mobilization of patients with femoral arterial catheters resulted
in adverse events. Methods: A retrospective case series was
undertaken on patients in a 40-bed cardiovascular and thoracic
intensive care unit. The list of potential catheter-related
adverse events investigated included bleeding at the femoral
arterial catheter site, accidental catheter dislodgement and/or
removal, non-functioning catheter after activity event, and
acute limb ischemia within 24 hours. Results: The 30 patients
identified for the study underwent 47 physical therapy sessions
with a total of 156 activity events including sitting on the side
of the bed, standing at bedside, transfers to a regular chair or a
stretcher chair, and walking. No femoral arterial catheter
related adverse events that could be attributed to participation
in physical therapy were documented in either the nursing or
physical therapy notes. Conclusion: The data from this single
center retrospective case series suggest that early mobility and
walking activities do not affect femoral arterial catheters used
for hemodynamic monitoring and orders for bed rest may
unnecessarily add to symptom burden faced by these patients.
Background/Intro: Previous studies have been published
reporting the rate of femoral arterial catheter related
complications, although not directly related to patient
mobilization. The complications observed in the study
included accidental catheter removal, vascular insufficiency,
infection, circulatory impairment, bleeding at the catheter site,
arterial occlusion, neurological impairment, and clot formation
in the catheter. Bed rest is often prescribed by physicians to
reduce the risk of complications. However prolonged bed rest
can result in muscle atrophy, increases inflammatory markers,
insulin resistance, tachycardia, and decreased cardiac output.
Purpose: The purpose of this study was to explore whether
mobilizing patients with femoral arterial catheters for
hemodynamic monitoring in a cardiovascular ICU (CVICU)
is associated with any catheter-related complications.
Methods
•
A retrospective, single-center case series study was
conducted in a 40-bed CVICU at a large
metropolitan teaching hospital.
•
June 1, 2005 – Dec. 31, 2005.
•
Inclusion criteria were individuals 18 years or older
who received PT and had a femoral arterial catheter
for the purpose of hemodynamic monitoring.
•
30 patients (18 M, 12 F)
•
Femoral arterial catheter insertion technique was
consistent and standardized among physicians via the
Seldinger approach.
•
Cardiovascular and thoracic surgical patients
•
Patients in study underwent :
•
Coronary artery bypass
•
Aortic or Mitral valve replacement
•
Heart transplant
•
Other cardiothoracic surgical
procedures
•
(Patient characteristics shown in
Table 1)
•
Information was obtained from nursing
documentation to examine potential catheter related
adverse events within 24 hours after supervised PT
•
Potential catheter adverse events included:
•
Bleeding at catheter site
•
Accidental catheter
dislodgement/removal
•
Acute limb ischemia
•
Data collected from PT documentation included:
•
Frequency of activity events
•
Documentation of catheter related
complications during PT
interventions
•
Activity events for the purpose of this study
included:
•
Sitting on the side of bed
•
Standing at bedside
•
Transfers to a stretcher/regular chair
•
Walking of any distance
•
Any activities performed during PT sessions prior to
insertion or after removal of femoral arterial catheter
were not included.
•
All subjects performed at least one activity event
during PT sessions and each activity was recorded as
a separate event.
•
During activity the only restriction was excessive hip
flexion on the side of femoral arterial catheter.
Presented by : Seth Pinkerton, DPT Student
Bellarmine University
Results
•
30 patients underwent 47 PT sessions with a total of 156
activity events
•
Number of PT sessions received varied from 1 to 4
sessions.
•
Number of days with femoral arterial catheter in placed
varied from 1 to 25 days.
•
Frequency of activity events that occurred during the 47
PT sessions were:
•
Sitting on the side of bed – 47 times
(100%)
•
Standing at the bedside – 38 times (81%)
•
Transfers to chair – 30 times (64%)
•
Ambulation – 25 times (53%) mean
distance was 182 feet.
•
In 8 of the ambulation events patients were able to walk
equal to or less than 100 feet.
•
In 17 of the ambulation events patients were able to walk
more than 100 feet.
•
No femoral arterial catheter related adverse events that
could be attributed to PT sessions were documented in
either nursing or PT notes.
http://www.cvapc.com/handler.cfm?event=practice,template&cpid=27133
Discussion
•
Investigating strategies to provide early mobility
interventions and to confirm their feasibility is vital due
to the importance of preventing decline in functional
mobility associated with prolonged bed rest.
•
Study suggests that early mobility (walking) in the
CVICU is safe for patients with femoral arterial
catheters; as no catheter complications were found in PT
or nursing documentation.
•
Limited subjects may not be sufficient to argue that all
patients with femoral arterial catheter participating in
functional mobility would be stable and not result in
serious injury.
•
Investigators had no control over what data was
available
•
Adverse events may have occurred and not documented
•
Specific to CVICU not generalized to all ICU
populations or children.
Clinical Significance
•
The clinical significance of this study
suggests that patients in CVICU who
have a femoral arterial catheter in
place should be safe and appropriate
for PT interventions.
•
Early mobilization of patients in ICU
help reduce the negative effects of
bed rest and this article suggests that
femoral arterial catheters should not
be considered a contraindication for
PT intervention.
•
Patients with femoral arterial
catheters have a low or no risk of
catheter related complications during
or after PT interventions including
walking and transfers.
Conclusion
•
Early mobility and walking activities
appear to be safe and do not affect
femoral arterial catheters.
•
Orders for bed rest for patients with
femoral arterial catheters may be
unnecessary
•
Further investigation with larger
samples, more institutions, and
different ICU setting is crucial to
evaluate the safety and feasibility to
such practice.
Article 1
Scheer, BV, Perel, A, Pfeiffer, UJ Clinical
Review : Complications and risk factors of
peripheral arterial catheters used for
haemodynamic monitoring in anaesthesia and
intensive care medicine. Critical Care. 2002;
Vol 6 No.3 : 198-204.
Evidence
In this review 3899 cases of femoral arterial
catheterization was reviewed. Femoral artery is
the second most cannulated artery for
haeodynamic monitoring and was found to have
a low complication rate.
Temporary occlusion was reported at a rate of
1.18%, serious ischemic complications was
reported at a mean rate of 0.18%,
pseudoaneurysm at a rate of 0.3%, and sepsis at
a rate of 0.44%.
This review concluded that incidence rates for
major complications for femoral arterial
catheters are low and occur in fewer than 1% of
cases.
Article 2
Morris, PE, Goad, A, Thompson, C, et al. Early
intensive care unit mobility therapy in the
treatment of acute respiratory failure. Crit Care
Med. 2008. Vol 36 No.8: 1-6.
Evidence
This study included 330 subjects who were
intubated at a Medical Intensive Care Unit
(MICU). 165 were placed in usual care group
and 165 were in protocol (mobility) group.
There no differences in the number of femoral
arterial catheters, venous devices, or
reintubations between the groups.
The study concluded that mobility therapy
delivered early in the course of acute care is
feasible, safe, did not increase cost of care, and
was associated with decreased ICU and hospital
length of stay (LOS) in survivors.
Summary
The main article suggests that early mobilization
(walking) in patients with femoral arterial
catheters is safe and causes no adverse effects.
The first supporting article found that femoral
arterial catheters have a complication incidence
rate of 1%. The second supporting article found
that early mobility of patients in acute respiratory
failure with femoral artery catheters and other
tubing is safe and has shown to decrease patients
LOS in the hospital and ICU.