Elsevier

Journal of Critical Care

Volume 28, Issue 4, August 2013, Pages 535.e9-535.e15
Journal of Critical Care

Safety and feasibility of femoral catheters during physical rehabilitation in the intensive care unit,☆☆,

https://doi.org/10.1016/j.jcrc.2013.01.006Get rights and content

Abstract

Objective

Femoral catheters pose a potential barrier to early rehabilitation in the intensive care unit (ICU) due to concerns, such as catheter removal, local trauma, bleeding, and infection. We prospectively evaluated the feasibility and safety of physical therapy (PT) in ICU patients with femoral catheters.

Design, Setting, and Patients

We evaluated consecutive medical ICU patients who received PT with a femoral venous, arterial, or hemodialysis catheter(s) in situ.

Measurements and Main Results

Of 1074 consecutive patients, 239 (22%) received a femoral catheter (81% venous, 29% arterial, 6% hemodialysis; some patients had > 1 catheter). Of those, 101 (42%) received PT interventions, while the catheter was in situ, for a total of 253 sessions over 210 medical ICU (MICU) days. On these 210 MICU days, the highest daily activity level achieved was 49 (23%) standing or walking, 57 (27%) sitting, 25 (12%) supine cycle ergometry, and 79 (38%) in-bed exercises. During 253 PT sessions, there were no catheter-related adverse events giving a 0% event rate (95% upper confidence limit of 2.1% for venous catheters).

Conclusions

Physical therapy interventions in MICU patients with in situ femoral catheters appear to be feasible and safe. The presence of a femoral catheter should not automatically restrict ICU patients to bed rest.

Introduction

Survivors of critical illness often experience important impairments in their physical function and quality of life [1], [2], [3], [4], [5], [6], [7]. Early physical medicine and rehabilitation interventions in the intensive care unit (ICU) can improve these impairments [8], [9], [10], [11], [12], [13]. However, perceived barriers often pose challenges for such early rehabilitation interventions [14], [15], [16], [17]. An indwelling femoral catheter is one such perceived barrier, due to concerns such as catheter removal, local trauma, bleeding, and infection [15], [18], [19], [20].

Arterial and venous femoral catheters are generally quick and easy to obtain and are widely used in ICUs [21]. There are relatively little data evaluating use of femoral catheters in conjunction with early rehabilitation and mobilization of patients in the ICU setting. Our objective was to prospectively evaluate the feasibility and safety of physical therapy (PT) interventions in ICU patients with venous, arterial, and/or hemodialysis femoral catheters.

Section snippets

Setting and patients

Data for this analysis were prospectively collected as part of the Critical Care Physical Medicine and Rehabilitation Program at the Johns Hopkins Hospital in Baltimore, MD. The program maintains a registry of all consecutive adult patients admitted to the hospital's 16-bed medical ICU (MICU). The program uses a number of physical therapists who complete rotations in the MICU (with durations ranging from several weeks to several months) to maintain a staffing level of 2.25 full-time equivalent

Results

Of 1074 consecutive patients admitted to the MICU during the 16-month period from September 2009 to January 2011, 239 (22%) received a femoral catheter. Of these, 101 patients (42%) received PT interventions, while a femoral catheter was in situ. Of the 101 patients, 67% were mechanically ventilated in the MICU during their ICU stay, and 41% were male, with a median (IQR) age of 55 years (46-68 years) (Table 1). A large majority of patients (85%) were able to stand and/or walk before hospital

Discussion

We conducted a prospective evaluation of the feasibility and safety of MICU patients receiving PT, as part of routine care, with a femoral catheter in situ. Over a 16-month period, 239 (22%) of all 1074 MICU patients ever had a femoral catheter, and 101 patients received 253 PT treatment sessions with a femoral catheter in situ (average 2.5 sessions per patient). These sessions included standing/walking, sitting, supine cycle ergometry, and in-bed exercises. Physical therapy sessions were not

Conclusion

We prospectively evaluated the feasibility and safety of physical rehabilitation interventions in adult MICU patients with in situ femoral catheters. Among 101 consecutive MICU patients, 253 PT treatment sessions were successfully performed, including standing/walking, sitting, cycle ergometry, and in-bed exercises. No adverse events were identified with the greatest number of interventions occurring with a femoral venous catheter in situ (0% event rate; 95% upper confidence limit, 2.1 %).

References (29)

  • D.M. Needham et al.

    The functional costs of ICU survivorship. Collaborating to improve post-ICU disability

    Am J Respir Crit Care Med

    (2011)
  • D.M. Needham

    Mobilizing patients in the intensive care unit: improving neuromuscular weakness and physical function

    JAMA

    (2008)
  • P. Bailey et al.

    Early activity is feasible and safe in respiratory failure patients

    Crit Care Med

    (2007)
  • P.E. Morris et al.

    Early intensive care unit mobility therapy in the treatment of acute respiratory failure

    Crit Care Med

    (2008)
  • Cited by (0)

    Funding: Michelle Kho, PT, PhD, is funded by a Fellowship and Bisby Prize from the Canadian Institutes of Health Research. The Canadian Institutes of Health Research had no influence on the design, analysis, or decision to submit this paper for publication.

    ☆☆

    Conflict of interest: None.

    Author contributions: AD, JMZ, MEK, and DMN contributed to the conception and design of this evaluation. JMZ, EM, MEK, and DMN contributed to the acquisition of data. AD, JMZ, EM, EC, MEK, and DMN contributed to the analysis and interpretation of data. AD drafted the manuscript, and all authors critically revised it for important intellectual content and approved the final version to be submitted. DMN is the guarantor of the paper, taking responsibility for the integrity of the work as a whole.

    View full text