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.

Previous studies looked at the major complications in patients with femoral arterial catheters (FAC) related to early mobilization. These complications include 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. Recent research shows early mobilization minimizes functional decline.

To explore whether mobilizing patients with FAC for hemodynamic monitoring in a cardiovascular ICU (CVICU) is associated with any catheter-related complications.

All patients in study underwent on of these: Coronary artery bypass , aortic or mitral valve replacement, heart transplant, other cardiothoracic surgical procedures (Patient characteristics shown in Table 1)

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 All subjects performed at least one activity during PT sessions and each activity was recorded as a separate event. only restriction was excessive hip flexion on the side FAC.

• 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 FAC in placed varied from 1 to 25 days.

• Study suggests that early mobility (walking) in the CVICU is safe for patients FAC; as no catheter complications were found in PT or nursing documentation.

Limitations: • 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.

• This study suggests that patients in CVICU who have a FAC in place should be safe and appropriate for early mobility and walking PT interventions.

• Early mobilization of patients in ICU help reduce the negative effects of bed rest and this article suggests that FAC 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, therefore orders for bed rest is unnecessary

• Further investigation with larger samples, more institutions, and different ICU setting is crucial to evaluate the safety and feasibility to such practice.

Article 2: Foran JPM, Patel D, Brookes J, Wainwright RJ. Early mobilsation after percutaneous cardiac catherisation using collagenplug (VasoSeal) hemostasis. British Heart Journal. 1993; (69) 424-429. Evidence:This study is an outcomes study that assessed the efficacy and safety of a hemostatic bovine collagen plug (VasoSeal) in reducing patient immobilization after cardiac catherization from a percutaneous femoral arterial approach. Uncomplicated mobilzation within two hours of investigation was possible in 54 of 57 patients receiving device. The device is safe and effective for mobilizing patient compared to other hemostatic devices from a percutaneous femoral approach.

Overall, the main study suggests that early mobilization (walking) in patients with femoral arterial catheters is safe and causes no adverse effects. The first supporting article found patients who ambulated early had an increase in comfort level with minimal to no risks for hematomas. The second article suggest the specific type of catheter, VasoSeal, was beneficial in mobilizing patients and decreasing any risks associated with FAC.

Jacqueline Lopez, DPT Student; Bellarmine University Dec 2012

Background/Intro:

Purpose:

Methods: • A retrospective, single-center case

series study was conducted in a 40-bed CVICU at a large metropolitan teaching hospital.

• 30 patients (18 M, 12 F)

• Inclusion criteria: individuals 18 years or older who received PT and had a FAC for the purpose of hemodynamic monitoring.

• FAC insertion technique was consistent and standardized among physicians via the Seldinger approach.

• Cardiovascular and thoracic surgical patients

Methods: (cont.)

Results:

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Discussion

Conclusion: Article 1: Morteza RA, Fazlollah A, Mohammed AJ. The effect of changing position and early ambulation after cardiac catherization on patients’ outcomes: A single-blind randomized controlled trial. International Journal of Nursing Studies. 2009; 46: 1047-1053.

Evidence: This study is a single –blind randomized control trial that assessed the effect of changing position and early ambulation on the level of comfort, satisfaction, and fatigue on the amount of bleeding and hematoma after cardiac catherization. The sample size was of 70 patients who undergone 6-French cardiac catherization. Results showed changing patient’s position according to the current protocol in the experimental group produced no significant increase in the amount of bleeding and hematoma when compared to the control group.

Summary

• Frequency of activity events that occurred during the 47 PT sessions were:

• Sitting on the side of bed – 47 times • Standing at the bedside – 38 times • Transfers to chair – 30 times (64%) • Ambulation – 25 times; mean distance

was 182 feet. No FAC related adverse events that could be attributed to PT sessions were documented in either nursing or PT notes.

Results: (cont.)