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Femoral catheters provide access to major organs via the femoral blood vessels for lifesaving diagnostic and treatment purposes. But patients with femoral catheters may be restricted to bed rest because of perceived risks associated with mobility, such as kinking the catheter. However, evidence is beginning to show that the benefits of early mobilization outweigh the risks and can lead to improved patient outcomes.

Early Ambulation in the ICU
“After extensive informal collaboration with ICU healthcare professionals in many regions of the country, I realized that placing patients with femoral catheters on bed rest is common practice in the ICU,” says Christiane Perme, PT, CCS, a senior physical therapist at The Methodist Hospital in Houston. With proper precautions, this need not be the case, she says. At Methodist, nurses and PTs routinely mobilize patients with femoral catheters without seeing any complications related to the mobility.

Perme and Faisal Masud, MD, did a six-month retrospective study (as of yet unpublished) in which they reviewed charts of patients with femoral arterial catheters who received physical therapy. “There were no documented catheter-related complications when patients were mobilized,” Perme says. She presented her research at this year’s American Physical Therapy Association Combined Sections Meeting, as well as last year’s meeting of the American Thoracic Society. She teaches on the topic of physical therapy in the ICU (including early mobilization) as an instructor with Education Resources Inc., a continuing education provider headquartered in Medfield, Mass., and for Motivations Inc., headquartered in Fort Mill, S.C.

There are several benefits of mobilizing patients in the ICU, Perme says. Recent studies have shown that early mobilization in the ICU is essential to minimizing functional decline and decreasing the length of hospital and ICU stays. Perme points out that “many studies in the literature show the harmful effects of bed rest even when you’re healthy. So when patients are critically ill, those effects are compounded.”

She advises any PTs who will be working with patients with femoral catheters to familiarize themselves with the different types of catheters and their uses and take proper precautions while working with these patients. PTs can glean information from hospital policies and procedures documentation as well as by talking with nurses and other medical staff. (If hospital policy requires patients with femoral catheters to remain on bed rest, PTs should adhere to those guidelines until they are revised.)

Some of the uses of catheters in the femoral veins include drawing blood, administering fluids or medications, or dialysis. Femoral arterial catheters may be used in the ICU to continuously monitor blood pressure or withdraw arterial blood.

“Unfortunately, there’s not a structured training in all physical therapy schools to teach therapists how to mobilize patients who are critically ill,” Perme says. Communicating with nursing and medical staff about the ICU equipment in use and the patient’s medical condition can help fill the gaps of knowledge.

Once a patient is cleared for physical therapy, do a thorough evaluation of the catheter site before mobilizing the patients, Perme says. “It’s very important before you move anybody that you must certify that the catheter is in place and it’s not bleeding,” she says.

After Removal
How soon a patient can be mobilized after a femoral catheter is removed depends on many factors, says Craig Moreland, PT, MS, director of Inpatient Physical Therapy at UPMC Presbyterian-Montefiore (Centers for Rehab Services) in Pittsburgh. “Whether they use a sealing device or manual compression [to close the vessel after the sheath is removed], it’s patient-specific, it’s doctor-specific, it depends on anti-coagulation, blood pressure, difficulty with access to the artery, etc.”

In general, use of a sealing device after removal of the sheath can decrease the amount of required bed rest. “It used to be a very conservative four to six hours of bed rest after the sheath was removed. But they found that that length of time — six hours of bed rest — is associated with patient discomfort and increased medical costs.

There have been studies that found shortened amount of time [on bed rest] would not increase vascular complications,” Moreland says. Because a sealing device speeds up the clotting process, “if a sealing device is used, it’s usually only one to two hours of bed rest and then they’re able to get up and ambulate.”

The benefits of early mobilization far outweigh the risks associated, because the adverse events don’t happen often, Moreland says. One study he reviewed (“Rapid Ambulation after Coronary Angiography via Femoral Artery Access: A Prospective Study of 1,000 Patients” by Scott Gall, MD, et al in the March 2006 issue of The Journal of Invasive Cardiology) found that only one patient out of 1,000 had minor bleeding after early ambulation, which was treated successfully with manual pressure and a pressure dressing. Another patient had a false aneurysm requiring surgical repair and a blood transfusion. All other patients remained hemodynamically stable.

When ambulating a patient who recently has had a femoral catheter removed, Moreland advises therapists be aware of warning signs that may signify adverse complications that, although rare, can be serious. These include bleeding from the site, swelling at the site (that could signify a hematoma), numbness or tingling at the groin site, or dizziness.

“I can’t speak for other hospitals, but I think here at UPMC, the physicians take a very aggressive approach and are very supportive of early mobilization,” Moreland says. “A cardiac cath isn’t something that we typically modify our [PT] program for. Obviously, we monitor their vitals, ask if they’re having any pain in their groin site, but typically, the patient is pretty asymptomatic.” •

Anne Federwisch is a freelance writer.