Safety and Feasibility of Femoral Catheters During Physical Rehabilitation in the ICU

Abstract

PURPOSE: Early physical medicine and rehabilitation interventions in the intensive care unit (ICU) can improve physical function and quality of life in ICU survivors. Femoral catheters pose a potential barrier to early rehabilitation due to concerns for catheter dislodgement and dysfunction, or local trauma and bleeding. The objective of this study is to prospectively evaluate the feasibility and safety of physical therapy in ICU patients with femoral catheters. METHODS: We evaluated all consecutive adult patients admitted to a 16-bed medical ICU (MICU) at Johns Hopkins Hospital in Baltimore, MD who received physical therapy with a femoral venous, arterial or hemodialysis catheter(s) in situ between September, 2009 to January, 2011. We prospectively evaluated the following 4 adverse events: non-functioning catheter, dislodgement of catheter, bleeding at the catheter site, and acute limb ischemia within 24 hours after the rehabilitation intervention. RESULTS: Of 1,074 consecutive patients admitted to MICU, 239 (22%) received a femoral catheter (81% venous, 29% arterial, 6% hemodialysis - some patients had >1 catheter). Of those, 101 (42%) received physical therapy while the femoral catheter was in situ, for a total of 253 treatment sessions over 210 MICU days. Of the 101 patients, 67% were mechanically ventilated in the MICU and 41% were males, with a median [IQR] age of 55 [46, 68] years. Among the 210 MICU days with physical therapy treatment with a femoral catheter in situ, 49 (23%) achieved standing or walking, 57 (27%) sitting, 25 (12%) cycle ergometry, and 79 (38%) in-bed exercises as their highest daily level of activity. During 253 physical therapy sessions, there were no femoral catheter-related adverse events for a 0% event rate with a 95% upper confidence limit of 1.44%. CONCLUSIONS: Physical therapy in MICU patients with in situ femoral catheters appears to be feasible and safe.