Does anyone have policy/procedures or know of any national standards/practice guidelines for patients walking with femoral catheters? Our physical therapy department is trying to put together guidelines for patient sthat have a physical therapy consult but also have a femoral catheter either arterial/venous tunneled/non-tunneld. Should the patient be walking with theres lines or having leg exercisies? Physical therapy is telling us more and more of the ICU patients are now getting mobilized even on ventilators, with the push for mobility to decrease Ventilator associated pneumonia and skin breakdown.
My first thought is that femoral catheters should be the rare site and only for a very short time, if at all. All standards, guidelines, recommendations, etc from all organizations state to avoid the femoral sites due to the increased risk of infection. Also, I would have to know where the tip of these catheter are, confirmed by xray. Sometimes this is not done, but it is really not a central line unless it is in the IVC above the diaphragm. There are numerous articles about aberrant tip locations for femoral sites including renal and hepatic veins. Also for some stiffer catheters I would worry about this movement leading to catheter erosion. A puncture abd vein would not be easy to manage!! Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Ironically, I have a friend who is a retired IV RN. Due to multiple complications with implanted ports in the arm and chest, she has a port in her leg via the femoral vein! Has had it for several years for her metastatic breast cancer chemo. So far, so good with the usual activities of daily living !
Was this catheter a tunneled cuffed CVC? Where exactly was the skin exit site? Acute care catheters, usually a stiffer material and a direct percutaneous venipuncture site are the femoral lines with the greatest risk of infection. When the tunneled cuffed catheter is used, the subq skin tunnel brings the exit site around from the inguinal area and the catheter is a softer material. Implanted ports can also be used in this manner with the port body implanted over the iliac crest for stability. The use of long-term VADs inserted via the femoral with skin exit sites in another area are commonly used when no other access is available. The highest risk are those that are used in acute care for short term use. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861