I'm a bioengineering student interning at a company this semester that is producing a specialized venous femoral catheter. I am tasked with finding different ways a catheter in the IVC might move around, anywhere from twisting to bending to being pulled out.
I am looking for worst case scenarios to test that might have an impact on the integrity of the catheter.
This femoral catheter in particular is secured with a suture wing, and the line itself is relatively stiff. It is specialized for use in ICU trauma patients who are at high risk for PE.
How would patients that fit these criteria be moved around? How often would you turn them? Would you still turn them laterally with a femoral line? Would you ever ambulate a patient with a venous femoral line? Is most of this dictated by policy or is it left to your discretion? How common is it for patients to move around on their own? Do they usually just move around in bed or is it common for them to get up and walk around? How often do securement sutures come loose? Do physical therapists interact with ICU trauma patients with femoral catheters?
Any insight is very helpful, as you can imagine most of my information comes from literature which is not too specific and since protocols vary considerably between hospitals I can't get a clear overview.
Oct 3, '17
Femoral venous access lines are most usually done when no other central access exists in adults. They are less than optimal, not the least of which because of the increased risk of central line infection, being in the groin. Ordinarily, they are very short term if possible and the patients are not ordinarily ambulatory but there are, obviously, exceptions. Another reason they're not desired is that they are right over a joint and require a straight leg to avoid kinking or damage. This is uncomfortable for patients.
Lines being pulled out are a problem no matter where they are. Sewing them in is no guarantee at all of their not being accidentally pulled out.
Oct 4, '17
We turn and reposition every 2 hours- just like every other patient (as long as they are hemodynamically stable).
Our trauma patients are always on DVT prophylaxis- medications if condition allows and ALWAYS SCDs unless contraindicated (our attendings can be very unpleasant when SCDs are not in place).
Femoral lines stay in for no more than 72 hours at my facility. As stated by Offlabel the infection risk is very high and the line is removed and/or replaced in a different location ASAP.
I haven't seen a patient ambulate with a femoral line- they are placed on bed rest. I've had a patient who was transferred from another hospital with a femoral line in and if that line wasn't in place could have ambulated some. We removed the line (wasn't needed, had been in for 5 days, etc) and later the patient was allowed to ambulate.
I haven't been in the ICU long, but I haven't seen a femoral line accidentally pulled. I think this is because the patients tend to be very sick and therefore they tend to be sedated and intubated. We are very aware of our lines while turning and repositioning the patient in bed. I'd say the greatest risk for accidental removal would be during patient transport to other areas of the hospital. It can be incredibly stressful to transport ICU patients to tests and procedures because of all the potential equipment- ventilator, central lines, radial lines, critical drips, etc. I've known of nurses that have lost central lines during transport- that's a scary thought when you have a vasoactive medication (or any medication) that is literally keeping the patient alive. The central line lost was not a femoral line- it was an IJ.
Oct 5, '17
That makes sense, I don't think I would want to walk much either with a tube going into my groin. Thank you!
Oct 5, '17
A flexible, non-kink, spiral wound catheter would be a new idea for groin lines. Could allow for ambulation, but the conditions needing something like that would be relatively uncommon.
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