Ambulation with Femoral Lines?

Specialties MICU

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Specializes in CCU, SICU, CVSICU, Precepting & Teaching.

anyone allow patient ambulation with femoral lines? anyone know of any literature endorsing this practice?

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Specializes in ICU, Research, Corrections.

It sounds dangerous. I have not read anything endorsing it. Personally, I

wouldn't want to be the ambulatee either.

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Specializes in multispecialty ICU, SICU including CV.

You didn't specify whether this was an arterial or a venous line.

Arterial -- absolutely not, no way, no how. High, high, high risk of bleeding. Most facilities will have a policy to keep all patients with femoral arterial lines on bedrest.

Venous -- I would say it is not ideal to get them out of bed. Standing up puts a lot of weight and pressure on the groin that wasn't there before, and sitting up might kink the catheter. I can't say that I've seen it done before -- usually if you are sick enough to need femoral venous access, you are sick enough to be on bedrest.

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Specializes in ICU.

How high can you put the HOB on a vented pt with a femoral art line?

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Specializes in multispecialty ICU, SICU including CV.
How high can you put the HOB on a vented pt with a femoral art line?

This varies facility to facility. At my facility, 30 degrees is ok'ed because of the VAP risk but not higher than that. Some facilities want 15 degrees.

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Specializes in CCU, SICU, CVSICU, Precepting & Teaching.

thanks. that's pretty much what i thought, but our nurse practitioners and surgeons have being writing orders for patients to be out of bed to chair and to be ambulated with femoral venous lines. i wasn't able to locate a hospital policy against the practice, although it seems rather unsafe to me. there is a policy against ambulating with femoral arterial lines, and even one against standing with a pedal art line.

so anyone know how much trouble i'd be in if something went wrong in the face of an unclear policy and an order from the provider?

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Specializes in multispecialty ICU, SICU including CV.
thanks. that's pretty much what i thought, but our nurse practitioners and surgeons have being writing orders for patients to be out of bed to chair and to be ambulated with femoral venous lines. i wasn't able to locate a hospital policy against the practice, although it seems rather unsafe to me. there is a policy against ambulating with femoral arterial lines, and even one against standing with a pedal art line.

so anyone know how much trouble i'd be in if something went wrong in the face of an unclear policy and an order from the provider?

do your docs know they still have their lines in? most surgeons are happy to get lines out and go with something more practical (like a piv) if they are well enough to be up and ambulating because of central line infection rates. for your fyi, groin lines are much more likely to get infected than a subclavian or ij just because of the "dirtier" location. if i received and order like that, i would be calling and asking them if you could pull the line so you could get them up and around. i would also let them know that you were worried about the patient's safety if they insist on leaving a groin line in and ambulating them. i think patient safety concerns trump a physician's order any day, anyway. if they insisted we were to do this, i think i would request clarification from management/your cns/cnl/education department (someone in authority able to make a decision) on what to do/not to do before i did it.

it never hurts to cover your butt.

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Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
do your docs know they still have their lines in? most surgeons are happy to get lines out and go with something more practical (like a piv) if they are well enough to be up and ambulating because of central line infection rates. for your fyi, groin lines are much more likely to get infected than a subclavian or ij just because of the "dirtier" location. if i received and order like that, i would be calling and asking them if you could pull the line so you could get them up and around. i would also let them know that you were worried about the patient's safety if they insist on leaving a groin line in and ambulating them. i think patient safety concerns trump a physician's order any day, anyway. if they insisted we were to do this, i think i would request clarification from management/your cns/cnl/education department (someone in authority able to make a decision) on what to do/not to do before i did it.

it never hurts to cover your butt.

the providers know they still have the lines in. i've discussed it with them and expressed my safety concerns. our manager has bent to the provider's will and issued an email that says it's ok to ambulate with a femoral line, but the hospital's policies don't reflect this.

i think that if they want to ambulate a patient with a femoral line, they need to show me some literature that says it's ok and change the hospital policy rather than just ignore it. but in the meantime, i have providers up my butt demanding that i ambulate these folks. i just wanted to know if anyone else has experienced the same dilemma.

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Specializes in MICU, neuro, orthotrauma.

I wouldn't want to be the nurse responsible for that.

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Specializes in Critical Care.
anyone allow patient ambulation with femoral lines? anyone know of any literature endorsing this practice?

ruby: went thru a similar issue in our cardiothoracic icu not too long ago. our anesthesia docs (who manage the unit) wanted patients with femoral lines up in the chair. we couldn't find supporting literature either and after a while, the issue went away.

that being said, i did a quick cinahl search as well as pubmed and couldn't find any study info. also looked on cochrane, to no avail. i did have a thought. have you tried contacting anyone from the infusion nursing society? they may have a position paper or it may be addressed in their standards of care. i know they have research for picc lines as well as a bundle of info re: other access issues.

link:table of contents - infusion nurses society

that is a link to their standards of care page. they might be able to help you or send you in the right direction. sorry i don't have more time, i will look it up in my aacn books at home but i don't think they have anything either. nothing on the website and i seem to recall my search in the past (looking to them as a resource) was fruitless.

i agree though that your manager's comment won't protect you. the educators at your facility or cns staff need to come up with a formal policy. otherwise, i'd refuse to do it. no policy, no way i'd expose myself. be one of those situations i'd let the doc stew about. if they are concerned about dvt's..they need to be ordering scd's and prophy. if it's muscle strength, get pt involved earlier. just my humble opinion. i'll do more research at home tomorrow. take care.

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