Safety  of  Out  of  Bed  Ac/vity  and  Ambula/on  in  Pa/ents  with  Pulmonary  Artery  Catheters  A.  Pawlik,  PT;  C.  Esbrook,  OTR/L;  S.  Harrison,  PT;  C.  Steinberg,  OTR/L,  V.  Jeevanandam,  MD  

University  of  Chicago  Medicine,  Chicago,  IL,  United  States  

Background

Aims

The Intervention

Lessons Learned

Due  to  the  absence  of  literature  suppor2ng  or  refu2ng  the  prac2ce  of  mobilizing  pa2ents  with  PACs,  our  aim  was  to  gather  data  to  support  the  hypothesis  that  mobilizing  pa2ents  who  have  a  PAC  is  safe.  

Presence  of  PAC  is  not  a  contraindica2on  to  out  of  bed  ac2vity  at  UCM.    This  allows  for  retrospec2ve  analysis  via  chart  review  to  inves2gate  whether  adverse  events  occurred  in  pa2ents  who  were  mobilized  while  PAC  was  in  place  or  within  24  hours  aDer  the  PAC  was  removed.

•  Analysis  of  the  preliminary  data  supports  our  current  prac2ce  of  mobilizing  pa2ents  with  a  PAC.      

•  There  is  a  need  for  literature  to  support  PT  and  OT  prac2ces  for  consistency  across  ins2tu2ons  and  to  ensure  pa2ent  safety.      

Next Steps

Results

• Total  PT/OT  sessions  with  PAC  in  place=94  sessions  • Avg.  dura/on  of  PAC  in  place=3.6  days  • Avg.  #  of  PT/OT  sessions  per  pa/ent  with  PAC  in  place=2  sessions  

In  the  seKng  of  increased  Physical  Therapy  (PT)  and  Occupa2onal  Therapy  (OT)  involvement  in  the  ICU,  there  is  a  need  for  inves2ga2on  of  safe  mobiliza2on  prac2ces  in  the  presence  of  medical  devices.  Pa2ents  with  pulmonary  artery  catheters  (PAC)  oDen  remain  on  bed  rest  due  to  concerns  regarding  catheter-­‐related  adverse  events,  although  there  is  limited  data  describing  the  mobiliza2on  of  pa2ents  with  PACs.  Pa2ents  may  be  subjected  to  unnecessary  risk  associated  with  bed  rest  due  to  the  presence  of  a  PAC.  The  purpose  of  this  study  is  to  examine  the  incidence  of  pulmonary  artery  catheter-­‐related  events  during  PT  and  OT  sessions  in  a  cardiothoracic  surgery  intensive  care  unit  (ICU).    Addi2onally,  pa2ents  who  remain  on  bedrest  while  hospitalized  have  a  greater  need  for  long-­‐term  care  and  rehabilita2on  than  those  who  undergo  early  PT  and  OT.

•  Con2nue  data  collec2on  for  larger  sample  size  (goal=150  charts)  •  Complete  sta2s2cal  analysis  to  screen  for  trends,  associa2ons  •  Submit  and  publish  manuscript  to  disseminate  informa2on  

Contact: A. Pawlik, amy.pawlik@uchospitals.edu

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Week  1  Week  2  Week  3  Week  4  Week  5  Week  6  Week  7  Week  8  

G4P   Std.  Campaign   Baseline  

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50.00%  

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Week  1  Week  2  Week  3  Week  4  Week  5  Week  6  Week  7  Week  8  

G4P   Std.  Campaign   Baseline  

Baseline: 58.0% Standard HH Campaign: 72.3%, p<0.001 Giving for Performance: 83.9%, p=0.003

Data  Collec/on  1)  Administer  survey  to  bedside  nurses  in  cardiothoracic  surgery  ICU  regarding  loca2on  in  medical  record  of  informa2on  regarding  adverse  events    

2)  Review  charts  for  evidence  of  the  following  adverse  events  while  PAC  was  in  place  or  within  24  hours  aDer  PAC  was  removed:  •  Catheter  dislodgement  •  Bleeding  at  PAC  inser2on  site  •  New  onset  arrhythmia  •  Change  in  heart  rhythm  •  Pulmonary  hemorrhage  

Retrospec/ve  Study:      48  pa&ent  charts  currently  reviewed.  Inclusion  Criteria  •  Adults  over  age  18,  admi`ed  to  the  cardiac  surgery  or  

medical  ICU  between  January  1,  2010  and  December  7,  2013.    •  Ac2ve  referral  to  therapy  services  present  in  medical  record  

at  the  2me  they  were  admi`ed.    •  Subjects  must  have  par2cipated  in  mobility  ac2vi2es  with  

physical  or  occupa2onal  therapy  including  siKng  at  the  edge  of  the  bed,  standing,  walking  or  other  ac2vi2es  of  daily  living.  

   Exclusion  Criteria  •  Subjects  unable  or  inappropriate  to  par2cipate  with  out  of  

bed  ac2vity  while  the  PAC  was  in  place  for  other  medical  reasons  unrelated  to  the  PAC.    

•  PACs  placed  in  the  femoral  artery  

Discharge  disposi&on  (n  =  48)  •  Home  =  36      (75%)  •  Acute  Rehab  =  8        (17%)  •  SNF  =  1    (2%)  •  Deceased  =  3      (6%)  

0   20   40   60   80   100  

Sit  EOB  Stand  

Ambulate  ADLs  

%  of  pa/ents  

Ac/v

ity  

Ac/vi/es  Completed  with  PAC  in  Place  

0  

5  

10  

15  

20  

Arrhythmia   Line  dislodgement  

PA  hemorrhage  

Site  bleeding  

#  of  pa/

ents  

Adverse  Events  

Prior  to  ini2a2on  of  PT/OT   ADer  ini2a2on  of  PT/OT