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Safety and Patients' Response to Ambulation With a Pulmonary Artery Catheter in the Cardiac Intensive Care Unit
Elisa Mattioli1, Bienvenido Tabuzo1, Prasama Sangkachand1
1Elisa Mattioli and Bienvenido Tabuzo Jr are both a clinical nurse III and Liberty Reyes is a clinical nurse II in the cardiac intensive care unit, Yale New Haven Hospital, New Haven, Connecticut. Prasama Sangkachand is a service line educator, Heart and Vascular Center, and Janet Parkosewich is the nurse researcher, Yale New Haven Hospital. Marjorie Funk is the Helen Porter Jayne and Martha Prosser Jayne Professor Emerita of Nursing, Yale School of Nursing, West Haven, Connecticut.
Background:
Early mobilization of patients in the intensive care unit can be beneficial, but evidence is insufficient to indicate whether allowing patients with an indwelling pulmonary artery catheter to walk is safe.
Objective:
To describe the physiological and emotional responses to ambulation in patients with heart failure and a pulmonary artery catheter.
Methods:
This prospective, descriptive study included 19 patients with heart failure monitored with a pulmonary artery catheter in a cardiac intensive care unit. Each patient, accompanied by a nurse, walked with continuous observation of heart rate and rhythm and pulmonary artery tracing on a transport monitor. Pulmonary artery catheter position and waveform, arrhythmias, and perceived levels of exertion and fatigue were recorded before and after each walk. The distance ambulated was documented. One to 3 times per week, nurses administered a questionnaire addressing patients' sense of well-being.
Results:
The 19 patients had 303 walks (range, 1-68; median, 7). During 7 patient walks (2.4%), catheter migration of 1 to 5 cm occurred, but no arrhythmias or waveform changes were observed. Changes in exertion and fatigue were significant (P < .001, paired t test), but levels of both were minimal after walking. Patients expressed physical and emotional benefits of walking.
Conclusions:
This study provides preliminary evidence that for hemodynamically stable patients with heart failure, ambulating with a pulmonary artery catheter is safe and enhances their sense of well-being. The presence of an indwelling pulmonary artery catheter should not preclude walking.