Femoral Catheter‐Related Adverse Events during Physical Rehabilitation of Patients with Critical Illness: A Systematic Review

BACKGROUND: Physical rehabilitation is a recommended practice in critical care. However, femoral catheters are commonly viewed as barriers to mobility, extending bed rest. AIM: To determine the incidence of femoral catheter-related adverse events during physical rehabilitation sessions of patients with critical illness. STUDY DESIGN: Systematic review following PRISMA guidelines. MEDLINE, Web-of-Science, LILACS and CINAHL were searched from inception to 27 June 2025. Eligible studies included adults who received physical rehabilitation while a femoral catheter was in place. The primary outcome was the incidence rate (exact Poisson methods) of catheter-related adverse events occurring during or immediately after rehabilitation sessions. Data were synthesised descriptively, and study-specific incidence rates were calculated. Risk of bias was assessed using Joanna Briggs Institute tools. The protocol was registered in PROSPERO (CRD42020178029). RESULTS: Fifteen studies were included, involving 504 patients and 1846 rehabilitation sessions delivered with femoral catheters. Activities ranged from cycling in bed to walking. A total of 19 catheter-related adverse events were identified across four studies (27%). The overall incidence rate was 3.8 (95% CI 2.3-5.9) per 100 patients and 0.81 (95% CI 0.45-1.34) per 100 sessions. Incidence rates per 100 patients were 1.3 (95% CI 0.4-3.4) for mixed venous/arterial, 0.0 (95% CI 0.0-4.8) for haemodialysis and 11.8 (95% CI 6.6-19.5) for intra-aortic balloon pump catheters. Incidence rate per 100 rehabilitation sessions solely occurred for intra-aortic balloon pump catheters (3.5 [95% CI 2.0-5.7]). CONCLUSIONS: Physical rehabilitation in patients with femoral catheters appears to be safe, with a low incidence of adverse events. RELEVANCE TO CLINICAL PRACTICE: Femoral catheters should not be considered an absolute contraindication to mobilisation, supporting efforts by nursing and rehabilitation professionals to minimise bed rest. REVIEW PROTOCOL REGISTRATION: The review protocol was prospectively registered in PROSPERO (International Prospective Register of Systematic Reviews), registration number CRD42020178029.