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

ABSTRACT 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.