CRRT and mobility

Specialties MICU

Published

So here is my question: our ICU prides itself on being pro-active with new evidence based practices. We have an aggressive "early mobility" program. One of our hospitality-CNPs insists that we attempt to walk patients while they are on CRRT. The last one coded, but she is undeterred. What are your thoughts and your hospital practices in this area? Thanks for your input!

Specializes in Nephrology, Cardiology, ER, ICU.

I'm a nephrology APN and no way in the world should this be done - uh just no way. BTW, CRRT don't run on batteries, you have to plug them into the wall - how the heck did you ambulate this pt anyway?

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I'm a nephrology APN and no way in the world should this be done - uh just no way. BTW, CRRT don't run on batteries, you have to plug them into the wall - how the heck did you ambulate this pt anyway?

My question exactly. How the heck??? My first thought was that this has to be a joke.

A patient that needs CRRT (which as evidence suggests does not improve outcomes...just saying...) is in no way able to ambulate. I am scratching my head on this one.

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I've never seen (in my very limited experience anyway) a CRRT patient that wasn't intubated! The hospitals I work in use a regular dialysis machine with a CRRT mode and the tubing is generally 36" long - certainly not long enough. not to mention CRRT patients generally have a temporary catheter sticking out of the side of their neck....

Holy hell your CNP is crazy!

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Amen, Brother/Sister (wasn't sure) !!!!! Wish I was at your​ hospital !!!!

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I'm a nephrology APN and no way in the world should this be done - uh just no way. BTW, CRRT don't run on batteries, you have to plug them into the wall - how the heck did you ambulate this pt anyway?

Amen, Bother/Sister! Wish I worked at your​ hospital!!!

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I swear to you this NOT a joke, but it IS a nightmare! I HATE being put in this position. I HATE my patients being put in this position. I especially hate that it is being done to satisfy the personal ego of a CNP that no longer actually cares for real patients!

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I've never seen (in my very limited experience anyway) a CRRT patient that wasn't intubated! The hospitals I work in use a regular dialysis machine with a CRRT mode and the tubing is generally 36" long - certainly not long enough. not to mention CRRT patients generally have a temporary catheter sticking out of the side of their neck....

Holy hell your CNP is crazy!

Thank you for saying what I can't!!!!!

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Specializes in PICU.

I have taken care of non-intubated pts on CRRT, but they were still very sick. I couldn't imagine ambulating any of them, it would cause too many fluid shifts, if you are aggressively pulling off fluid, how does the shif from lying to sitting to walking. It could potentially affect how much you could pull off. Also, the CRRT circuit needs to be plugged in to a wall outlet, I haven't heard of a portable CRRT. When pts have to go to CT scan, or OR, or out of the ICU for any reason you can't bring the circuit with you. Yikes, sorry OP.

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I swear to you this NOT a joke, but it IS a nightmare! I HATE being put in this position. I HATE my patients being put in this position. I especially hate that it is being done to satisfy the personal ego of a CNP that no longer actually cares for real patients!

My LTACH had a lot of trached/vented/HD patients (though I'll confess to being ignorant on CRRT). There was a specific mobility protocol that we charted on q shift as to their mobility level and the reasoning behind it. If they were hemodynamically unstable, we charted that, and it limited their required mobility for the shift. Does your hospital have a specific mobility protocol for unstable patients? If so, I would hope that taking that protocol and the code event to someone besides the CNP would get some attention. I would hope that most people would be alarmed at the prospect of killing patients for the sake of early ambulation.

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My LTACH had a lot of trached/vented/HD patients (though I'll confess to being ignorant on CRRT). There was a specific mobility protocol that we charted on q shift as to their mobility level and the reasoning behind it. If they were hemodynamically unstable, we charted that, and it limited their required mobility for the shift. Does your hospital have a specific mobility protocol for unstable patients? If so, I would hope that taking that protocol and the code event to someone besides the CNP would get some attention. I would hope that most people would be alarmed at the prospect of killing patients for the sake of early ambulation.

It seems like a no brainer, right?

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My LTACH had a lot of trached/vented/HD patients (though I'll confess to being ignorant on CRRT). There was a specific mobility protocol that we charted on q shift as to their mobility level and the reasoning behind it. If they were hemodynamically unstable, we charted that, and it limited their required mobility for the shift. Does your hospital have a specific mobility protocol for unstable patients? If so, I would hope that taking that protocol and the code event to someone besides the CNP would get some attention. I would hope that most people would be alarmed at the prospect of killing patients for the sake of early ambulation.

CRRT (Continuous Renal Replacement Therapy) is as it states - continuous dialysis. The blood pump and dialysate flows are slower and it can run for days at a time. Certainly not conducive to ambulation. Hell we don't even let our inpatient dialysis patients sit up in bed - and they are only on for 4 hours. Our PT's won't even come and do range of motion on HD patients in the ICU - they defer until they are done with HD.

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No way! I sat up a CRRT patient for comfort and she almost coded. I'd outright refuse. Make whoever is telling you this call the nephrologist and get consent, then walk them herself. Seriously.

I'm sorry you're in this position but especially sorry for the patients of new nurses on your unit who may not question her.

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