CRRT and mobility

  1. 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!
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  2. 32 Comments

  3. by   MLB4
    We don't get our CRRT patients OOB. Usually our patients are hemodynamically unstable if on CRRT and do not tolerate ambulation. I haven't looked into the evidence on it. We have mobility criteria that is assessed on each patient and we rule out mobility on patients who are hemodynamically unstable with 2 or more vasopressors, increase in vasopressors, low BP, as well as many other criteria.. The patient just has to meet one of the criteria to fail the screen. Most of our patients are on CRRT FAIL our mobility screen.
  4. by   Chisca
    The patient is on CRRT because he is too unstable for regular hemodialysis. The fact that it is run through an extracorporeal blood circuit should also cause you to reconsider.
  5. by   NPOaftermidnight
    This sounds a little too aggressive to me, I don't know that I would agree to ambulate such a patient. I have, however, gotten "stable" CRRT patients OOB to cardiac chair.

    I wonder if there is any evidence re: ambulating CRRT pts? It doesn't seem like a good idea in the first place but I would say a femoral vascath is a definite contraindication, so that's something to consider as well.
  6. by   offlabel
    We ambulate all of our ecmo patients within 2 hours of admission to the unit. It was a DNP capstone project of on of our managers. Very successful.
  7. by   billswife
    Quote from offlabel
    We ambulate all of our ecmo patients within 2 hours of admission to the unit. It was a DNP capstone project of on of our managers. Very successful.
    Could you tell me some details, rationale, risk vs. benefits, process you utilize, that kind of thing? Appreciate the info!
  8. by   hidethecallbell
    We lead an early mobilization program and evidence shows that it leads to shorter hospital stays and decreases mortality. We mobilize many of our CRRT patients by either doing bedside exercises and sitting them in a chair. If they need to ambulated, return the blood and temporarily discontinue treatment for a walk with PT. Does it seem like an inconvenience? Sure it does, but if they are hemodynamically stable, do it - they benefit from moving. Our ECMO pts ambulate as well, it used to be a circus moving these patients but now they have portable treadmills for the pts to walk at the bedside.
  9. by   offlabel
    Quote from billswife
    Could you tell me some details, rationale, risk vs. benefits, process you utilize, that kind of thing? Appreciate the info!
    Early mobilization of patients receiving extracorporeal membrane oxygenation: a retrospective cohort study | Critical Care | Full Text

    Actually, I was joking because the idea seemed so impractical.... jokes on me I guess...
  10. by   ErraticThinkerRN
    Usually patients on CRRT are hemodynamically unstable. That's one of the clinical indications for CRRT. The AACN has put out several pieces, including a few protocols, for determining exclusion criteria for early mobility as well as for determining stages of mobility. You can literally just google them. I'm generally against doing much more than active range of motion and maybe chair mode in the bed if you have that capability while the patient is on CRRT. If the patient can walk around, then they're just not a CRRT candidate. They should be getting HD. The corollary to that being that if a patient is sick enough to be on CRRT, they probably don't meet AACN criteria for ambulation in early mobility protocols.

    The point about walking ECMO patients is sort of apples and oranges considering that ECMO has broader range of uses from super acute, super sick patients to walking, talking stable patients who are using ECMO as a bridge to a lung transplant or a heart transplant. CRRT on the other hand is for patients too unstable to tolerate HD. Generally speaking, you can't compare a stable ECMO patient walking to a patient on CRRT since the populations are different and the reasons for starting ECMO vary, but the indications for CRRT are usually pretty clear.
  11. by   Cook26
    Quote from offlabel
    The hospital I worked at when I was a bedside nurse did walking ECMO. Didn't seem very safe to have a centrally cannulated patient up and moving around when one slip could mean exsanguination. As far as I know there haven't been any mortality issues, but it still seems crazy as hell.
  12. by   cbob
    that seems very risky. I would hate to be the nurse that ambulates someone on crrt. That would freak me out. I would make sure that the person that has in acted that policy is there while you ambulate them instead of them being in their office doing CNP stuff. I get a little angry about people making policy and never being involved in the actual process. I would request the CNP to be present when you mobilize them.
  13. by   billswife
    Quote from cbob
    that seems very risky. I would hate to be the nurse that ambulates someone on crrt. That would freak me out. I would make sure that the person that has in acted that policy is there while you ambulate them instead of them being in their office doing CNP stuff. I get a little angry about people making policy and never being involved in the actual process. I would request the CNP to be present when you mobilize them.
    This is exactly the situation I am dealing with. The last CRRT person she insisted should be ambulated coded upon standing. Of course, the CNP in question was nowhere to be found!
  14. by   traumaRUs
    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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