Mobilizing While On CRRT

[yoj1001]

Hi all!

just wondering if anyone in your unit do ambulate or sit out of bed your patients while on continuous renal replacement therapy?

I just came across into one of the research article that it is safe to do it..

many thanks!

[chare]

Would you post the article citation?

[Sun0408, ASN, RN]

I would like to see it actually done. Walking would almost be impossible. Our machine goes nuts if one of the bags on the scale move. If the lines move too much it will again alarm. I can see sitting in a chair but not walking. I will add many of our CRRT pts are also on many pressors and on the vent, not a whole lot is movement coming from them.

[spacemonkey15]

We sit out patients who are having filtration, but it's not practical to walk them while they're attached.

[yoj1001]

This is the research im referring to. There is also one literature i saw that was done in Michigan.

Critical Care | Full text | Early mobilization on continuous renal replacement therapy is safe and may improve filter life

[calivianya, BSN, RN]

So few of the patients are well enough to even be conscious that it's not practical. The rest are usually extremely weak and couldn't walk anyway.

I can't really picture having someone stable enough to walk on CRRT.

[Dranger]

To be fair the study never really looked ambulation.

"(1) passive bed exercises, (2) sitting on the bed edge or (3) standing and/or marching" were the three interventions. My guess is that most patients would make it to 1 only.

[ausrnurse]

I wouldn't mobilise a patient on dialysis back when I was a dialysis nurse, let alone an ICU patient with a a bunch of other things going on. I have no problem with sitting out in a chair though, although I know a lot of nurses I work with won't do it because they think it's dangerous in case of hypotension/cardiac arrest, however both of those things can be managed in a chair (our chairs are the same as used in a renal unit so they have a CPR function and a trendelenburg option). I'd prefer to do it with a SLED type therapy than a CVVHD however.

[Lennonninja, MSN, APRN, NP]

I've seen one patient in my MICU able to sit in the chair during CVVH, but like others have said, the vast majority of ours are vented.

[Rocknurse, MSN, APRN, NP]

As a nurse with a dialysis AND a critical care certification, I would say no. If a patient has an IJ then possibly get them out of bed and stand on the spot. With a femoral line, forget it. Our hospital policy actually forbids us to get patients out of bed with a femoral line. There's too many risks: line displacement, vessel rupture, clotting, hypotension...too many to think of. It's easy to disconnect a patient and recirculate the system (if you have the appropriate machine) and mobilize the patient while not attached. 20 minutes off is not going to make a difference to your creatinine clearance.

[arnwest]

We've done it with a couple of patients who were on CVVH for weeks, once they were stabilized, but just couldn't tolerate hemo. We didn't get them up to walk, just slid them out of bed to the chair. It's kind of like getting a vented patient out of bed.It's by no means practical or easy, but anything to increase mobility.