krispywaffle23

While the vast majority of my CRRT patients are intubated and on one or more pressors or inotropes, I have cared for relatively mobile patients who are very volume overloaded and either have failed diuresis, have an AKI from diuresis/other reason and are no longer producing urine, or have CKD (whether related to the heart failure or not) that evolves to ESRD. These patients are few and far between but as you all know, a low BP for most of these heart failure patients is usually a good thing (to a point) for afterload, however, because of this they would not tolerate normal HD at the time. Example: I cared for one chronically on dobutamine at home that I got up to the chair x3/day and when their machine clotted off (even happened on citrate a few times!) we seized the opportunity to disconnect them and ambulate them in the hallway while we waited for the HD RN to replace the filter. The attending also requested once for us to do it solely for the purpose of ambulating the patient. Obviously they were stable enough that their lytes would tolerate being off the machine for a bit and they weren't in pulmonary edema from fluid overload (we were doing CVVH, not SCUF just to clarify). Please NEVER unplug your CRRT machine; I learned the hard way once as a new ICU RN after an experienced RN told me it was fine to unplug it. The entire machine shuts down and I could not return their blood because the filter locked:nailbiting:! We all learned a lesson that day. Anyways, it's not impossible but I would say rare to ambulate a CRRT patient. Also as far as the ambulating ECMO joke, I had the opportunity to go to NTI this year and there are a few centers that are ambulating their VV ECMO patients when they are cannulated with the dual lumen catheter in the IJ! It sounded like most of them were usually CF patients awaiting lung transplant. Obviously it takes an army but it is being done! Crazy but awesome :)