Early mobilization on continuous renal replacement therapy is safe and may improve filter life (Critical Care)

IntroductionPatients with femoral vascular catheters for continuous renal replacement therapy are frequently restricted from mobilization despite studies demonstrating benefit. No studies have reported filter pressures during mobilization and it is unknown whether mobilization is safe or affects filter lifespan. The objective of this study was to test the safety and feasibility of mobilization in this population. Methods: A total of 33 patients undergoing continuous renal replacement therapy via femoral, subclavian or internal jugular vascular access catheters at two general medical-surgical intensive care units in Australia were enrolled. Patients undertook one of three levels of mobilization intervention as appropriate: a) passive bed exercises; b) sitting on the bed edge; or c) standing/marching. Catheter dislodgement, haematoma and bleeding during and following intervention were evaluated. Filter pressure parameters and lifespan (hours), nursing workload and concern were also measured. Results: No episodes of filter occlusion or failure occurred during intervention. No adverse events were detected. Intervention filters lasted longer (regression co-efficient (robust 95% confidence interval), p value: 13.8 (5.0 to 22.6), P = 0.003). Sensitivity analyses found patients who had more position changes had a longer filter life (2.0 (0.6 to 3.5), P = 0.007). The nursing workload between the intervention shift and the following shift were similar. Conclusions: Mobilization during renal replacement therapy via a vascular catheter in patients who are critically ill is safe and may increase filter life. These findings have significant implications for the current mobility restrictions imposed on patients with femoral vascular catheters for renal replacement therapy.Trial registration: Australian and New Zealand Clinical Trials Registry ACTRN12611000733976. Registered 13 July 2011.