title: Early mobilization on continuous renal replacement therapy is safe and may improve filter life.
abstract: BACKGROUND
  Despite studies demonstrating benefit, patients with femoral vascular catheters placed for continuous renal replacement therapy are frequently restricted from mobilization. No researchers have reported filter pressures during mobilization, and it is unknown whether mobilization is safe or affects filter lifespan. Our objective in 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 underwent one of three levels of mobilization intervention as appropriate: (1) passive bed exercises, (2) sitting on the bed edge or (3) standing and/or marching. Catheter dislodgement, haematoma and bleeding during and following interventions 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 any of the interventions. No adverse events were detected. The intervention filters lasted longer than the nonintervention filters (regression coefficient = 13.8 (robust 95% confidence interval (CI) = 5.0 to 22.6), P = 0.003). In sensitivity analyses, we found that filter life was longer in patients who had more position changes (regression coefficient = 2.0 (robust 95% CI = 0.6 to 3.5), P = 0.007). The nursing workloads 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.
  
  
  BACKGROUND
  Australian and New Zealand Clinical Trials Registry ACTRN12611000733976 (registered 13 July 2011).
authors: Yi Tian
authors: YT
authors: Wang
authors: Terry P
authors: TP
authors: Haines
authors: Paul
authors: P
authors: Ritchie
authors: Craig
authors: C
authors: Walker
authors: Teri A
authors: TA
authors: Ansell
authors: Danielle T
authors: DT
authors: Ryan
authors: Phaik-Sim
authors: PS
authors: Lim
authors: Sanjiv
authors: S
authors: Vij
authors: Rebecca
authors: R
authors: Acs
authors: Nigel
authors: N
authors: Fealy
authors: Elizabeth H
authors: EH
authors: Skinner
mesh_terms: D003422:Critical Care / Q000379:methods*; D004434:Early Ambulation / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005374:Filtration / Q000295:instrumentation / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D011446:Prospective Studies; D017582:Renal Replacement Therapy / Q000295:instrumentation / Q000379:methods*; D018709:Statistics, Nonparametric; D062666:Vascular Access Devices / Q000009:adverse effects; D014739:Victoria