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Early mobilization on continuous renal replacement therapy is safe and may improve filter life.

Wang YT, Haines TP, Ritchie P, Walker C, Ansell TA, Ryan DT, Lim PS, Vij S, Acs R, Fealy N, Skinner EH - Crit Care (2014)

Bottom Line: No adverse events were detected.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).These findings have significant implications for the current mobility restrictions imposed on patients with femoral vascular catheters for renal replacement therapy.

View Article: PubMed Central - PubMed

ABSTRACT

Introduction: 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.

Trial registration: Australian and New Zealand Clinical Trials Registry ACTRN12611000733976 (registered 13 July 2011).

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Comparison of femoral filter life. Preintervention filters are those that patients had prior to recruitment and intervention. Intervention filters are those in place during the time the intervention took place. Postintervention filters are those placed after the intervention filter.
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Fig2: Comparison of femoral filter life. Preintervention filters are those that patients had prior to recruitment and intervention. Intervention filters are those in place during the time the intervention took place. Postintervention filters are those placed after the intervention filter.

Mentions: Mean filter life at the time of the intervention was 19.5 hours (SD ±13.8), with no difference observed between femoral and nonfemoral filters (21.6 (15.1) hours vs 15.3 (9.9) hours, P = 0.45). Filters lasted for a mean of 17.4 (SD 12.7) hours after intervention. Intervention filters lasted longer than nonintervention filters (regression coefficient = 13.8, robust 95% confidence interval (CI) = 5.0 to 22.6, P = 0.003). A difference was also found in the femoral filter subgroup (regression coefficient = 15.7, robust 95% CI = 4.6 to 26.7, P = 0.008), but not in the nonfemoral access filter subgroup (regression coefficient = 9.2, robust 95% CI = -6.0 to 24.4, P = 0.20) (Figure 2).Figure 2


Early mobilization on continuous renal replacement therapy is safe and may improve filter life.

Wang YT, Haines TP, Ritchie P, Walker C, Ansell TA, Ryan DT, Lim PS, Vij S, Acs R, Fealy N, Skinner EH - Crit Care (2014)

Comparison of femoral filter life. Preintervention filters are those that patients had prior to recruitment and intervention. Intervention filters are those in place during the time the intervention took place. Postintervention filters are those placed after the intervention filter.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4262200&req=5

Fig2: Comparison of femoral filter life. Preintervention filters are those that patients had prior to recruitment and intervention. Intervention filters are those in place during the time the intervention took place. Postintervention filters are those placed after the intervention filter.
Mentions: Mean filter life at the time of the intervention was 19.5 hours (SD ±13.8), with no difference observed between femoral and nonfemoral filters (21.6 (15.1) hours vs 15.3 (9.9) hours, P = 0.45). Filters lasted for a mean of 17.4 (SD 12.7) hours after intervention. Intervention filters lasted longer than nonintervention filters (regression coefficient = 13.8, robust 95% confidence interval (CI) = 5.0 to 22.6, P = 0.003). A difference was also found in the femoral filter subgroup (regression coefficient = 15.7, robust 95% CI = 4.6 to 26.7, P = 0.008), but not in the nonfemoral access filter subgroup (regression coefficient = 9.2, robust 95% CI = -6.0 to 24.4, P = 0.20) (Figure 2).Figure 2

Bottom Line: No adverse events were detected.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).These findings have significant implications for the current mobility restrictions imposed on patients with femoral vascular catheters for renal replacement therapy.

View Article: PubMed Central - PubMed

ABSTRACT

Introduction: 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.

Trial registration: Australian and New Zealand Clinical Trials Registry ACTRN12611000733976 (registered 13 July 2011).

Show MeSH
Related in: MedlinePlus