The safety and feasibility of Movement On renal replacement therapy via Vascath Evaluation in ICU patients: a pilot study

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Some patients are admitted to the intensive care unit (ICU) either with renal failure or develop renal failure during their stay. Renal failure in ICU is often treated with continuous renal replacement therapy, usually continuous veno-venous haemofiltration (CVVH) or continuous veno-venous haemodiafiltration (CVVHDF). The nature of continuous renal replacement therapy is that it is run over consecutive 24 hour periods (as long as the circuit remains patent). However, there is wide variability in the mobility restrictions imposed on patients undergoing CVVH or CVVHDF therapy in ICUs and patients may often remain immobilised and bed-bound whilst on renal replacement therapy. These mobility restrictions may contribute to the adverse effects of immobilisation in ICUs and there is some evidence to suggest that immobilisation secondary to a vascular catheter (vascath) increases risk of blood clots. Although there is no empirical evidence to suggest that mobilisation of patients with a vascath is detrimental, vascath manufacturers provide no guidance around the specifications of vascaths with movement. In some settings, patients undergoing CVVHDF or CVVH do mobilise out of bed and there is no evidence with which to guide practice around this. Empirical data is required to demonstrate the effects of patient movement on renal replacement therapy flows via vascath and treatment cessation in ICU. However, prior to determining the effect of movement on CVVHDF flows, the safety and feasibility of moving patients on renal replacement therapy must be established. This pilot study will look at patients who have been admitted to an ICU and are requiring continuous renal replacement therapy via a vascath. The aim is to see if it is safe to move and mobilise patients who are having continuous renal replacement therapy via the vascath. Possible adverse events may involve the vascath being pulled out, clotting at the catheter site or in the blood vessels, bleeding or bruising at the catheter site. The settings and parameters on the dialysis machine will be measured to establish a baseline standard of renal replacement therapy flows and performance for comparison in future studies. The collected data will be analysed for safety and assessed for the feasibility of moving the hip or mobilising patients on CVVH or CVVHDF. The project will be written up for publication in an Australian Journal. Depending on the result of this pilot study, a study powered to examine the effects of mobilisation on haemofiltration circuit life may follow.