Untangle the Technology

Concern:

Managing multiple tubes, lines, and monitors.

Solution:

Before beginning mobility exercises, create slack in the lines and make sure all connections are secure.²

Concern:

Mobilizing mechanically ventilated patients.

Solution:

Patients are safe to move when:

• PEEP ≤10 cm H₂O
• FiO₂ ≤0.6
• ≥90% SpO₂
• ≤30 breaths/minute ³

Concern:

Preventing endotracheal extubation

Solution:

Use an endotracheal securement device.⁴

Assign someone to monitor the patient’s airway to prevent tube migration and displacement.⁵

Concern:

Avoiding kinking, breaking, or disconnecting invasive arterial lines (central, femoral, etc.)

Solution:

Inspect catheter for proper placement and signs of bleeding before the mobility session.

Adverse catheter-related events during mobility are rare.⁶

Concern:

Managing mobility effects on the renal replacement therapy catheter filter lifespan

Solution:

Mobilization may actually prolong filter life of dialysis catheters.⁷

Concern:

Safe equipment management

Solution:

Discuss needs and roles. For example:

• Respiratory therapist (RT) — Suction airway, switch patient to portable ventilation, manage ventilation ^8,9
• Physical therapist (PT) — Secure gait belt, direct mobility exercises ^9,10
• Registered nurse (RN) - Secure and manage lines, ⁹ assist PT

Concern:

Safe ventilation settings

Solution:

Mobilize patient with:

• PS or SIMV mode ¹⁰
• PEEP >10cm H₂O (use ventilator) ⁹
• PEEP <10cm H₂O (may use manual ventilation bag) ⁹

Concern:

Safe equipment management

Solution:

Streamline equipment:

• Place the chest tube suction and other containment systems on a wheeled walker.
• Put the oxygen tank and monitor on a wheelchair or double IV pole.
• Hang the pressure bag and supporting monitor cords on the wheelchair pole. ¹⁰