Dialysis chair -> stretcher

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medicdan

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For everyone here who works for a private ambulance, and regularly does dialysis calls, a question.

My company has several dialysis patients who are totally non-ambulatory, and for several reasons, cannot sit safely. We bring them in from SNFs, and usually transfer them to the stretcher using their sheet. The particular clinics they go to do not have beds, but only chairs, which can be converted to be semi-horizontal. We often drop our stretcher down and using the same sheet, pull (and lift over the side) the patient into the chair, or back to the stretcher. Aside from the fact we need to lift the patient significantly when going back to the stretcher, I run into a significant problem.

I am a tall guy and it is just plain uncomfortable, and sometimes hard to get down as low as the chairs to transfer the patient. In terms of ergonomics, or back health, it is terrible. The chair is too low for me to bend down safely, and too high for me to be effective kneeling on the ground (trust me, I’ve tried, and it’s just plain disgusting).

How do others do this? Is there a trick or a method I am missing? We are seeing power cots, etc, that claim to reduce workplace injury on emergencies at least, but not reducing the strains of everyday calls.

Thanks
Dan
 
no tricks. I guess you need to get shorter.
 
emt.dan said:
For everyone here who works for a private ambulance, and regularly does dialysis calls, a question.

My company has several dialysis patients who are totally non-ambulatory, and for several reasons, cannot sit safely. We bring them in from SNFs, and usually transfer them to the stretcher using their sheet. The particular clinics they go to do not have beds, but only chairs, which can be converted to be semi-horizontal. We often drop our stretcher down and using the same sheet, pull (and lift over the side) the patient into the chair, or back to the stretcher. Aside from the fact we need to lift the patient significantly when going back to the stretcher, I run into a significant problem.

I am a tall guy and it is just plain uncomfortable, and sometimes hard to get down as low as the chairs to transfer the patient. In terms of ergonomics, or back health, it is terrible. The chair is too low for me to bend down safely, and too high for me to be effective kneeling on the ground (trust me, I’ve tried, and it’s just plain disgusting).

How do others do this? Is there a trick or a method I am missing? We are seeing power cots, etc, that claim to reduce workplace injury on emergencies at least, but not reducing the strains of everyday calls.

Thanks
Dan
Click to expand...

I used the taco slide for dialysis patients.
 
I wish I had a good trick also. Try working at least one to two codes a week in a dialysis center with the position of that chair, the dialysis machine and a dozen other patients attached to machines in one cramped pod. We had one patient arrest while being delivered by 2 EMTs. They seemed puzzled as to why we hijacked their stretcher when they wanted to put an apneic patient onto one of those chairs.
 
How tall are you? I'm 6'3 and I have no problem, just bend at the knees, a little balance, a little flexibility and a little strength and you're fine. We usually do a high/low and I make sure to get the high end. I don't know about your specific dialysis centers but at all of the ones I've been to have removeable arms on the chairs, if you pop those off and you already have a sheet under the patient you can do a sheet draw like any other time we move a patient.
 
marineman said:
How tall are you? I'm 6'3 and I have no problem, just bend at the knees, a little balance, a little flexibility and a little strength and you're fine. We usually do a high/low and I make sure to get the high end. I don't know about your specific dialysis centers but at all of the ones I've been to have removeable arms on the chairs, if you pop those off and you already have a sheet under the patient you can do a sheet draw like any other time we move a patient.
Click to expand...

Not all dialysis have that much room or the fancy chairs. To meet demand, some centers are also very cramped for space.
 
VentMedic said:
Not all dialysis have that much room or the fancy chairs. To meet demand, some centers are also very cramped for space.
Click to expand...

Hahaha. There's usually only two or three and they are usually occupied by ambulatory patients!
 
I'm 6'3'', I'll try to explain, but it's difficult without showing you in person.

Any time that I do a head to toe lift, I'll take the top and position the chair and stretcher to form a V, with me standing in the gap between the chair and cot. This allows you to get right up next to the pt, and pull vertically, close to your body, like a conventional deadlift. You're preventing the action of leaning over the pt with semi-straight legs to lift, placing undue stress on your lumbar region. Once you've lifted the pt, just hold them with an isometric contraction and pivot (your whole body as one unit, not rotation of your torso only) to the stretcher. New partners show concern for potentially dropping the pt this way, but I've always had the pt securely in my grasp with this method. the further away from your body you place the load will exponentially increase the stress on your L-spine.

execute a BB deadlift properly - keep the bar in contact with your legs on the way up. Next, place the bar a few inches from your shins, and lift the load a few inches away from your body. See the difference? Do this with a fairly light weight, so as not to injure yourself.

Another thing, when doing a sheet slide (taco slide), keep the load near your umbilical/belt region. It's optimal for lifting power and leverage. Lfting from the Cx or shoulder area gives you a much weaker pull, unduly stresses the shoulders, and I find that I feel it in my lower back in a bad way.

Need proof? Go to the cable row machine, set the load, and pull it into your lower abd region. Next, pull it to your face or neck. Alternatively, do a BB bent over row. Same thing, pull to your lower abd/upper pelvic region. then pull the weight to your neck. Feel the difference.

Hope this helps.
 
The way some centers are designed, or lack of, one person is going to be leaning across the stretcher and will have to lift the patient out of the chair and over the arm of the chair onto the stretcher. It is very difficult to balance the patient with a halfway over pull on the arm of a chair. There is rarely room to get between the stretcher and chair due to the closeness of the dialysis machines on either side. As well, if you do a head to toe lift you may have to do a full twist of your torso which is not a good idea.
 
I didn't realize that things were THAT tight. Maybe grab two more people if available for a side to side lift. Crisscross your near arm with the other lifter so that the person near the head is grabbing at the shoulder and hip, and the other person is grabbing by the knee and mid abd. region. That should work.
 
46Young said:
I didn't realize that things were THAT tight. Maybe grab two more people if available for a side to side lift. Crisscross your near arm with the other lifter so that the person near the head is grabbing at the shoulder and hip, and the other person is grabbing by the knee and mid abd. region. That should work.
Click to expand...

That's about what we have to do especially when transferring to a gurney for transport to the ICU. Sometimes we have to move the patient totally from the chair and carry to the gurney that can not be moved alongside the chair safely because of the close proximity of the other patients or lift the patient that high in a safe move.
It takes at least 4 people for a safe move.
 
When I worked IFT we would recline the chair as far as possible and put the head of our stretcher under the foot rest and slide the pt down. It takes at least one dialysis worker to secure the stretcher from bolting on ya but it works. Of course this was for our larger patients and we were lucky enough to have hydrolyic stretchers.
 
Medic744 said:
When I worked IFT we would recline the chair as far as possible and put the head of our stretcher under the foot rest and slide the pt down. It takes at least one dialysis worker to secure the stretcher from bolting on ya but it works. Of course this was for our larger patients and we were lucky enough to have hydrolyic stretchers.
Click to expand...

This, for larger patients it was al ife saver. No one I ever worked with was over 6 foot so I never had the issue you describe but try the slide. It's pretty damn easy. Specially when you have a facility with chairs without the removable side, and a 450 lbs lady.
 
When I worked IFT we would recline the chair as far as possible and put the head of our stretcher under the foot rest and slide the pt down. It takes at least one dialysis worker to secure the stretcher from bolting on ya but it works.
Click to expand...

The Taco Slide! We used that all the time, especially with bigger patients. It was easier on our backs, easier on theirs too because they didn't risk getting dragged over the side of the chair.
 
I want a new dialysis center with about another 1000 sq ft of room. But then, we would get another 100 patients to occupy that space.
 
Thanks everyone for the advice/ideas. Some of the clinics I frequent really dont have much space, but I will try some of this stuff.
 
That is so weird... All of the dialysis centers here have really small lobbys but the treatment area is huge with lots of open space. It's hospital rooms we have trouble transferring the patients in sometimes! Especially double occupancy rooms.
 
Medic744 said:
When I worked IFT we would recline the chair as far as possible and put the head of our stretcher under the foot rest and slide the pt down. It takes at least one dialysis worker to secure the stretcher from bolting on ya but it works. Of course this was for our larger patients and we were lucky enough to have hydrolyic stretchers.
Click to expand...

This is by far the easiest and safest way to transfer the patient, not to mention the easiest on the old back muscles. Getting the staff to hold the cot is usually the hardest part. Whoever designed these chairs never took non-ambulatory patients into account.
 
Medic744 said:
When I worked IFT we would recline the chair as far as possible and put the head of our stretcher under the foot rest and slide the pt down. It takes at least one dialysis worker to secure the stretcher from bolting on ya but it works. Of course this was for our larger patients and we were lucky enough to have hydrolyic stretchers.
Click to expand...

Do you stand/pull from the sides of the patient?
 
Sasha said:
That is so weird... All of the dialysis centers here have really small lobbys but the treatment area is huge with lots of open space. It's hospital rooms we have trouble transferring the patients in sometimes! Especially double occupancy rooms.
Click to expand...

Same, we have ALOT of centers here. The lobbys can be on the small size but the treatment rooms are always huge. One facility has two very large treatment rooms probably a couple thousand square feet total if not more.
 
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