© Springer International Publishing Switzerland 2017Andrew Loveitt, Margaret M. Martin and Marc A. Neff (eds.)Passing the Certified Bariatric Nurses Exam10.1007/978-3-319-41703-5_24
24. Special Equipment for the Bariatric Patient
Department of General Surgery, Rowan University, Stratford, NJ, USA
The bariatric patient represents a patient population that requires dedicated hospital equipment. The standard hospital equipment is not sufficient for these patients. Hospital beds, patient chairs, OR tables, wheelchairs, radiologic tables, surgical instruments, etc., are rated for a specific weight maximum. For the bariatric patient, this needs to be taken into consideration.
When a hospital becomes accredited by the American College of Surgeons, they must meet certain standards of care for this patient population. Weight capacities must be documented by the manufacturer’s specifications, and this information must be readily available to relevant staff. The staff must also be trained on this equipment and its proper usage. Centers do not need to change all of the equipment, furniture, and instruments throughout the entire facility. This requirement only applies to those areas where patients undergoing metabolic and bariatric surgery receive care, including the operating room, emergency department, radiology suite, designated metabolic and bariatric unit, and waiting areas . Most equipment defined as bariatric has a 300–900 pound weight limit – though there is not a specific width or designated weight limit that defines bariatric products .
Entrances and routes of the bariatric patient must provide adequate space to accommodate the bariatric wheelchair (39–49 in) with a 6-foot turning radius. The typical hospital elevators will accommodate 2000–3000 pounds, which may be exceeded when considering the weight of the patient, the patient’s bed, the transport staff, and other specialized equipment. The Bariatric Room Advisory Board states that the patient rooms should be 14 ft x 15 ft to sufficiently accommodate the patient and the equipment. Patient bathrooms must have floor-mounted toilets and sinks as opposed to the typical wall mount design. This allows for a higher static load. The toilets and showers must also have enough space on either side for staff assistants. All of these things must be taken into consideration when designing a bariatric unit .
Bariatric equipment must combine load limit, appropriate dimensions, and a design aesthetic that blends with the environment by which a patient’s and caregiver’s comfort and safety are ensured. A safe working load or working load limit is a rating for bariatric beds, lifts, and other equipment. It is the largest load that equipment can safely lift, whereas the static load is the maximum amount of nonmoving weight a piece of equipment can bear. This would be applied to furniture, handrails, grab bars, and toilets, for example. The dynamic load accommodates the weight of a patient in falling motion. Dynamic load must always exceed the static load. This load rating is critical as unstable patients often will reach out to grab or lean upon items like grab bars, furniture, or railings to stop a fall. As a rule of thumb, a falling human is double their weight. If accommodating for a bariatric population of up to 900 pounds, this equipment has to withstand an impact weight – or dynamic load – of 1800 pounds. The functional load is the level of loading intended to be typical of hard use .
Another major consideration is the operating room itself. The table must be rated for 1000 pounds and have powered movement for easy patient transfer. When the bariatric patient is on the operating room table, they have a much higher risk of developing rhabdomyolysis (the breakdown of skeletal muscle due to prolonged pressure) secondary to their increased BMI and body positioning. No studies have been done to specifically detail preventative techniques, but clinically, these patients have a lower risk of developing rhabdomyolysis if they are positioned with appropriate padding on the OR table and care is taken to ensure there are no points of increased pressure. Patients have a higher risk if placed in lithotomy or lateral decubitus position, if the operation is longer than 4 h, or if the patient’s BMI is greater than 50 g/m2 . The concern of developing rhabdomyolysis is the subsequent renal failure that can result. These patients need postoperative fluid resuscitation and close monitoring of their creatinine and creatinine kinase (CK) levels. Bariatric patients have died from renal failure secondary to rhabdomyolysis. Postoperative labs, skin exam, and reported muscle pain must be taken seriously in this patient population.
It is clear there are innumerous small details that add up to create a successful bariatric unit. Some additional considerations include high-capacity (weight and girth) CT scanners, hanging overhead trapeze to assist in immediate postop mobility, special equipment (AccuVein), and skilled phlebotomists to limit needle sticks. Comfort should also be considered. Many patients find their own CPAP (continuous positive airway pressure) machine and clothes to fit more comfortably than hospital-provided materials and should be encouraged to bring their own on the date of surgery.