the bariatric patient in the ED

see also:

• obesity and weight management
• the obese patient in the ED
• all major Australian hospitals should have bariatric facilities and procedures to safely manage these patients, although they will have restrictions on capacity for radiologic imaging
• WH procedures (intranet only):
  • Safe handling of the bariatric patient
  • The bariatric patient and medical imaging at WH
  • Brain CT for the bariatric patient presenting to WH who is over 280kg

• a bariatric patient can be defined as any patient whose weight is greater than 120kgs or any patient whose body size restricts their mobility, health or access to available services and equipment.
• bariatric patients pose major problems in the ED
  • iv access and other life saving procedures can be extremely difficult and with greater morbidity/mortality
  • physical clinical signs can be impossible to detect and evaluate leading to delayed diagnosis and misdiagnosis
  • physical transfers, nursing and pressure care are a major issue
  • appropriate beds required
    • if the patient weighs >150kgs the patient must be transferred to / from the ambulance trolley onto a bed with the appropriate SWL:
      • for patients who weigh more than 240kg or have a widest measurement (not girth) which is greater than 500mm, then the bariatric bed with a SWL of 400kg should be used, otherwise a standard 250kg SWL bed may be adequate.
  • patient bed transfers
    • see local hospital policies and procedures
    • HoverMatts used by trained personnel may be indicated
    • a lifting machine may be indicated however this will depend on the clinical constraints of the patient and will require assessment at the time of transfer
      • standard lifting machines have a capacity of 240kg
      • bariatric designated hospitals usually have a lifting machines with a capacity of 300kg
    • beds should be moved using a battery powered bed moving device, however, if this is not available, as a last resort, if the bed or trolley needs to be transported manually, a minimum of three staff members is required. Two staff members are to push from behind the bed/trolley and one staff member is to steer from the front. (Increase staff members assisting as required).
    • if the bariatric patient needs to be moved off the bed, ensure that the capacity of the equipment that they are to be moved onto is able to tolerate the patient’s weight. i.e. commode chair, bedside chair, operating table, radiology tables, catheristion lab equipment, walking and mobilisation aids.
  • radiology equipment has weight and girth limitations
    • sonography is generally limited to those under 200kg based upon bed weight limits and on operator issues.
    • general Xray facilities are usually limited to 200 or 220kg.
    • most CT scanners have a limit of 150kg or 200kg, although most bariatric designated hospitals now have CT scanners able to accommodate up to 300kg and have a larger CT bore size of 78cm instead of 70cm, while MRI scanners have capacity for up to 190kg and a bore width of 60cm although certain facilities can accommodate up to 250kg with a bore of 70cm.
    • nuclear medicine generally have a limit of around 227kg and a bore of 70cm but girth issues may limit use to those under 180kg.
    • angiography tables tend to have girth issues which may limit patient selection to around 160kg even though they may be able to carry 200-250kg depending upon the table.
    • some patients over 280kg may need transfer to veterinary radiologic centres.
  • older wards may not be suitable for patients over 100kg
  • ambulance transfers require purpose-built bariatric patient transport vehicles