New Beginnings: Equipment Check

Posted by Nurse Linda in Life After Paralysis on January 19, 2022 # Health, Lifestyle

Two individuals on a boardwalk next to water. They are both using wheelchairs. As the new year has started, it is a good time to think about looking forward. One topic that is often overlooked is checking your equipment. The items that you use every day often become second nature which does not include a quick check of how your equipment is holding up. On occasion, a good inspection is needed to make sure everything is functioning as it should.

Mobility

Items that are used for getting around are heavily used. Individuals depend on properly working equipment to get from place to place. Some issues can become apparent right away, such as a loose wheel or brake on your chair or walker, but other issues might be looming without notice.

Check the frame of your equipment for stability both when in the device as well as out of it. This includes wheelchairs, walkers, canes, lifts, commode or shower chairs, beds, or any other item used. Looking at your equipment without any coverings is the best place to start. Examine the overall condition then specifics. Check the frame for any loose connections or points of instability. You may need assistance if you are checking a larger piece of equipment. Apply some pressure to ensure there is no ‘shimmy’ to the equipment. Your mobility equipment should be solid to hold your body with and without movement, such as transfers and turning.

If there is a power supply such as for a power chair or lift, be sure the electrical cord is covered without any slits, cracks, or raw cord showing. Check to be sure the plug is not bent out of shape so it can be fully placed within the wall socket.

Wheels should support the weight of your body. If you have something with inflatable tires, be sure they are at the manufacturer’s psi. Canes and walkers should have secure caps that do not slide or are so worn that they cut your floors. Different caps can be used for safety and ease of use. Make sure yours fit securely and are the right cap for your needs.

Ensure nothing is sticking out that can cut your body or a person who may be helping you. Look for sharp edges. Cover these as needed or replace them with the proper equipment.

Breathing equipment

Breathing equipment can include mechanical ventilators, CPAP machines, suction devices, incentive spirometers, or any other device used to improve your respiratory function. Look over the equipment to make sure knobs are not missing, and it is in good shape. If electrically powered, the cord is well covered, and the plug is secure. Notice the dials that should be easy to read and safe if needed to be adjusted.

These devices need to be cleaned to ensure that bacteria do not gather in them. Many utilize sterile water, which maintains a moist environment for your lungs but also is a perfect environment for bacteria. Strictly follow the manufacturer’s directions for cleaning your equipment. If you are not sure how to clean your equipment, and the manual for use has disappeared as they typically do, check online for the device by the manufacturer and product number (found on the device). The product manual will usually be easily accessed.

Incentive spirometers typically have cleaning instructions to use a damp cloth on the outside. The mouthpiece and tubing can be removed and washed with warm soapy dish detergents. Rinse well. There are many services in the tubing so shake thoroughly and dry overnight. The body of the machine may also need cleaning as the moisture of your breath collects. If there is a cardboard bottom to the device, you can pop that off and clean the inside.

If you are using suction equipment, sterile suction catheters are used each time. Be sure the catheter is the size you still need, that there is no bleeding with suctioning and that mucous plugs do not clog the catheter frequently. If there is more or excessive bleeding or mucous, check with your healthcare professional to see if a change should be made.

Surfaces

Surfaces are critically important to your skin protection from pressure injury. They do not eliminate the need to do pressure releases or turning, but they assist with offloading some weight from your boney areas. Be sure your surfaces are medical grade as any other type of cushions will not supply weight dispersion for your body.

Your pressure dispersing equipment should be clean and without any debris. It should be without leaks. Test your equipment to be sure it is still effective. There are two parts to this process, your equipment and your body. Your equipment should be checked to make sure there is adequate cushion under your boney prominences, such as when sitting or lying. This can be assessed by you or someone putting their hand between your boney prominences and the equipment to feel for support. If your equipment is adjustable, you may need to pump it up as these can consolidate without an air leak. Check all boney prominences, not just sitting or lying areas, but sides, spinal column, head, arms, legs, heels, ankles, ears. Do the same if you lay on your stomach.

The other part of checking is to look at your body. All bodies change with time. Adding or losing weight or muscle affects your skin, both with additional fat, which is not pressure dispersing or with loss which decreases your muscle protection. Development of a change in pigment over a boney area is a pressure injury that can be from equipment failure, body changes or both.

Urinary and bowel supplies

Often overlooked, urinary equipment and bowel supplies need a review as well. These articles are usually ordered when leaving the rehabilitation setting, and that is what individuals use. There are a wide variety of catheters and bowel supplies that may make your life less complicated. If you have leaking around your catheter, increases in clogging with indwelling or intermittent catheters, it is time for a size change. Bleeding can come from trauma to the urethra, which may be easily corrected with a thigh strap or by taping the catheter to your abdomen. However, bleeding can also be from an incorrect catheter size to trauma from not enough lubrication with insertion. Any change in your catheterization process or bleeding or clogging should be reviewed with your healthcare professional.

The same is true during your bowel program. You may have been given one type of suppository upon rehab discharge, but on your home diet, another brand may work better. You may find a suppository is not needed depending on your level or type of injury. Lubricant with anesthetic might be better if you have hyper sensation with the bowel program. Perhaps you did your bowel program in bed at the hospital but now would like to use a commode, for which sitting has gravity assist with your results.

In bladder and bowel care, there are options. If you search catheters online, you will find so many options, and it can be overwhelming. There are catheter supply companies that will provide a trial package of different types of their brand. If one works better for you, they will work with your payor to attempt to obtain coverage. This is true for men and women. Women can get shorter catheters which is easier than managing that long catheter.

In bowel programs, the bisacodyl and magic bullet are the same price. Bisacodyl has a vegetable coating that melts before action, which is needed by some. Others like the magic bullet, which does not have the coating. Others like using a mini-enema which may not have been an option at your facility but is a great choice for some individuals. These companies will assist with support to your payor for their product as well as offer free samples.

Other equipment

There is a huge variety of equipment that individuals use to improve their quality of life. Look at all of the devices and equipment you use to make sure all the nuts and bolts are in place. Nothing is sticking out that would harm you or a care provider and that they are electrically safe. Some fixes can be easily done at home, but other equipment needs to be professionally repaired.

Payment

It is not always easy to get payment for your equipment from your health insurance provider. Understand your policy to know what will be covered and when. One of the biggest concerns individuals have about their wheelchairs is what the provider will cover every so often. Knowing the regulations of your policy will avoid some angst for you. But there can be some workarounds.

Keep the warranty for all equipment that you purchase or is purchase by your payor. Many larger companies will assist with intermittent repairs. Smaller repairs might be able to be done by your therapist.

Small items such as caps can be purchased directly online for a reasonable amount of money compared to medical supply stores. I once bought a set of walker glider caps for $7 online that was $70 at the store. They were exactly the same product. Be a savvy shopper.

Keeping your equipment running smoothly can keep you on the move. Looking for issues early may avoid excessive repairs later. Nurse Linda

Pediatric Consideration:

Equipment use and repair are the same for children. As the adult or care provider, include the child in the assessment of their equipment to set a good habit for adulthood. Ask them about their devices. They will be able to tell you in their own words if something is amiss.

Pediatric equipment is generally made for growth. Ask how growth is accommodated with all equipment to ensure that feature is included. Of course, not all child growth happens on a schedule! If your child has an unusual spurt, you will need to ask for an exemption from your payor. Documentation of growth spurts by the health care professional, along with pictures of your tall child in a too-small device, helps. Nurse Linda

Linda Schultz is a leader, teacher, and provider of rehabilitation nursing for over 30 years. In fact, Nurse Linda worked closely with Christopher Reeve on his recovery and has been advocating for the Reeve Foundation ever since.

In our community, Nurse Linda is a blogger where she focuses on contributing functional advice, providing the "how-to" on integrating various healthcare improvements into daily life, and answering your specific questions. Read her blogs here.

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The National Paralysis Resource Center website is supported by the Administration for Community Living (ACL), U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $8,700,000 with 100 percent funding by ACL/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by ACL/HHS, or the U.S. Government.