Redbud Medical Systems, Inc.
Custom-made beds for Supine bike stress
echo, Post treadmill imaging exercise echo, & Resting echo
Models:
400
500
Features & accessories
Delivery, installation, & warranty
[The following has been excerpted, with permission, from the Manual for Stress Echo.]
• The Ergometer
• must be mechanically reliable, easily serviced
• must provide reproducible work loads
• must be easily and comfortably pedaled by the typical, often compromised, cardiac patient
• mounted on the bed so that it can be easily and quickly repositioned to fit each patient
• light enough to be removed from table, (preferably by one person) in a few seconds
• can be used as stationary bike on the floor
• the display panel should be easily read in a dark room
- time - easily re-set
- rpm - easily seen by patient for monitoring pedaling speed
- workload displayed in watts is preferable but not necessary
• attractive in appearance, low profile
• quiet operation
• pedals equipped with easily fastened, easily adjustable, and quickly released securing straps.
• Pedal design allows use without shoes (because so many patients show up in high heels, or other unsuitable footwear)
• Left Lateral Tilt
- Tilts patient to the left for improved apical images - this is important and can make the difference in a diagnostic vs. non-diagnostic study in a subclass of patients.
- Cannot tip so much as to alarm the patient or to make it impossible for patient to pedal to target heart rate.
- Tilting must not reduce bed's stability. It must remain rock steady or it will make imaging very difficult.
- All movements must be quiet - no loud squeaks, clicks, moans, groans, shudders
• Head elevation
- The echo bed should hinge in the approximate middle, at patient’s hip level, to elevate the patient’s upper body. This increases patient comfort (some patients are unable to lay flat) and also allows a patient to pedal longer, achieving a higher work load. Elevation sometimes improves the apical window.
- Minimize pinch sites (fingers) and sites for entanglement or damage of the ECG patient cable.
- All movements should be controlled by foot pedals to allow the echocardiographer to keep his/her hands on the transducer and control panel at all times.
• Stability - table should not wobble , shake or vibrate during use.
-
Some beds rattle, rock and roll when elevated - a great
annoyance.
• Length
Should be approximately 84" long to accommodate most patients comfortably. In offices of limited space, a smaller bed might be an option.
• Width
A 30" width works for most of the patient population. Twenty-five inches would be inconvenient but minimally possible in an office with limited space. Consider the ergometer's size and allow space on each side for comfortable positioning of the resting patient’s legs. Consider that you must be able to access either side of the bed. The bed must be narrow enough to pass through doors.
• Height
- Approx.. 27-32" — This is dictated by the needs of the sonographer and patient comfort. The lower the bed, the easier it is for an aging, arthritic patient to mount. This is of particular importance when haste is crucial in post treadmill imaging. The height of the bed, however, must also consider the height of the ultrasound system’s control panel and its monitor. With my systems, I prefer an exam table height of about 31". Ideally, each bed should be custom made to the user’s specifications.
Adjustable height is of little value in my opinion. For post treadmill exercise echo exams, the bed must be low enough to allow the patient quick and easy access. I have watched post-treadmill exams rendered rather useless by waiting until the winded patient is on the bed and then squandering the precious time to elevate the bed to a height comfortable for the (standing) sonographer's 60-second imaging routine. If you image while standing, and need to have your bed higher, I recommend providing a 10 inch step stool to assist your patient in getting onto the bed rather than relying on slow (and expensive) hydraulics. The chief complaint of many people is that their beds wobble when raised by the hydraulics or electrical motors. Select a bed that is exactly the right height for your imaging style (sitting or standing, right hand or left) and is compatible with your ultrasound system's control panel. The ability to move the bed up an down 10" is of limited value, especially if it compromises stability.
A supine bike stress echo exam demands a very solid bed.
• Line conditioner
to provide electrical isolation for safety and to minimize introducing line noise (from its motors) that could affect ultrasound image quality.
• Hospital grade power cord and plug
Locate main power cord to minimize damage by casters. Provisions for storage of cord during relocation
• Casters
All four casters should lock, swivel, and be removable. Suitable for vinyl and carpeted floors. Must be easily locked and easily swiveled. Four inch casters in office is suitable, but 6" may be better in circumstances where bed is moved over greater distances as for mobile work. Should not be pneumatic or soft rubber as this would allow too much movement of bed during pedaling
• Paper roll
Provisions for standard exam bed paper roll. Cloth sheets are expensive, slow to change, and seem to get in the way more than paper.
• Head board
To prevent pillow from falling from bed. Must be easily removed for resting studies that reverse the patient’s position on bed for foot elevation, peripheral vascular studies, general ultrasound, etc. In my early days of stress echo, my bed lacked a headboard. I don't know how many hours I spent retrieving pillows the patients pushed off the bed.
• Mattress
3" medium density foam complying with all fire codes. Density must allow patient to "sink" into the foam slightly to decrease body movement when pedaling and when placed in left lateral tilt, but not so soft as to allow excess motion during exercise or to be uncomfortable
• Vinyl
Heavy duty, complying with all fire codes. Easily cleaned. Must withstand heavy duty cleaners. If you have a choice, remember that dark colors hide ballpoint pen marks, scuff marks, etc.
• Seat belt
To secure patient when in left lateral tilt. Must be easily coupled and uncoupled
• Hand grips
To help secure patient and to provide source of some isometric exercise (increased BP) particularly for younger, more fit patients. Hand grips should be adjustable and to the patient’s sides. Grips must not be overhead.
• Overall appearance
Minimal. Spartan. Uncluttered look. Unstyled. Compatible with the design of ultrasound systems. Must look comfortable and non-threatening to patient. Must feel comfortable to the patient (especially laying in left lateral decubitus for over thirty minutes) and to sonographer during ten hour work days.
• Retail Cost
Must be consistent with stress echo reimbursement!
The Imaging Cut-out
The task of the sonographer is to present the fine, translucent line of endocardium. Considering the general low quality of ultrasound images, we must do everything possible to assist in this endeavor. That includes the obvious, such as the choice of ultrasound system and skilled transducer placement, but it also dictates that we consider the less obvious components of patient control. This includes establishing a rapport with the patient to allow him to relax and to follow instructions. It also includes controlling patient respiration and proper positioning of the patient. The ideal position for most patients is steep left lateral decubitus over a mattress cut-out. In order to get the best images from most patients it is required that they roll up completely onto their sides, not slumped back at a 45º angle where most wedges place them. And to get the best views in some patients requires that they roll up and forward to the point of leaning over the edge of the bed. ( On the other hand, some obese people image better when they lean back a little.)
Once the patient is in the proper position, if not given support, he must hold himself there, sometimes in a tense manner that tightens his intercostal spaces, and thereby restricting the windows. So a pillow or wedge is conventionally used in attempt to secure the patient in this position. And then, typically, the pillow slides off onto the floor and the patient gradually leans back to a near supine posture and the sonographer has to hang up the transducer, get up, walk to the opposite side of the bed, retrieve the pillow, reposition the patient, stuff the pillow back, sit down, retrieve and re-gel the transducer and begin anew. Or because of time constraints, the pillow is left on the floor to collect dust and hair and whatever else has collected or crawled there and the exam continues with the patient slowly slumping backward and the tech decides that these sub-optimal images are not that unsatisfactory after all. (I am certain that the reason so many echocardiographers "see no difference" in placing the patient in left lateral decubitus is because of the time required to deal with falling cushions and clumsily designed cut-outs.)There is a product called the Bundle Block which holds the patient in any degree of tilt or rotation and cannot be pushed out of position by any normal motion. I have seen it remain perfectly stable and secure with 300 pound patients docked against it. It even acts a tool to roll the reluctant (post treadmill) patient up onto his side. Its position can be altered to adjust the patient’s degree of tilt, remaining secure at every position. While this support cushion cannot be pushed back by the patient, it can be instantly displaced by the sonographer. When displaced, it automatically hangs within reach so the sonographer can easily retrieve it for repeat use without having to walk around to the far side of the bed. This simple device is so effective it makes all other support pillows and wedges obsolete.
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Content revised: January 26, 2004