oakworks frame question

[willabeast]

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my x ray tech is concerned that my (new) oakworks frame might slip off the x ray table if we tilt the table.
is this a valid concern? any way around it?
thank you.

 

[101N]

my x ray tech is concerned that my (new) oakworks frame might slip off the x ray table if we tilt the table.
is this a valid concern? any way around it?
thank you.

It is a valid concern. We tape ours down to the table for that reason.

 

[specepic]

Maybe if a pt was not attached to it. When you have the weight on the pt on it, you would have to do quite a bit of table tilt to cause an issue. What situation are you tilting the table instead of the C?

 

[bedrock]

Mine never slides, because the patient weighs it down. Do you have a slippery table?

Some older C-arms like the OEC 9600 only oblique 45 degrees to one side and so you compensate by tilting the table for 60 degree oblique if you need it.

 

[bevel master]

I have found a wide velcro strap over the pt's SIJ region and around the table and then cinched down prevents the pt from lsliding off the spinal positioner when the table is tilted. Also prevents a slight pt lean during longer cases when the pt is relaxed from IV sedation

 

[mdvol]

I use for cervical injections are you guys using for lumbar?

 

[willabeast]

I use for cervical injections are you guys using for lumbar?

i did an afternoon schedule of all lumbar cases yesterday using it.
one patient liked it more, thought he could breathe easier. he has severe lung disease.
i had less room under the c arm to work, only negative (so far, i just started using it).

 

[Jcm800]

i did an afternoon schedule of all lumbar cases yesterday using it.
one patient liked it more, thought he could breathe easier. he has severe lung disease.
i had less room under the c arm to work, only negative (so far, i just started using it).

i only use it for cervical. i tried to use it for lumbar cases, but it was annoyoing.

Never had it fall off with a patient on it. Sometimes it makes them lean funny, but i have never been concerned about it falling off. i tilt often, just because i get tired of saying "oblique a little bit, a little more, ohh too much, go back a little, now pull back towards you, thats too much..."

 

[bedrock]

I use for cervical injections are you guys using for lumbar?

My patients love this frame, particularly the chronic low backs and the more obese patients.

Did an SCS trial today my patient said she was more comfortable that she has been in any bed for 3 years. Wanted to buy one to sleep on at home.

(mind you this is the newer oakworks frame (generation 2) not the first version)

 

[PMR 4 MSK]

I'd say 80-90% of my patients like the Oakworks frame, the rest hate it.

 

[Pain Fluoro]

@Bedrock.. Are you kidding??.. Only this device's inventor (who I know) would sleep on this at home. We have a new BMI protocol for use of this platform due to the change in center of gravity and subsequent instability, and that no one with a BMI > 40 is to be positioned on this. We have had multiple issues with obese patients being very uncomfortable when prone on this device. The opinion of Anesthesiology staff as to airway acesss is also 50-50. As for the use of strapping it down to the table-- this interferes with room turnover, and frankly we have not noticed the platform itself to move, just the patients that are heaped on top of it. Yes, it does seem to increase spacing of vertebral levels, and make lateral fluoroscopy of prone cervical patients easier to obtain. Other than that, the wedges which costs 10% of the platform is safer, and still allows adequate fluoroscopic imaging.

 

[Pain Fluoro]

For us its about 70-30 against in regards to the patients that "like" it.

 

[Pain Fluoro]

@JCM800.. sounds like you get inconsistent fluoro support, or you need a new tech.

 

[bedrock]

Who are you since those are your only 3 posts on this board? Are you even an attending, you sound like a resident/fellow?

We have had multiple issues with obese patients being very uncomfortable when prone on this device.

Are you using the second version of the Oakworks frame? It specifically adjusts/caves in to fit in larger bellies/breasts. The first version doesn't have this.

no one with a BMI > 40 is to be positioned on this

You must be at a university. Anyone I see with a BMI over 40 doesn't get procedures. They get referred to a local nutritionist/bariatric center.

I don't waste time doing procedures on patients who require a needle 3 times longer than anyone else. They're overweight, they hurt because they're overweight, and until some actually puts their foot down, they'll blame everything and everyone else and want a pill or procedure to fix what only they themselves can fix.
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Sorry you don't like the oakworks frame but 80% percent of my patients love it and are more comfortable than on pillows/wedges. For that 20% that don't, I've got pillows/wedge in the room.

What option do you have for your patients that don't like your wedge? Nothing I'd wager.

 

[PMR 4 MSK]

If BMI > 40 were my restriction, they might as well throw the thing out for lack of use.

 

[101N]

If BMI > 40 were my restriction, they might as well throw the thing out for lack of use.

Amen brother.

 

[willabeast]

Who are you since those are your only 3 posts on this board? Are you even an attending, you sound like a resident/fellow?



Are you using the second version of the Oakworks frame? It specifically adjusts/caves in to fit in larger bellies/breasts. The first version doesn't have this.



You must be at a university. Anyone I see with a BMI over 40 doesn't get procedures. They get referred to a local nutritionist/bariatric center.

I don't waste time doing procedures on patients who require a needle 3 times longer than anyone else. They're overweight, they hurt because they're overweight, and until some actually puts their foot down, they'll blame everything and everyone else and want a pill or procedure to fix what only they themselves can fix.
----------------------------------------------------------------------
Sorry you don't like the oakworks frame but 80% percent of my patients love it and are more comfortable than on pillows/wedges. For that 20% that don't, I've got pillows/wedge in the room.

What option do you have for your patients that don't like your wedge? Nothing I'd wager.

you are missing out on a lot of fun if you do not inject obese people.
LOTS of fun.
like saying you are a mountain climber but never trying Everest.

 

[bedrock]

you are missing out on a lot of fun if you do not inject obese people.
LOTS of fun.
like saying you are a mountain climber but never trying Everest.

LOL!

Ok, it's been a while since I actually calculated out a BMI. My distant recollection was that >30 is obese.
I checked the numbers and I'd say my cutoff is more around BMI >55. Anymore than that and I'm not doing anything more than an ILESI for a acute radic. Any other procedure is put on hold until I can use something shorter than a 8 inch needle.

 

[bedrock]

you are missing out on a lot of fun if you do not inject obese people.
LOTS of fun.
like saying you are a mountain climber but never trying Everest.

Does anybody here do lumbar RF on patients that are so fat you can't reach the medial branches (using ISIS technique) with a 15cm RF cannula?

Somehow this never came up during fellowship as I did that in a extremely active and slim city. Since fellowship, this has come up several times as there are a lot of big people out in my local area.
Many of my orthopedic friends have set strict BMI limits for total joints, mainly hips, because the hip of a 400 lb patient is a PITA to manipulate on the table. So if they want their hip replaced, they have to reach a BMI goal.

I do the same things with certain procedures. I'm not going to spend all day doing a lumbar RF on someone that I can't reach with the "long" 15cm cannulae. Their crushing overall weight is more of a factor than their poor little facet joints.

 

[Ligament]

Does anybody here do lumbar RF on patients that are so fat you can't reach the medial branches (using ISIS technique) with a 15cm RF cannula?

Somehow this never came up during fellowship as I did that in a extremely active and slim city. Since fellowship, this has come up several times as there are a lot of big people out in my local area.
Many of my orthopedic friends have set strict BMI limits for total joints, mainly hips, because the hip of a 400 lb patient is a PITA to manipulate on the table. So if they want their hip replaced, they have to reach a BMI goal.

I do the same things with certain procedures. I'm not going to spend all day doing a lumbar RF on someone that I can't reach with the "long" 15cm cannulae. Their crushing overall weight is more of a factor than their poor little facet joints.

Yes, unfortunately. 200mm cannulae are made!

 

[willabeast]

Does anybody here do lumbar RF on patients that are so fat you can't reach the medial branches (using ISIS technique) with a 15cm RF cannula?

Somehow this never came up during fellowship as I did that in a extremely active and slim city. Since fellowship, this has come up several times as there are a lot of big people out in my local area.
Many of my orthopedic friends have set strict BMI limits for total joints, mainly hips, because the hip of a 400 lb patient is a PITA to manipulate on the table. So if they want their hip replaced, they have to reach a BMI goal.

I do the same things with certain procedures. I'm not going to spend all day doing a lumbar RF on someone that I can't reach with the "long" 15cm cannulae. Their crushing overall weight is more of a factor than their poor little facet joints.

we have a 400 pound weight limit on our fluoro table.
also - there is a strange set of rules regarding sedating patients with BMI over 50 and/or have sleep apnea.
between the two it limits the weights somewhat.