Tilt Table

Question 1

What is the main reason that individuals “pass out”?

Answer 1

they have problems with the reflexes that control blood pressure

Question 2

what does pooling of blood in veins of the leg and abdomen with upright posture result in?

Answer 2

drop in blood pressure
symptoms of lightheadedness or syncope

Question 3

what can tilt table testing be used for?

Answer 3

provokes syncope in a controlled setting to to see if this explains why someone is passing out

Question 4

what is typical degrees/length of time that the tilt table is used per session?

Answer 4

60-70 degrees, 30-45 minutes

Question 5

why do you restrict the patients legs to the table to where they are unable to move (other than for safety)?

Answer 5

this allows for blood to not actively pump to the thorax
makes other reflexes activate in order to keep the blood pressure from falling

Question 6

what will happen if the reflexes cannot compensate for the drop in blood pressure (from lack of venous return)?

Answer 6

blood pressure will fall and the patient may pass out

Question 7

what two things are measured constantly throughout the tilt table test?

Answer 7

heart rhythm and blood pressure

Question 8

what is inserted before the test is given to ensure the patient has ample fluids and medications throughout test?

Answer 8

intravenous line

Question 9

what are examples of possible symptoms during the tilt table test?

Answer 9

no symptoms
nausea, sweaty
passing out completely

Question 10

what is a common reason why you would want to use the tilt table on a patient (think inpatient rehab)?

Answer 10

a patient has been stationary for too long or hasn’t gotten out of bed in 2-3 months
used to re-acclimate the patient to upright position before sitting, standing, or walking can be started
used in patients after prolonged bed-rest
generalized weakness
disturbance of balance
proprioception, kinesthesia, or LE circulation

Question 11

which measurement of blood pressure is likely to drop during syncope?

Answer 11

diastolic

Question 12

why would you want to prevent patient from ankle pumping/LE movement during tilt table?

Answer 12

improves blood flow

Question 13

if administration of IV fluids or medication is needed, who will be present to do so?

Answer 13

nurse typically

Question 14

when do you need to check baseline measurements?

Answer 14

when laying down, when tilt table is at 60-70 degrees, continue to talk to patient to make sure they are staying alert

Question 15

what things do you need to watch for whenever the tilt table treatment is being performed?

Answer 15

alertness
movements from baseline measurement
watching for drop of 10+ in diastolic
need to administer IV fluids of BP increasing medications

Question 16

what are the red flags of tilt table treatment (stop treatment immediately)?

Answer 16

excessive changes in BP and HR
changes in consciousness
excessive perspiration
development of edema in LE
complaints of nausea or numbness (if persistently worsened)
decrease or loss of pedal pulses
changes in facial or limb color (cyanotic)
dizziness

Question 17

if patient’s dizziness remains the same or reduces during tilt table treatment, what should you do?

Answer 17

keep them there

Question 18

if patient’s dizziness continues to get worse, what should you do?

Answer 18

lower them back down.

Question 19

what are the benefits of tilt table treatment?

Answer 19

increase circulation/circulatory system function
assists with bowel and bladder function due to gravity forces
may assist in promoting or maintaining bone density in patients with SC injury (compression forces/stress/loads that have been absent)
UE exercising (against gravity)
some LE muscle groups can be positioned for prolonged passive stretch
muscle setting exercises can be performed to assist with venous return
mental outlook (different environment)

Question 20

what is proper positioning for tilt table treatment?

Answer 20

feet flat and shoulder width apart
pillow underneath head (that can be removed after ~75 degrees) and knees
restraint straps at distal thigh (prevents buckling)
restraint straps across mid/upper trunk (can place towel under strap if needed)
third strap across pelvis or abdomen (optional)

Question 21

what is the procedure to follow before initiating tilt table treatment?

Answer 21

positioning/proper restraints
check vital signs (BP, pulse, respiration)
baseline measurements

Question 22

what is the procedure to follow when initiating treatment? (after pre-treatment procedures have been done)

Answer 22

raise table slowly and steadily
take vitals
determine tolerance
wait until stable
maintain several minutes (or more, depending on treatment goals)
***repeat as per patient tolerance
lower slowly, take vitals, document

Question 23

during what phases of treatment should you take vitals?

Answer 23

before, during, after

Question 24

what is the time range in which you may perform a tilt table treatment?

Answer 24

anywhere from 5-10 minutes or as long as one hour
***dependent upon patient tolerance

Question 25

how often can you perform tilt table treatment?

Answer 25

once or twice per day OR on alternate days

Question 26

what is typically a sufficient prescription of tilt table treatment (not necessarily standard)?

Answer 26

70-80 degrees for 15-20 minutes

Question 27

if you begin to see the blood pressure drop and the patient is dizzy, but not passed out yet, what should you do?

Answer 27

lower table to half of current degrees, then reassess

Question 28

if the patient passes out, what should you do?

Answer 28

return tilt tablet to 0 degrees