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I was recently contacted by someone asking about a home visit.

They volunteered the information that they had been having a practitioner call on them but they felt that this person "wasn't very professional". When I asked why they were of this opinion, I was told that the practitioner used a hand towel over their knee (to rest the foot on) during treatment.

Has anyone heard of this idea of using hand towels ( instead of plastic aprons and couch-rolls) ?

Does any particular training organisation suggest this? It seems like it creates an awful lot of extra laundry, to me !

 

This is turning the clock back- I think you'll find that the patient is supplying the towel and that is how I worked when newly qualified in the dark ages (mid-70's). I don't understand why anyone does home visits without a foot stool these days - it's too intimate to have a foot on your knee. I'm not sure if it comes from any particular training institution or whether someone's just taking short cuts but it's definitely unhygienic and un-professional.

 

Hi ClareN,
Apparently the practitioner is supplying the towel. :rolleyes:

That's what I thought......

 

Catfoot & ClareN

Under the circumstance domestic paper towel on the knee is no more unhygenic than a plastic sheet or vice verse. If the plastic cover is from a sterile pack then yes, otherwise you would need to disinfect the plastic sheet with a preoperative antiseptic , but even then, once the foot rests on the surface it is contaminated. Challenges with working in antisepsis and not a sterile field are real but when used in conjunction with standard precautions e.g. antiseptic skin prep, use of sterilised small tools, gloves and fast acting post op antiseptics etc podiatry on unbroken skins presents few problems with cross contamination and post op sepsis. When working with ulcerations in the home situation I would use a sterile dressing pack.

Foot stools are helpful to some but not always practicable. Not only does it give mobile operator something else to carry often the juxtaposition of operator and foot can lead to bad posture and occupational back ache. As a practitioner I sat cross legged with the foot resting on my knee which kept my back straight and free from lumber strain. I had a clear view of the operating field (highlighted with a head lamp) and I have a been working for many year with no back complaints. Not ideal and certainly not a situation many practitioners would feel comfortable with but when dom visits are required you need to make the best of what you have.

toeslayer

 

I have a foot stool with a vinyl cover, which is easy to sanitize with Trionic wipes. I also have a plastic mat, made from a shower curtain, (after several years experimentation, this was the best,) which lies on the floor to catch the bits, this is swept clean and sanitized with the wipes. Putting a patients foot on your knee means you can't get to the heel properly. A hand towel is a bio-hazard in my opinion!

 

Regardless of whether a Pod sits on the floor, a stool or stands, It is important to have the correct posture for your particular circumstance. When I do home visits ( of which I have done thousands ) I find it best for my back to rest the patients foot on my knee, unless they have a great reclining chair. I have perfected the best way for me, and still be able to do a perfect PCA debridement.

Years ago I use to use any clean towel on my lap.......until I had a gentleman just released from hospital with a massive weeping wound. The wound leaked through his dressing, then thro the towel....gross! So now I use a new Blueys for each pt. Works very well, just a bit more cost.

I do a couple of days home visits each week. I love being in different 4 walls everyday. I couldn't do the same 4 walks everyday.
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