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Living with Resilience: A Guide to Toilet Use for Iron Lung Users

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Iron lungs, also known as negative pressure respirators, were once the only lifeline for individuals with severe respiratory muscle weakness. While their use has declined due to the advent of mechanical ventilators, there are still some patients who rely on iron lungs for breathing support.

The Challenge of Daily Activities in an Iron Lung

Life within the confines of an iron lung presents unique challenges. Even basic daily tasks require careful planning and assistance. Using the toilet is one such essential activity that necessitates a well-coordinated approach to ensure hygiene, comfort, and safety.

Pre-Transfer Preparations

  • Communication: Clearly communicate your intent to use the restroom to your caregiver. Discuss any specific needs or preferences you may have.
  • Positioning: Ensure the iron lung is set to a comfortable pressure level that allows for slight head and neck movement. This will facilitate easier transfer and cleaning.
  • Catheterization: Indwelling urinary catheters are often used for long-term management. If you don’t have one, ensure a bedside collection system is readily available.
  • Catheter Management: If using a bedside collection system, have a designated pouch positioned for easy drainage and within reach after transfer.

Transfer Techniques

There are two primary methods for transferring from the iron lung to a bedside commode or raised toilet seat:

  • Manual Assisted Transfer: With the assistance of a trained caregiver, one side of the body is manually lifted and supported onto a transfer board. The caregiver then repeats on the other side, facilitating a safe and controlled movement to the commode.
  • Mechanical Lift Transfer: A mechanical lift equipped with a sling can be used for a more effortless transfer, especially for individuals with limited upper body strength. Ensure the lift is properly positioned and operated by a trained professional.

Commode or Raised Toilet Seat?

The choice between a commode and a raised toilet seat depends on individual needs and preferences.

  • Commodes: These portable toilets can be positioned directly beside the iron lung, eliminating the need for extensive transfers. Commodes are often easier to maneuver and clean.
  • Raised Toilet Seats: These elevated seats attach directly to a standard toilet, raising the user for easier sitting and standing. Raised toilet seats may offer a more normalized bathroom experience for some users.

Considerations for Both Options

  • Stability: Ensure the commode or raised toilet seat is stable and has a wide base to prevent tipping.
  • Grab Bars: Install grab bars on both sides of the commode or next to the raised toilet seat for additional support during transfers.
  • Padding: Consider using comfortable padding on the commode seat or raised toilet seat for extended periods of use.

Maintaining Hygiene

  • Perineal Care: After using the toilet, perform a thorough cleaning of the perineal area using pre-moistened wipes or a peri bottle with warm water. Ensure proper drying before applying any skin protectants.
  • Catheter Care: If using a bedside collection system, follow proper emptying and cleaning procedures as instructed by your healthcare provider.
  • Handwashing: Maintain good hand hygiene by washing hands thoroughly with soap and water after using the toilet and completing perineal care.

Post-Transfer and Iron Lung Repositioning

  • Caregiver Assistance: With the help of your caregiver, carefully reverse the transfer process, ensuring proper alignment and support during re-entry into the iron lung.
  • Pressure Adjustment: Once back in the iron lung, gradually adjust the pressure settings to a comfortable level for optimal breathing.
  • Disinfection: Clean and disinfect the transfer board, commode, or raised toilet seat after each use with a hospital-grade disinfectant wipe or solution recommended by your healthcare provider.

Additional Tips for Success

  • Bowel Management Programs: Work with your doctor or a nutritionist to establish a bowel management program that promotes regularity and reduces the frequency of bowel movements. This can minimize the number of transfers required.
  • Skin Care: Regular skin assessments and meticulous hygiene practices are crucial to prevent pressure injuries and skin breakdown, especially around the transfer areas.
  • Mental Resilience: Living with an iron lung can be emotionally challenging. Building a strong support system, practicing relaxation techniques, and maintaining a positive outlook are essential for overall well-being.


While using the toilet in an iron lung presents unique obstacles, careful planning, preparation, and a skilled care team can ensure a safe and dignified experience. By following these guidelines and working closely with your healthcare providers, you can maintain independence and a high quality of life.

Living with an iron lung requires a spirit of resilience and a commitment to adaptation. By adopting these strategies, you can manage your bathroom needs effectively and continue to live a fulfilling life.

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