Chapter 11 Exam 3 manual lateral transfers Flashcards
General procedures for manual transfers
first 6 steps
- Gather items needed for moving, draping and positioning the patient
- Non-slip footwear
- Organize the management of equipment
- Postition transfer surfaces close together.
- Prepare surface you’re moving toward (place drawsheet)
- Secure both surfaces with equipment locks
General procedures for manual transfers
Next 7 steps
- apply gait belt
- Communicate appropriatly and engage the patient in the proceedure.
- Coordinate with other people who may be assisting.
- Establish a secure hold on gait belt
- Use good body mechanics
- Position the patient safely at the end of the transfer. Raise upper rails - footplates, armrests.
- Insure important items are within reach (call light, glassses, remote, telephone)
Underlying Assumptions for a dependent Transfer with One Clinician
- Clinician is physically able to control and support the load
- clinician is able to manage any lines and tubes or leads.
- the equipment is functioning properly
- Patient is not resisting transfer
- patient has some voluntary head control and the ability to bear at least some of the weight.
- the transfer will not violate movement precautions.
Gait belt
transfer belt or walking belt.
safety device.
support to prevent fall.
2 inches wide - 54-60 inches long
bariatric 71 inches long
gait belt placement
narrow part of waist, just above the pelvis.
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Extra care if: back or abdominal surgery. Ostomies or feeding tubes.
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place above vunerable site.
How to apply a gait belt
- Communicate with patient
- place belt arround waist with buckle in front and slightly to side. Over clothing. Teath to the front and metal flap on the side closer to patient
- Pass the metal-tipped end through the teeth and buckle
- Pull the belt snug, but not uncomfortably tight. Two fingers
- Lift far metal loop causing the teeth to grip
- Readjust the belt as needed
- tuck any excess length.
How to grip a gait belt
supinated or underhand grip.
How to remove a gait belt
patient seated:
1. unbuckle the belt and have patient lean forward.
2. must be cleaned after each use.
Wheelchair to bed lift transfer. - two people - first 3 steps
- position the chair beside bed with legrests and armrest removed bed height same or lower than chair. wheels locked on both.
2.Taller stronger technician behind patient. wide BoS Stradle the drive wheels.
3.Second clinician in front - squats or half-kneels perpendicular to patient’s legs, facing the bed.
Wheelchair to bed lift transfer. - two people - second 3 steps
4 Hold patient securly
* fold pts arms accross chest.
* clinician behind reaches under patient’s upper arms and with forearms pronated, grasps the patient’s forearms just proximal to writs.
* clinician in front reaches under pt’s legs so legs are resting on forearms. closer to hips provide greater control.
5 Lift shift and lower
* Lift: clinician in front can see pt’s face so they count. on 3 both clinicians lift upward enough to clear lateral barriers.
* Shift. to create lateral movement, the clinician behind the pt shifts laterally. at the same time the clinician in front steps forward.
* Lower. Once pt is over bed lower gently. Bend from knees.
6 Reposition as necessary, recheck any lines leads or tubes.
Wheelchair to bed lift transfer
If you are the clinician in front
- Decrease the moment arm, by supporting the legs closer to the hips
- Getting closer to the line of action of gravity on the head arms and trunk
- participating more in upward portion of the lift.
Opposite of wheelchair to bed
Bed to wheelchair dependint lift transfers
- patient in a sitting position so clinician can reach around upper body from behind
- bed position so compressed mattress is the same or slightly higher than the chair’s seating surface
- Clinician supporting the LEs moves backward so create a clear path
- when lowering the pt, situate hips back in chair.
Full flexion Transfer - alternate depedent lift.
- the ready position: pt scooted forward with feet beneath them. Armes crossed and hips flexed forward head over knees. Clinician leans over the patient and reaches under their hips while maintaining good body mechanics.
- Clinician leans backward slightly, lifting the patient’s hips just enough to clear the chair as they pivot.
- In one continuous movement, the clinician pivots the patient and lowers them to bed or mat.
- Clinician maintains a guarding position as he ensures the patient’s stability in sitting.
* Not the best movement pattern to practice on the way to becoming more independent in transfers.
dependent repositioning in a chair (scooting pt’s hips back for instance.)
wide BoS from behind chair.
uses same arm position as lifting the patient
Count of 3 lifts the patients hips up and back
2nd clinician can help by grasping lateral aspects of gait belt or reaching under the buttocks and blocking knees.
Transfer board
sliding or slide board. allows transfer without having to bear weight through LE.
Steps 1-3
Independent Lateral Seated Transfer with Transfer Board: Bed to wheelchair
- adjust bed height to same or slightly higher than chair with compressed mattress. Remove right armrest of chair and place right side of chair close to the bed. Secure both surface. Locks.
- Lean trunk away from transfer, lifting the hip up off the bed, and place slide board weell beneath hip, under the iscial tuberosicty.
- Position the board in front of the wheelchair’s drive wheel, aimed toward the chair seat.
Steps 4-6
Independent Lateral Seated Transfer with Transfer Board: Bed to wheelchair
- Lean slightly to left, toward the chair, and place open left hand far enough out to allow room for hips to move toward it. right hand directly under axilla. Lean forward slightly. depress the shoulders and push down with borth arms to lift the body up and sideways on the board. Repeat hand placement and sideways movement until on wheelchair seet.
- Lean away from bed and remove the transfer board
- Replace wheelchair armrest and legrest and adjust the sitting position as needed.
Steps 1-4
Independependent Lateral Seated Transfer with Transfer Board: wheelchair to Bed
- approach bed and remove right armrest and legrest.
- Position the right side of chair as close as possible to bed. Angled slightly to prevent drive wheel from hindering transfer. Secure both surfaces. (bed and wheelchair locks)
- Lean trunk to the left, lifting the right hip up off the seat. Place end of transfer board beneath right hip. May need to be moved side to side to correctly position.
- position the board in front of drive wheel and aimed toward the mat (bed)
Steps 5-7
Independependent Lateral Seated Transfer with Transfer Board: wheelchair to Bed
5 Lean slightly to the right, toward the mat, and place open right hand far out on the board. Allow room for the hips to move laterally. Place left hand on wheelchair armrest or seat, directly beneath axilla.
6 Lean slightly forward. depress shoulders and push down with both arms to lift the body up and sideways on the board. Repeat hand placement and lateral movement until positioned securly on the mat.
7 Lean to the right, away from the wheelchair and remove the transfer board. Replace the armrest and legrest.
Clinician Assistance for lateral Seated Transfer with Transfer Board
Second person can assist from behind, helping lift the patient’s torso as in the dependent lateral shift. CCDD
Guard from the front. both hands at shoulders or shoulder and one on gait belt.
knees ready to block any unwanted forward sliding.
There are hand holds in transfer boards - don’t let patient use them for transfers as fingers can get caught.
Clinician Assistance for lateral Seated Transfer with Transfer Board
Safe hand placement.
There are hand holds in transfer boards - don’t let patient use them for transfers as fingers can get caught.
Don’t put fingers under end of slide board as fingers could get crushed.
Steps 1-3
Assisting in a lateral transfer using a transfer boardL: Bed to Wheelchair
- Remove the wheelchair’s right armrest and legrest and postion the right side of the wheelchair at a slight angle to the mat. secure both surfaces.
- postition self in front with wide BoS. Be prepared to block knees. Place gait belt around patient.
- Lean patients trunk to the right, lifting left hip off the bed to place the transfer board. Aim transfer board toward the seat of wheelchair, but in front of the drive wheel.
Steps 4-6
Assisting in a lateral transfer using a transfer boardL: Bed to Wheelchair
4- Patient leans toard the chair, places hand far enough toward the chair to allow lateral movement. Other hand below axilla
5- Grasp lateral aspects of gait belt or use shoulder and pelvis depending on level of control needed. Count of three, pt depresses shoulders, pushes down with both arms, and transfers laterally with assistance. Repeat until in chair.
6 - Lean patient to the left and remove the transfer board from underneath the hip. Remove gait belt. Replace wheelchair armrest and legrest and adjust the sitting position for comfort and safety. Provide call button or cell phone.
Assisting in a lateral transfer using a transfer board: wheelchair to bed
similar to bed to wheelchair but in oposite direction.
If the patient is wearing a hospital gown. powdering board or placing a towl or pillowcase over the board may help.
Encourage patient to lift rather than slide.
environment may pose challenges to positioning slide board.
Standard slide boards
support 300 to 400 lbs.
Bariatric slide boards
500 lbs.
Steps 1-3
Independent Lateral Seated Transfer without transfer board: Wheelchair to Mat to the left.
- Approach transfer site and remove the wheelchair’s armrest and legrest on the transfer side
- position left side of chair as close as possible to the mat. Angle the chair slightly to prevent the drive wheel from hindering the transfer. Engage locks. secure both surfaces.
- lean left toward the mat. A slight shift of the body toward the edge of the seat may be necessary. Place left hand on mat, just beyond the destined location of the hips and the right hand on the armrest under tha axila.
Steps 1-3
Independent Lateral Seated Transfer without transfer board: Wheelchair to Mat to the left.
4- Depress the shoulders and push down with both arms, lift the body up, clear the wheel chair seat, and then move move over and down onto the surface of the mat.
5- Adjust the new sitting position as neded for comfort and safety.
Independent Lateral Seated Transfer without transfer board: reverse Mat to wheelchair.
process is the same as the opposite except patient rreaches for the far armrest of the chair before shifting. If the arm is too far away for safety, it may need to be done in a sequence of up and over shifts. Mind the gap.
Steps 1-3
Independent A-P Transfer: Bed to Wheelchair
- Adjust bed and chair as needed to minimize height difference between bed and chair. With legrests out of the way, bring chair to face the bed at right angle, inline with waist when you are lying supine. lock surfaces
- In long sitting, pivot in the bed so that your back is positioned directly in line with the chair. Scoot backward to EOB.
- Reach posteriorly to grasp both armrests of the chair or seat.
steps 4,5
Independent A-P Transfer: Bed to Wheelchair
4- Depressing the shoulders and pusing down with the arms, lift the body up and back, positioning the hips at the back of the seat.
5- Unlock the wheelchair and back away from the bed, positioning the LEs on legrests as appropriate.
steps 1-3
Independent A-P Transfer: Wheelchair to Bed
exits chair facing forward
1. adjust bed/chair as needed to minimize the height difference. with legrests out of the way, position chair at right angle to bed, leaving enough room to manuver LEs.
2. Place both feet and lower legs up on bed with knees extended.
3. Place both hands on the armrests of the chair, chair seat or drive wheels, directly below the axilla.
steps 4,5
Independent A-P Transfer: Wheelchair to Bed
4- Lift the body up and slide it forward onto bed, repositioning LEs as needed
5- Once fully and safely on the bed, pivot to realign yourself on the bed.
Most common piece of equipment to assist is a trapeze bar
Transfer boards placed under the patient in long sitting can be used to bridge the surfaces from the chair to the bed after the patient gets their legs onto the bed/chair
Stand pivot transfer from bed to chair with total hip arthroplasty posterolateral approach on the right side things to consider:
Chair placed on patient’s left side, so lead with unaffected leg and prevent adduction on right side.
right foot forward when standing up rather than under pt to prevent hip flexion past 90 degrees.
Stand pivot transfer definition
when a patient stands erect, turns ans sits.