Transferring Dependent Patients

Question 1

____ patients increases risk of musculoskeletal disorders

Answer 1

Lifting/moving

Question 2

Risk of injury is affected by

Manual Dependent Lifts

Answer 2

• Force required
• Repetitions
• Awkwardness of posture

Chair to and from toilet transfers most stressful!

Question 3

Most common injuries reported:

Answer 3

• Low back
• Shoulder
• Neck

Question 4

Body Mechanics

Answer 4

• Don’t rotate spine
• Keep the load close
• Good BOS
• Near reach is safer than far
• Waist to shoulder is the stronger for arms

Question 5

Clinical Reasoning for Use of Total Body Lifts

Answer 5

• Point-to-point transfers (seated or supine) requiring extensive assistance or total dependence with bed mobility and early transitions
• Lower-extremity (LE) non–weight-bearing (NWB) patients who cannot perform a seated lateral transfer safely
• Decreased postural control
• Inability to stand/step transfer
• Non-ambulatory history
• Severe LE contractures
• Maybe: Uncooperative or limited cognition

Question 6

Egress Test Progressions

Answer 6

• From seated on edge of bed, patient first clears hips 1-2 inches from bed and returns to seated position. If successful:
• Patient performs two reps of sit to stand. If successful:
• Patient stands and marches in place 3 repetitions. If successful:
• Patient steps forward and back with one leg then the other

In front of a seated surface

If they can’t get up from EoB, Raise bed or use handles to help with pushing up. If they can’t stand doing EoB exercises LE and UE.

Question 7

Types of Slings

Answer 7

Total body sling
* Reposition on the bed
* Transfer from one table to another

Single limb
* ROM

Black Sling
* Seated transfer
* Camode transfer

Question 8

What 4 things do you need to consider when choosing a sling?

Answer 8

• Area of the body that the sling will support
• Where the seat edge of the sling fits on the body
• The location of the leg straps
• The position of the overhead sling bar

Question 9

Sling is too small

Answer 9

upper back may not be supported, leg straps may crowd or chafe, or sling bar may be too close to patient’s face

Question 10

sling too large

Answer 10

hips and buttocks may slide through the opening or the leg straps will not support the lower body appropriately (too long for support)

Question 11

Sling Placement

Answer 11

• Position sling behind and under thepatient, with the bottom edge of the sling as close to the sacrum as possible
• Smooth wrinkles from the sling.
• Position leg straps.

Discourage the patient from holding onto the transfer bar with their hands (ask them to cross their arms over their chest)

Question 12

To position the sling in recumbent position…

Answer 12

either have the patient pull up on a trapeze bar or elevate the head of the bed so that the patient is sitting up

Question 13

To position the sling from a supine position,

Answer 13

will have to roll / fold sling to half position and place under patient in sidelying, then have the patient roll to other side to lay out full sling under patient

Question 14

When doing a manual hoyer lift, what do you need to remember to do with the legs?

Answer 14

You need to spread them out as much as possible so it is most stable.

Question 15

Total Body Lift—Floor to Bed

Answer 15

If the patient cannot tolerate long-sitting, roll the patient to the side to position the upper portion of the sling behind the patient with its lower edge near the sacrum.

Question 16

Sit to Stand Lift

Answer 16

• Designed for patients who are dependent in their transfers, but able to bear some weight on their lower extremities during the transfer

May be used for:
* Moving from one seated position to another through standing
* Coming to stand for therapeutic purposes
* Especially useful for toileting and perineal hygiene

Question 17

Sit to Lift Indications

Answer 17

• Lift does not exacerbate any back problems (example: thoracic kyphosis).
• Patient is able to bear some weight on the LEs.
• Patient can flex hips, knees, and ankles.
• Patient can maintain sitting balance without extensive support.
• Patient can participate (physically and cognitively) in transfer process.

Must have cognition

Question 18

Sit to Stand Considerations

Answer 18

• Capacity of lift
• Level of seated postural control
• Level of arousal
• Hemodynamic stability
• Skin integrity
• Bracing
• Lower extremity injury/pain
• WBing restrictions

Question 19

Lateral Transfer Indications

Answer 19

• Moving a dependent patient from one horizontal surface to an adjacent horizontal surface (e.g., bed & gurney or stretcher & treatment table / tilt table)

May also be useful for:
* Patients who require significant assist with bed mobility
* Hygiene
* Skin integrity maintenance

All lateral transfer devices have a surface that remains in contact with the patient’s skin or clothing so that the shearing forces occur primarily between the transfer device and the surface beneath it rather than at the patient’s skin.

Question 20

Lateral Transfer Considerations

Answer 20

• Weight (check device for limitations)
• Musculoskeletlal complications
• Lateral distance being covered
• Patient’s psychological condition
• Width of adjacent surfaces
• Need for head control

Question 21

Types of Lateral Transfer Equipment

Answer 21

• Slippery sheets and draw sheets
• Rigid andsemirigidtransfer boards
• Air-assisted devices

Friction-reducing devices are the most common type of lateral transfer device.

Question 22

Slippery Sheet Placement

Answer 22

• Turn the patient to one side and slide / place the device as far under the patient as possible
• For sheets, fold the sheet half way and place it under the middle of the patient’s body
• Return the patient to supine and have them roll to the other side to fold out the sheet
• Return the patient to supine, centered on the sheet

Consider if you need help to keep the body moving as one!

Question 23

Lateral Transfer Procedure

Answer 23

• Inform the patient oftransferexpectations.
• Place device underneath patient (rolling).
• Lower bed rails and bring surfaces together.
• Stabilize both surfaces
• Grip handles, set abdominal muscles
• Move patient on count of 3
• Leave patient safely positioned (reails ip/call light)

Question 24

Supine Repositioning Equipment

Answer 24

• Use trendelenburg position to slide patient back up the bed
• Use of a slippery sheet

Question 25

Bariatric equipment is labeled as…

Answer 25

Extended capacity (EC)