Transferring Dependent Patients Flashcards
____ patients increases risk of musculoskeletal disorders
Lifting/moving
Risk of injury is affected by
Manual Dependent Lifts
- Force required
- Repetitions
- Awkwardness of posture
Chair to and from toilet transfers most stressful!
Most common injuries reported:
- Low back
- Shoulder
- Neck
Body Mechanics
- Don’t rotate spine
- Keep the load close
- Good BOS
- Near reach is safer than far
- Waist to shoulder is the stronger for arms
Clinical Reasoning for Use of Total Body Lifts
- 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
Egress Test Progressions
- 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.
Types of Slings
Total body sling
* Reposition on the bed
* Transfer from one table to another
Single limb
* ROM
Black Sling
* Seated transfer
* Camode transfer
What 4 things do you need to consider when choosing a sling?
- 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
Sling is too small
upper back may not be supported, leg straps may crowd or chafe, or sling bar may be too close to patient’s face
sling too large
hips and buttocks may slide through the opening or the leg straps will not support the lower body appropriately (too long for support)
Sling Placement
- 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)
To position the sling in recumbent position…
either have the patient pull up on a trapeze bar or elevate the head of the bed so that the patient is sitting up
To position the sling from a supine position,
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
When doing a manual hoyer lift, what do you need to remember to do with the legs?
You need to spread them out as much as possible so it is most stable.
Total Body Lift—Floor to Bed
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.
Sit to Stand Lift
- 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
Sit to Lift Indications
- 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
Sit to Stand Considerations
- Capacity of lift
- Level of seated postural control
- Level of arousal
- Hemodynamic stability
- Skin integrity
- Bracing
- Lower extremity injury/pain
- WBing restrictions
Lateral Transfer Indications
- 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.
Lateral Transfer Considerations
- Weight (check device for limitations)
- Musculoskeletlal complications
- Lateral distance being covered
- Patient’s psychological condition
- Width of adjacent surfaces
- Need for head control
Types of Lateral Transfer Equipment
- Slippery sheets and draw sheets
- Rigid andsemirigidtransfer boards
- Air-assisted devices
Friction-reducing devices are the most common type of lateral transfer device.
Slippery Sheet Placement
- 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!
Lateral Transfer Procedure
- 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)
Supine Repositioning Equipment
- Use trendelenburg position to slide patient back up the bed
- Use of a slippery sheet
Bariatric equipment is labeled as…
Extended capacity (EC)
