Transfers Part 1 Flashcards
What is a transfer?
Moving from one position or surface to another position or surface
What are some common types of transfers?
- Sit to stand
- stand to sit
- car transfer
- toilet transfer
- stand pivot
- squat pivot
- slideboard transfer
Why would we need to transfer?
- For the patient’s heart function and for pressure ulcer prevention
- access to the patients environment to allow them to function
- mobilization
What should we consider about our patient’s abilities before we transfer?
- strength
- joint mobility
- balance
- pain level
- cognition
- endurance
- motor control
- spasticity
- precautions
What should we consider about the equipment being used before transfers?
- Are assistive devices necessary?
- is the wheelchair locked?
- Do you have a gait belt?
What should we consider about the environment before we transfer?
- Do you have the space to transfer?
- Are there hazards in the environment?
- Do you have to move a certain direction?
What should we consider about our own ability and skill before we transfer?
- Can you do this by yourself or do you need help?
- Do you have limitations that prevent you from keeping the patient safe?
- Significant height difference impacting mechanics?
When should gait belts be used?
For most transfers
What is the exception to when we should use a gait belt?
patients who are independent who do not have balance impairments
Where is the gait belt typically worn?
On the waist, but can be placed higher (axilla) as needed
What kind of a grip do we use with a gait belt?
Lumbrical grip
Why do we use a gait belt?
Improves safety for the patient and the caregiver
What are other considerations for gait belt placement?
Lines and tubes
What are the general principles of managing lines and tubes?
- keep them organized
- know which lines are critical
- know which lines can be removed
- move toward the shortest line
- rearrange the environment to accomadate the lines
- use extensions and portable lines when possible
What is the most important rule about managing lines and tubes?
NEVER STEP OVER A LINE
What are some examples of types of lines?
nasogastric tubes
HR monitors
Central lines
Endotracheal tubes
O2 monitors
Sequential compression devices
Arterial lines
Urinary catheters
Chest Tubes
BP cuffs
Rectal tubes
IV lines
Nasal canula
drains
What does good body mechanics help with during a transfer?
- uses less energy
- reduces strain on body tissues
- produces safe, efficient movement
- promotes control and balance
What are the principles for transfers?
- use physics to your advantage
- keep the patient safe
- consider your environment
- teach/cue the transfer if needed
- mental preparation
- guard patient where you do not impede motion but can still keep them safe
- consider patient positioning pre and post transfer
What are guarding principles for transfers?
- Stand where you do not impede movement
- promote safety
- promote function
- use a gait belt
- support/block limbs with strength deficits
- stand on the patient’s more affected side
- position yourself and the patient for efficient movement
What is a grade 1 transfer?
Dependent - patient requires total physical assistance with one or more persons to accomplish a transfer safely
What is a grade 2 transfer?
Maximal assist (MaxA) - patient performs 25-49% of the activity
What is a grade 3 transfer - mod a?
Moderate assist - patient performs 50-74% of the activity
What is a grade 3 transfer - min a?
Patient performs ≥ 75% of the activity
What is contact guard assist?
A grade 4 - therapist or caregiver has hands on pt and or/gait belt to provide safety as needed
What is stand by assist/ supervision?
A grade 4 - verbal or tactile cues, directions, instructions positioned close to, but not touching the patient
What is a level 5 assist?
Modified independent - pt. may require verbal cues, uses assistive device/adaptive equipment or requires additional time to complete the task (AKA setup/cleanup)
What is a stage 6 assist?
Independent - no assistance required to complete the task in the normal time frame
What would go in our subjective for documentation of a transfer?
“Patient reports wanting to independently transfer from wheelchair to bed at the end of a long day”
What would go in our objective for documentation of a transfer?
“Completed a level 3 high squat pivot transfer to the right from the wheelchair to the bed requiring partial assist or ModA from the patient. Gait belt used throughout session”
What would go in our assessment for documentation of a transfer?
“Patient requires further skilled therapy intervention due to requiring assistance as well as verbal and tactile cues for efficient mechanics and safety during transfers”
What would go in our plan for the documentation of a transfer?
“Practice similar transfers with less assistance, higher repetitions, and/or uneven surfaces next session
What are good sit to stand mechanics?
- Patients should be on the edge of the chair
- feet should be underneath them
- they should lean forward to stand
Where could you guard for sit to stand?
Side or front
What would influence your decision on where you guard?
- level of assist
- precautions
- assistive devices
- affected or unaffected side
- body mechanics
What is a stand pivot transfer?
Stand all the way up, turn and sit on an adjacent surface
When is a stand pivot good to use?
When…
- there is something obstructing a squat pivot
- the patient is capable of standing with or without assist
- the transfer is to a different height surface
What is a squat pivot transfer?
Staying in a squatted potion, turn and sitting on an adjacent surface
When is a squat pivot good to use?
when…
- There is nothing obstructing path to other surfaces
- the patient is not capable of standing
- the transfer is to a relatively similar height surface
What is the seesaw concept?
- your feet and the patients feet on the ground are the fulcrum, they lean forward and shift toward you while you drop your hips during the transfer
What must you do during a seesaw transfer?
Stay at balance point
lift hips and they shift their weight back to sit
Where do you guard for a squat pivot transfer?
In FRONT
