Chapter 13. Safe Patient Movement and Handling Techniques. Objectives. Body Mechanics

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1 Chapter 13 Safe Patient Movement and Handling Techniques Copyright 2012, 2007, 2002, 1997, 1991, 1984, 1979 by Saunders, an imprint of Elsevier Inc. All rights reserved. 1 Objectives 1. Define the terms associated with body mechanics. 2. Describe the cause, signs, symptoms, and treatment of orthostatic hypotension. 3. Describe the basic principles of proper lifting and transfer techniques. 4. Explain four types of wheelchair-to-bed transfers. 5. Explain a standard cart transfer procedure. 6. Identify five standard patient positions. Copyright 2012, 2007, 2002, 1997, 1991, 1984, 1979 by Saunders, an imprint of Elsevier Inc. All rights reserved. 2 Body Mechanics The purpose of a patient transfer is to safely move a patient from one place to another. Safety involves both the patient and the people doing the transfer. The application of proper lifting and transfer techniques increases job safety. Radiologic imaging professionals who use proper transfer techniques can reduce their injuries and minimize low back pain. Copyright 2012, 2007, 2002, 1997, 1991, 1984, 1979 by Saunders, an imprint of Elsevier Inc. All rights reserved. 3 1

2 Base of Support Fundamental to good patient handling techniques are the concepts of the base of support, center of gravity, and mobility and stability muscles. The base of support is the foundation on which a body rests. Base of support is the area between the feet, including the plantar surface area, in a standing position. Copyright 2012, 2007, 2002, 1997, 1991, 1984, 1979 by Saunders, an imprint of Elsevier Inc. All rights reserved. 4 Base of Support A wider stance improves your base of support. Standing with both feet flat on the floor improves the base of support. Standing with feet apart to increase the base of support improves stability. Standing on tiptoes decreases surface in contact with the floor and narrows the base of support. FIG Variations in base of support: normal; wide; narrow. Copyright 2012, 2007, 2002, 1997, 1991, 1984, 1979 by Saunders, an imprint of Elsevier Inc. All rights reserved. 5 Center of Gravity A hypothetical area of the body where the mass of the body is concentrated; gravity works from this area Typically at level of second sacral segment Holding heavy objects close to your center of gravity permits easier and safer transfer Stability can be achieved when a body s center of gravity is over its base of support FIG The center of gravity for most people is located at approximately S-2. Copyright 2012, 2007, 2002, 1997, 1991, 1984, 1979 by Saunders, an imprint of Elsevier Inc. All rights reserved. 6 2

3 Good Body Mechanics Use good posture. Always keep your body s line of balance close to your center of gravity (below waistline). Hold object close to body. Bend your knees. Don t twist your trunk. Push rather than pull. Copyright 2012, 2007, 2002, 1997, 1991, 1984, 1979 by Saunders, an imprint of Elsevier Inc. All rights reserved. 7 Muscles and Transfers Extremity muscles are classified as mobility muscles. Muscles of the torso are stability muscles. For effective patient transfers and handling, technologists should use mobility muscles for lifting and stability postural muscles for support. FIG Mobility muscles include the biceps brachii and the hamstring group. Postural muscles include the rectus abdominis and the erector spinae muscles. Copyright 2012, 2007, 2002, 1997, 1991, 1984, 1979 by Saunders, an imprint of Elsevier Inc. All rights reserved. 8 Transfer Techniques Mean Teamwork! Someone needs to take charge of the transfer Reviews procedures with team members Calls the play Establishes timing of play Synchronizes play events FIG B, At the command of the person supporting the patient s upper body, the patient is lifted to clear the wheelchair and moved as a unit to the desired place. Copyright 2012, 2007, 2002, 1997, 1991, 1984, 1979 by Saunders, an imprint of Elsevier Inc. All rights reserved. 9 3

4 Lifting Principles Lifting should be done by bending and straightening the knees. The back should be kept straight or in a position of slightly increased lumbar lordosis. Allow ample time, and handle patients gently. Always inform the patient of what you are going to do and how you intend to proceed. When performing a transfer, let patients do as much of the work as possible. Before executing the transfer, check the patient s chart and verify whether he or she has a restricted weight-bearing status. Patients with cognitive impairments, such as dementia, may overestimate their transfer abilities and require assistance. Copyright 2012, 2007, 2002, 1997, 1991, 1984, 1979 by Saunders, an imprint of Elsevier Inc. All rights reserved. 10 Lifting Principles Execute the transfer slowly enough for the patient to feel secure. The patient s center of gravity should be held close to the transferer s center of gravity. Taking a transfer belt is a good practice when planning to perform transfers. Avoid loose clothing on the patient. Let patients perform as much of the transfer as they can. When lifting patients, keep the back stationary and let the legs do all of the lifting. Twisting should be avoided. After the patient is standing, help him or her to pivot around to a bed or x-ray table and to sit down. Copyright 2012, 2007, 2002, 1997, 1991, 1984, 1979 by Saunders, an imprint of Elsevier Inc. All rights reserved. 11 Orthostatic Hypotension A sudden drop in blood pressure caused by a change in a patient s body position More pronounced in patients who have been bedridden for extended periods Symptoms of orthostatic hypotension include dizziness, fainting, blurred vision, and slurred speech To minimize the severity of orthostatic hypotension, have the patient stand slowly Encourage the patient to talk during the transfer by asking simple questions Do not send a symptomatic patient away and risk having the patient faint on the way to his or her room Copyright 2012, 2007, 2002, 1997, 1991, 1984, 1979 by Saunders, an imprint of Elsevier Inc. All rights reserved. 12 4

5 Skin Damage from Transfers Can occur in as little as 1 to 2 hours May occur going from one surface type to a different surface type Caused by several mechanical factors Copyright 2012, 2007, 2002, 1997, 1991, 1984, 1979 by Saunders, an imprint of Elsevier Inc. All rights reserved. 13 Wheelchair Transfers Determine patient s strong and weak sides Always position the patient so that he or she transfers toward the strong side Lock wheelchair locks and move footrests out of the way Four types of wheelchair transfers Copyright 2012, 2007, 2002, 1997, 1991, 1984, 1979 by Saunders, an imprint of Elsevier Inc. All rights reserved. 14 Standby-Assist Transfer Used for patients who have the ability to transfer from a wheelchair to a table on their own Provide movement instructions to the patient continually during transfer FIG Angle the wheelchair to be 45 degrees from the table. Copyright 2012, 2007, 2002, 1997, 1991, 1984, 1979 by Saunders, an imprint of Elsevier Inc. All rights reserved. 15 5

6 Assisted Standing Pivot Transfer FIG An assisted standing pivot transfer is used when transferring a patient from a wheelchair to a table. A, Use a transfer belt to hold the patient securely. B, Have the patient sit on the edge of the wheelchair seat. Provide assistance as needed. C, Have the patient push down on the arms of the wheelchair to assist in rising. D, Bend at the knees, keeping your back straight, and grasp the transfer belt with both hands. E, As the patient rises to standing, rise also by straightening your knees. F, When the patient is ready, pivot toward the table until the patient can feel the table against the back of the thighs. G, Ask the patient to hold onto the table with both hands and to slowly sit down. Copyright 2012, 2007, 2002, 1997, 1991, 1984, 1979 by Saunders, an imprint of Elsevier Inc. All rights reserved. 16 Two-Person Lift FIG Two-person lift. A, The first person asks the patient to cross his or her arms over the chest. The person making the transfer stands behind the patient, reaches under the patient s axillae, and grasps the patient s crossed forearms. The assistant squats in front of the patient and cradles the patient s thighs in one hand and the patient s calves in the other. B, At the command of the person supporting the patient s upper body, the patient is lifted to clear the wheelchair and moved as a unit to the desired place. Copyright 2012, 2007, 2002, 1997, 1991, 1984, 1979 by Saunders, an imprint of Elsevier Inc. All rights reserved. 17 Hydraulic Lift Techniques Used for heavy patients Familiarize yourself thoroughly with lift operations before using this type of lift Patients need to be seated on a lift sling before using this type of lift Sending a patient back to the ward to return sitting on a sling is better than risking injury to the patient, the transferer, or both by attempting transfer without using a sling Communication is critical to lift success FIG Hydraulic lifts often have four caster wheels but no wheel locks. The lift s base of support can be widened or narrowed by means of a lever. The lift has two handles for steering, a manual pump for raising the support arm, a release valve for lowering the support arm, and a spreader bar for the sling attachment. Copyright 2012, 2007, 2002, 1997, 1991, 1984, 1979 by Saunders, an imprint of Elsevier Inc. All rights reserved. 18 6

7 Cart Transfers Make sure cart wheels are locked and immovable. Allow patient to assist with move based on the patient s ability and condition. Cart transfers usually require three people. Use transfer aids. For the actual lateral transfer, both transfer surfaces must be side to side, as close as possible, and at the same height. Copyright 2012, 2007, 2002, 1997, 1991, 1984, 1979 by Saunders, an imprint of Elsevier Inc. All rights reserved. 19 Patient Transfer with Draw Sheet FIG Cart-to-table transfer without a moving device. A, Begin by rolling up the draw sheet on both sides of the patient. B, The person directing the transfer supports the patient s head and upper body from the far side of the radiographic table. An assistant supports the patient s pelvic girdle from the cart side. A second assistant supports the patient s legs from the tableside. The patient s arms can be crossed over the chest to avoid injury or getting in the way. Copyright 2012, 2007, 2002, 1997, 1991, 1984, 1979 by Saunders, an imprint of Elsevier Inc. All rights reserved. 20 Patient Positioning Considerations Talk with the patient and explain what you are going to do. Let the patient assist as much as possible. Check with patient before any move is attempted. Provide positioning sponges to help the patient maintain correct positioning. Work as a transfer team! Copyright 2012, 2007, 2002, 1997, 1991, 1984, 1979 by Saunders, an imprint of Elsevier Inc. All rights reserved. 21 7

8 Common Recumbent Patient Positions Supine Prone Lateral Sims Fowler s FIG Patient positioning. Copyright 2012, 2007, 2002, 1997, 1991, 1984, 1979 by Saunders, an imprint of Elsevier Inc. All rights reserved. 22 Conclusion Communication with patient and team members is critical to safe and efficient transfers. Work as a transfer team with a clear leader during the transfer. Let the patient assist with transfers if possible. Use a broad base of support, and maintain your center of gravity over base during lift. Use transfer and positioning aids when possible. Copyright 2012, 2007, 2002, 1997, 1991, 1984, 1979 by Saunders, an imprint of Elsevier Inc. All rights reserved. 23 8