LO3 RDGR 203 - Patient Transfer Techniques, Immobilization, and Restraints

What things must be considered before moving a patient?

• limited joint movement or immobility

• ability to walk

• general condition (respiratory, cardiovascular, metabolic, musculoskeletal)

• strength and endurance

• balance

• ability to understand the transfer, movement, and why

• medication history

• willingness

What are the 6 main rules of patient assistance?

1. Give the assistance needed for the patient’s comfort and safety.

2. Always move the patient the shortest distance possible.

3. Lock all brakes and/or wheels prior to the move commencing.

4. Give assistance to the patient on their weaker side.

5. Communicate with the patient at all times of the move. Advise the patient on what is going to be done and if they can help.

6. Make eye contact while providing clear and concise commands to the patient.

• counting up to movement is a clear way to communicate next steps for the patient

When are beds used instead of stretchers?

When the patient can not reasonably handle the transfer from bed to stretcher

Indicates high acuity!!

When are staxi chairs used?

Staxi chairs, unlike wheel chairs, are used for transport of the patient by staff. They are usually pushed rather than self propelled or steered by patient like wheel chairs. Patient must be able to sit upright but unable to walk long distances. Sometimes patients with Staxi chairs can walk but are transported for extra safety.

What must always be checked before patient transport?

ALWAYS check the area for equipment attached to the patient. Also make sure you have the right patient (patient id.)

What kind of phrases are best practice to ask rather than “can you walk?”

“have you been walking today?” or “do you use any mobility devices?” or “when was the last time you stood?” or “ do you walk to the bathroom?”

NOT yes or no questions

What is a good check in question to consistently ask during transfer to asses patient condition and balance?

“Are you feeling dizzy or weak?”

What is important to give patients in gowns when utilizing a wheel chair?

a blanket to cover down there

ALSO wipe before and after patient is seated on chair

What are the steps of a bed to wheel chair transfer?

• Lower the bed to its lowest position; then lower side rails - remember to lock bed

• Position wheelchair parallel to patient’s bed with wheels locked and foot-rests out of the way

• Assist patient to a sitting position; pivot while assisting, allowing patient’s legs to clear edge of bed, then allow patient to rest briefly before standing.

• apply transfer belt and utilize underhand grip

• Use face-to-face assist to raise weak patient to standing position

“Ill get you to stand on 3, 1..2..3”

“are you feeling alright? no dizziness?”

• Help patient pivot with his/her back to wheelchair

“can you feel the chair on the back of your legs?”

“alright Ill get you to lean forward, nose over toes, and you can bring your hands to the arms for support”

“Ill get you to sit down on 3.” “1..2..3..”

• Ease patient to sitting position

• Adjust leg-rests and footrests

• Cover patient’s lap and legs

What are the steps of a wheel chair to bed transfer?

• Lower the bed to its lowest position; then lower side rails. Ensure bed is locked

• Position wheelchair parallel to patient’s bed with wheels locked and foot-rests out of the way

• Ask patient to scooch forward until feet touch ground

• apply transfer belt and utilize underhand grip

• Use face-to-face assist to raise weak patient to standing position

“Ill get you to stand on 3, 1..2..3”

“are you feeling alright? no dizziness?”

• Help patient pivot with his/her back to wheelchair and walk to bed

• a stool can be utilized

“can you feel the bed on the back of your legs?”

“alright Ill get you to lean forward, nose over toes, and you can put your hands at your sides for support”

“Ill get you to sit down on 3.” “1..2..3..”

• Ease patient to sitting position or supine position, can support legs to bring up, or support shoulders

Remember to warn patient before moving bed/table for positioning

What are the 3 methods of stretcher transfer?

1. Draw sheet transfers

2. Slider board transfers

3. Sliding mat transfers

what are draw sheet stretcher transfers?

utilizes a draw sheet rolled on either side of the patient to provide handholds when sliding patient onto stretcher

What are slide board stretcher transfers?

utilize either a draw sheet to roll patient on side to place sliding board under. the sheet is then placed on top of sliding board to bunch up for had holds and slide patient across sliding board onto stretcher

• like a bridge to move patient across

what is a sliding mat transfer?

a draw sheet is used to roll patient on side to place a sliding matt under. The slippery surface of matt is used to facilitate transfer

what is a log roll?

A reposition method used to maintain spinal alignment for

patients with suspected spinal injury so no further

injury occurs

Who is in charge of a log roll?

The person at the head of the patient, supporting their neck. Should always be person of highest education and experience

How many people does a log roll transfer require?

at least 3 people

what are the 10 steps of a log roll transfer?

1. One person must hold the patient’s head.

2. Two people must support the chest, abdomen and lower limbs. If the patient is

obese, tall, or has lower limb injuries, an additional person may be necessary

3. Explain the procedure to the patient and ask the patient to lie still and to not

move

4. Make sure that urinary catheters, IV tubing, etc. are repositioned to prevent

overextension and dislodgement during movement. Make sure that the patient is

anatomically aligned before rolling

5. The patient’s arm away from the side of intended turn must be extended along

the thorax and abdomen or bent over the chest if appropriate

6. Place a pillow between the patient’s legs.

7. One assistant on the side of the patient supports the patient’s upper body by

placing one hand on the shoulders and the other hand around the patient’s thighs.

8. The other assistant supports the patient’s abdomen and lower limbs by

overlapping with the first assistant’s arm to place one hand under the patient’s

lower back and the other over the patient’s lower legs.

9. The technologist holding the patient’s head directs the turn. Upon this direction,

the patient is turned in anatomical alignment in one smooth action.

10. Once a sheet or smooth mover is placed under the patient to assist in the move,

the patient is returned to the supine position to be moved as stated above.

What MUST be remembered for patients on spinal precautions?

ALWAYS KEEP SPINE IN ANATOMICAL ALIGNMENT - any repositioning must be done with a person to support head and neck

what are the rules of restraints?

1. The patient must be allowed as much mobility as is safely possible

2. The areas of the body to which immobilizers are applied must be padded to

prevent injury to the skin beneath the device

3. Normal anatomic position must be maintained

4. Knots that will become tighter with movement are prohibited

5. The immobilizer must be easy to remove quickly if necessary

6. Neither circulation nor respiration must be impaired by the immobilizer

7. If leg immobilizers are necessary, wrist immobilizers must also be applied to

prevent the patient from either unfastening the device, or, in an attempt to

leave the table or gurney, unintentionally hanging themselves AKA Always apply both hand and wrist restraints when utilized

What are contraindications for restraining a patient?

• it is not ordered by physician

• The restraints are detrimental to an injury

• restraints are over areas of fragile skin

• patient has bone metastases

• some psychiatric patients

What is immobilization for?

to prevent movement on images

What is patient restraint for?

to restrict patient movement for patient and staff safety. To prevent IV or other therapeutic devices from bein dislodged

what should always be done before applying restraints or immobilization devices to the patient?

Before using any immobilization or restraining device the radiographer must explain to the patient (or the patient’s guardians) the need for the device and show them exactly how it will be used in their care

What is a key way to limit motion artifact aside from immobilization devices?

lessen exposure time as much as possible

When restraints must be removed from imaging reasons what must be done after?

replace removed restraints as soon as possible following imaging

what is a key legal thing to remember about restraints?

physical restraints must be ordered by a physician for adult patients - legal action can occur if this is not followed. this is not the same as safety devices like bed rails or straps to prevent falling

Why is it important to never leave a patient unable to change position unattended? (unconscious, drowsy, or restrained)

difficulty breathing, epistaxis, choking, vomit, may require quick position change