Chapter 13

Safe Patient Movement

Involves keeping both healthcare providers and patients safe during patient transfer and handling - over time we will lift and move a lot of patients. Important to use good body mechanics

US Department of Labor stat

strains, sprains and musculoskeletal injuries as the leading cause of disability for healthcare providers. Can have slip discs, popped rotator cuff, etc.

600,000

Injuries involve __________ HCP's a year in the work place

Healthcare Injuries

•Costs 50 billion dollars

•Hospitals and facilities

Body Mechanics

•A branch of physics that applies the laws of mechanics to living creatures

Physics

•Safe handling and moving of patients starts with applying laws of _______ to the human body

Body Mechanics

Enables healthcare professionals to transfer a patient safely from one place to another or move body parts into desired positions - keeping us safe but also keeping the patients safe

•Fundamentals of good patient handling techniques are the concepts of:

Base of Support, Center of Gravity, and Mobility and Stability Muscles

Base of Support

•Foundation on which a body rests

•When person is standing, the feet and space between them constitute this

widens

standing with feet apart _____ the base of support making it stable

reduces

Standing on one foot or on tiptoe greatly _______ the base of support making it unstable

base of support

When moving a patient, HCP must establish a stable ___________

Center of Gravity

Hypothetical point at which all the body mass appears to be concentrated

Center of gravity location in the body

in the anatomic position located at approximately the level of the second sacral segment

center of gravity

When moving patients, the patient should be held close to the HCP's __________

Stability

this is achieved when when the body’s center of gravity is over it’s base of support

Mobility Muscles

- Found in the limbs

- These muscles have long white tendons and cross two or more joints to hold things in place

Mobility Muscle Examples

Biceps and hamstrings

Stability Muscles

- Found in the torso

- These muscles are large expanses of red muscle and provide postural support

Stability Muscle Examples

lattisimusdorsi (back), rectus abdominus (abdominal)

Muscles for Lifting

White mobility muscles (biceps and hamstrings)

Muscles for Support

Red postural muscles (abdominal and back)

Principles of Lifting

- Let the patient do as much of the work as possible

- Patients sometimes overestimate their ability to move or assist in moving them

- Check the patient's weight-bearing status before assisting the patient to stand

- let legs do the lifting

- Hold the patient close to the HCP's center of gravity

During lifting

_________________ the back should be kept straight or in a position of slight increased lumbar lordosis (leaning back)

Orthostatic Hypotension

•When patient stands too quickly, they can experience this

•a drop in blood pressure that can cause patient to experience dizziness, fainting, blurred vision and slurred speech

•Patient experiencing this is at risk for falling

Types of Wheelchair Transfers

•Standby assist

•Assisted standing pivot

•Two-person lift

•Hydraulic lift

strong

before a wheelchair transfer, determine if a patient has a strong or weak side.

Always position the patient so that he/she transfers towards the _______ side

wheelchair

Before a ___________ transfer, ask the patient about restricted weight-bearing status, generalized weakness, arthritic conditions, or other conditions that might affect the patient's ability to stand.

- Also see if the patient has a leg cast, foot deformity, or extremity amputation

Standby Assist Transfer

The patient is stronger and able to talk with you and understand directions

Standby Assist Transfer Steps

- Position the wheelchair at a 45-degree angle to the table

•Move the footrest out of the way

•Lock wheelchair wheels

- We are just there to assist and catch them if they fall

•Instruct pt "sit on edge of wheelchair seat" - their center of gravity

•Instruct pt "push down on arms of chair"

•Instruct pt "nose over toes and stand slowly" - keeps their center of gravity over their base of support

•Instruct pt "reach out and hold onto table"

•Instruct pt "turn slowly until you feel the table behind you"

•Instruct pt "hold onto table with both hands"

•Instruct pt "sit on table"

Assisted Standing Pivot Transfer

•For patient who cannot transfer independently, but who can put weight on legs - does not have as much stability - for example might have an injury in one foot and cannot put much weight on it

Assisted Standing Pivot Transfer Steps

- Position wheelchair at 45-degree angle to table

- Move footrest out of way

•Lock wheelchair wheels - if they push down without it locked it will push the wheelchair out of the way and they will fall

•Instruct pt "sit on edge of wheelchair seat"

- Instruct pt "push down on arms of chair"

- HCP will bend at the knees, keep back straight and grasp the transfer belt with both hands

- Block patient's knees

•As the patient rises, HCP will straighten knees

•Both HCP and patient pivot until patient's legs/back are toward the table - get them straight up and pivot them until they are sat down

- Instruct patient "hold table with both hands and sit"

•HCP will assist patient with sitting and laying down on table

Two Person Lift

- For the patient who cannot bear weight on legs - they could be paralyzed or have some other condition

- •The stronger person should lift the torso, the second person lifts the patient's legs / feet

- •Explain the lift to the patient prior to the move

Two Person Lift Steps

- Align wheelchair parallel with table

•Lock wheelchair wheels

•Remove armrests

•Remove leg rests

•Ask patient to cross arms over chest - and cross them so they don't get in your way

•Stronger person stands behind patient, reaches under arms and grasps pt's crossed forearms

•Second person squats in front of ptto cradle pt's thighs in one hand and calves in the other

•On command, (1,2,3) the pt is lifted clear of the wheelchair and lowered gently to the bed, table, or stretcher

Hydraulic Lift

- For patients who are too heavy to lift manually - could be unconscious, paralyzed, not able to move at all, or on a ventilator

- Requires specialized equipment

• contains:

•Four caster wheels but no wheel locks

•Two handles for steering

•Spreader bar for sling attachment

•Transfer sling

- make sure all of this is equipment is under patient before you lift the patient so you can place them in it

Cart/Stretcher Transfers

- Position stretcher parallel to table, as close as possible to table

- Lock wheels on stretcher

- Determine if patient can assist

- Utilize a moving device (example, slide board) or draw sheet to transfer patient from stretcher to table - must have someone on both sides of the sheet.

- Make sure the table is aligned with your center of gravity

Moving Devices

- Slide Board

- Draw Sheet

Slide Board Moving Device

a thin, plastic board the length of the patient

Slide Board Moving Device Steps

- pt is rolled to one side toward you

- board placed under pt

- pt rolled to back

- •sheet and pt are pulled across slide board

Draw Sheet

- sheet is folded and placed under pt's center torso with sheet accessible from both sides - 2 people - needs to have the same length of sheet on both sides of the patient

Draw Sheet Steps

- Pt rolled to one side

•Folded sheet placed under pt's torso

•Pt rolled to back

•Sheet accessed from opposite side

•Pt and sheet are lifted/slid from stretcher to table

Basic Patient Positioning

- In moving a patient, always roll the patient toward you - helps to keep you from injuring yourself

•Support the patient on positioning sponges once in position

Attached Medical Equipment

- Often the pt will present with lines and tubes attached. Extra care must be taken with this equipment to ensure no lines are displaced

Types of lines/tubes

•Oxygen tubing

•IV lines

•Central lines

•Postsurgical drains

•Urine catheters and bags

•Chest tubes

•Cardiac monitors

Base of Support

foundation on which a body rests or stands; when people stand, their feet and the space between the feet define the base of support

Biomechanics

a component of physics, the laws of Newtonian mechanics, applied to living bodies at rest and in motion

Center of Gravity

hypothetical point around which all mass appears to be concentrated

Commonly Attached Medical Equipment

- items clipped, fastened, or affixed to the patients' bodies to deliver substances such as oxygen, medications, hydration, or nutrition, or drain away substances, such as postsurgical fluids or urine.

- Care must be taken when moving or positioning with these attachments. Neither the patient nor the clinician should get injured during this activity.

- The equipment should also survive intact without damage or functional impairment.

Ergonomics

the study of a person's efficiency in the working environment

Mobility Muscles

- muscles that are found in the four extremities and designed for movement; examples include the biceps femoris, biceps brachii, and gastrocnemius.

- These muscles have long white tendons and are also called white muscles

Orthostatic Hypotension

a sudden drop in blood pressure in the brain when a person stands up too quickly from a sitting or supine position, causing the oxygen in the brain to drop and the person to become dizzy and prone to falling

Stability Muscles

- muscles that support the torso and are designed to provide postural stability; examples include the latissimus dorsi, abdominal group, and erector spinae.

- These muscles tend to have thick red muscle bellies and are also called red muscles

Work-Related Musculoskeletal Disorder (WRMSD)

- injury or disorder of the muscles, nerves, tendons, joints, cartilage, and spinal discs in which work environment and performance contribute significantly, and/or the condition is made worse or persists longer due to work conditions