Chapter 13

Muscle design

  • Stability muscles - torso; large expanses of muscle that help support the torso, abdomen/back, rectus abdominis, and latissimus Doris.

  • Mobility muscles - limbs, long white tendons that cross 2 or more joints (biceps and hamstrings)

  • Use mobility muscles for lifting and stability muscles for support.

  • Lifting should be done by bending and straightening the knees.

  • The back should be kept in a position slight lumbar lordosis.

  • To avoid injury, the adage “lift with your legs, not with your back” is derived from this concept.

Body Mechanics

  • The purpose of a patient transfer is to safely move a patient from one place to another.

Base of support

  • The space between your feet is your base of support.

  • The base of support is the foundation on which a body rests.

  • A wider stance and planting both feet on the ground improves your base of support

  • Standing on tiptoes decreases surface area in contact with the floor and narrows the base of support.

Center of gravity

  • Typically at level of second sacral segment or S2.

  • In the middle part of your pelvic cavity.

Proper patient handling requirements

  • Good base of support

  • Awareness of ones center of gravity

  • Use of correct muscles for mobility

  • Use of muscles to maintain stability

  • Pay attention to condition of orthostatic hypotension (blood pressure dropping) in patient.

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.

  • Excuse transfer slowly enough for the patient to feel secure

  • The patients center of gravity should be held close to the movers center of gravity

  • Taking a transfer belt is a good practice when planning to perform transfers.

  • Secure loose clothing on the patient

  • When lifting patients, keep the back stationary and let the legs do all 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

Orthostatic Hypotension

  • A sudden drop in blood pressure caused by a change in a patients body position.

  • More pronounced in patients who have Ben bedridden for extended periods.

  • Symptoms include dizziness, fainting, blurred vision, and slurred speech.

  • Do not send a symptomatic patient away and risk having the patient faint on the way to their room

  • To minimize this, have the patient stand slowly.

  • Talk to patient and listen for symptoms.

Wheelchair transfers

  • Let patients do as much as possible

  • Check the chart for any precautions-non weight bearing status, cognitive impairments, and joint disease- before moving patient to minimize patient discomfort or harm.

  • Choose the correct type of transfer and have equipment and assistance to perform task safely.

  • Determine patients strong and weak sides

  • Always position the patient so that he or she transfers toward the strong side.

  • Lock the wheelchair locks and move footrests out of the way.

  • Establish base of support for your stability

  • Hold patients center of gravity close to your own center of gravity for a mechanical advantage

  • Use gait belt on patients waist to minimize stress on patients shoulder girdle

  • Lift patient with your legs and avoid bending or twisting

  • Never lift more than you safely can and ask for help

  • Watch patient for signs of orthostatic hypotension

  • Cart transfers Let patients always have 3 people

Types of wheelchair transfers

  • Standby Assist Transfer

    • Pt can bear weight: transfer on own

  • Assisted Standing Pivot Transfer

    • Pt cannot transfer alone but can bear weight on legs

  • Two person lift

    • Pt cannot bear weight on lower extremities

  • Hydraulic lift

    • Pt is too heavy to lift manually

Assisted Standing Pivot Transfer

  •     WC at 45 degree angle to table/bed

  •     Transfer toward strong side

Hydraulic Lifts

  • Used when patients are too heavy to lift manually.

    • Uses the power of hydraulic fluid to handle extreme weights:

      • Release valve mechanism

  • Feature adjustable base of support

  • Employs a lifting, transfer sling

  • Most lifts have standard features

    • Familiarize yourself with these features

  • Patients need to be seated or recumbent 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 mover, or both by attempting transfer without using a sling.

  • communication is critical to lift success, particularly with patients nurse.

Cart transfers

  • Make sure cart wheels are locked and immovable

  • allow patient to assist with move on the basis of the patients ability and condition

  • 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.

Cart to cart

  • Typically uses a transfer assist device

  • Roll patient away from table and toward you

  • Position device under patient and draw sheet

  • Roll patient back and ensure they are on device with draw sheet

  • Gently pull draw sheet and patient onto table

  • Roll up sheet for better grip[ and keeping patient close

  • When moving patient always roll patient toward you

  • Sims and Fowler are most common positions but also keep in mind the Trendelenburg which is when the head is down and feet up.