Patient Transfer Notes

Patient Transfer Considerations

  • Moving patients requires wheeled transport for safety.

  • Wheelchairs are for patients who can sit upright.

  • Stretchers (Gurneys) are for patients too weak to sit or with specific conditions:

    • Post-surgery

    • Stroke

    • Heart attack

    • Not ambulatory post-surgery/accident

  • Small children use cribs; infants use incubators.

  • Inpatients, including infants, are not allowed to walk to the Radiology Department; infants should not be carried.

Preparation for Transfer

  • Check with nursing service and obtain the patient's chart.

  • Verify patient identification (using two identifiers).

  • Plan the transfer process and prepare the work area.

  • Obtain and inspect equipment for safety and function.

  • Note any equipment that needs to accompany the patient:

    • Urinary bag

    • Oxygen (O2)

    • Pleuravac

    • ECG

  • Involve the patient and explain the process.

  • Obtain additional assistance when necessary, clearly communicating roles.

Bed-to-Wheelchair Transfer

  • Lower the bed to wheelchair level and elevate the head of the bed.

  • Position the wheelchair parallel to the bed, lock wheels, and move footrests out of the way.

  • Support the patient's shoulders and knees, and move them to a sitting position with feet dangling.

    • Patients with back pain may prefer to sit up from a lateral recumbent position.

  • Assist the patient with slippers and a robe and allow time to regain balance to prevent Orthostatic Hypotension.

  • Competent patients may stand and move to the wheelchair with minimal assistance, but offer support.

  • Use a gait belt with weak or unsteady patients for a secure hold:

    • Grasp the gait belt or reach around the patient to place hands firmly over the scapulae; patient's hands may rest on your shoulders.

    • On your signal, lift upward.

    • Use a broad base of support and keep your back straight.

    • Instruct and assist the patient to pivot until the wheelchair touches the back of their knees, then ease them into the chair.

    • Position footrests and leg rests.

    • Cover the patient's lap and legs with a sheet or bath blanket for warmth, comfort, and modesty.

  • Falls often occur when the patient sits in the wheelchair:

    • They may miss the edge of the seat or tip the chair.

    • Always lock the wheelchair and assist the patient until seated securely.

Wheelchair-to-X-Ray Table Transfers

  • Position the wheelchair parallel to the table, move footrests, and lock the brakes.

  • For adjustable-height tables, lower the table to chair height:

    • Help the patient stand and pivot with their back to the table, then ease them onto the edge of the table.

  • For stationary tables, use a step stool with a tall handle:

    • The patient places one hand on the handle, the other on your shoulder, steps onto the stool, and pivots with their back to the table, then sits.

  • After the patient is seated, raise the adjustable table to the desired height.

  • Support the patient's shoulders and knees and smoothly move their legs onto the table while lowering the head and shoulders to a supine position.

    • Patients with back pain may prefer to lie on their side first.

Special Considerations for Wheelchair Transfers

  • Stroke Victims:

    • Support affected side.

    • Position the stronger side next to the table.

  • Fractures of the Lower Extremity:

    • Assess weight-bearing ability.

    • Support affected side.

    • Position the stronger side next to the table.

  • Hip Joint Replacement:

    • Anterior Approach:

      • Patient may sit upright.

      • Weight-bearing is usually tolerated (check chart).

      • Avoid abduction and adduction.

      • Avoid internal and external rotation of the hip.

      • Avoid hyperextension.

    • Posterior Approach:

      • Patient may not flex beyond 90 degrees.

      • Weight-bearing is usually tolerated (check chart).

      • Abduction is permitted.

      • Avoid adduction.

      • Avoid internal rotation.

  • Knee Replacement:

    • Weight-bearing is tolerated, but use a walker for more than 1-2 steps.

    • Move patient toward the strong side.

    • Support under the calf and knee of the affected leg when sitting or lying down.

  • Spinal Trauma or Spinal Surgery:

    • Initially transferred on a stretcher.

    • May be transferred by wheelchair as recovery progresses.

    • Sit patient up from lateral recumbent position.

    • To lie down, lie on side first, then roll to supine with knees flexed.

    • Place bolster under knees to reduce spine stress.

  • Patients Who Cannot Stand Safely:

    • Perform imaging exams in wheelchair or on stretcher if possible.

      • Paraplegic

      • Quadriplegic

    • If transfer is needed, use a Hydraulic lift (Hoyer lift).

      • Requires proper instruction and training to operate.

Stretcher Transfers

  • Three methods:

    • Draw sheet

    • Slider board

    • Sliding mat

Safety Side Rails

  • Required up and locked:

    • For impaired/unconscious patients.

    • When patients are unattended on a stretcher.