Principles of transfers and assistive devices for movement

1. Principles of transfers and assistive devices for movement

2. Transfer techniques What type of condition does your patient have? Paralysis Hemiplegia Quadriplegia Weakness Total hip replacement Comatose Non weight bearing (NWB)

3. The technique you use depends on the condition of your patient Several different styles of transfers 1 man (person) lift 2 man (person) lift Mechanical lifts

4. 1 person lifts Stand pivot Knee to knee Your leg between their leg NDT

5. Bed to W/C 1 person lift knee to knee Position W/C at 450 angle Lock the brakes of W/C and bed Clear all tubes and lines Go towards the patient�s strong side Sit pt on side of bed Bend pt�s knees to 900 Block pt�s toes with your toes and knees with your knees Flex your knees and grab pt�s gait belt Give pt a count of 3 and tell pt have pt push up off bed

6. Bed to W/C 1 person lift knee to knee (Continued) Straighten your knees and lean back as pt stands Let pt do as much as he or she can Pivot toward W/C Have pt reach for handles of W/C as he or she lowers to the chair Keep your back straight during the transfer and avoid twisting

8. Bed to W/C 1 person liftalternate technique Same as previous technique but your knees do not touch pt�s knees. You position your feet between pt�s legs or as in next picture, your knees are covering 1 pt�s knees Your body is closer to pt

10. 2 person stand pivot bed to W/C lift Position W/C at 450 angle Lock the brakes of W/C and bed Clear all tubes and lines Go towards the patient�s strong side Sit pt on side of bed Bend pt�s knees to 900 1 person stands behind back of W/C and holds gait belt from behind or places hands under pts buttocks Other person is positioned as in 1 person lift Person in front of pt gives the command, 1, 2, 3 lift

11. 2 person total lift bed to W/C Reclining W/C placed parallel to bed 1 person stands next to pt�s head This person should be the tallest This person reaches under pt�s axillas, crosses pt�s arms over his chest 1 person stands facing the pt at his or her knees. This person grasps pt under thighs and calves 1 person gives a count of 3. Both lift pt into W/C

12. NDT transfer Simple technique to transfer a pt Bring pt to side of bed Place W/C parallel to bed and remove arm rest next to bed Flex pts trunk and neck under your axilla On a count of 3, pivot pt�s bottom toward W/C seat. Pt is not lifted. Only scooted. Use of gait belt vs. not

14. Moving a patient in bed Back protection for you Get help 1 person lift Use trapeze Have pt flex knees You stand at foot of bed and push pt�s knees as they pull up in bed Use this technique if there are no other contraindications Put the head of the bed down and the feet up 2 person technique Draw sheet

15. Moving pt into bed

17. Total Hip Arthroplasty (THA) Pt cannot flex the hip Pt cannot adduct hip Pt must stand straight up during transfer Pt must sit down with trunk erect It is a much harder transfer and requires careful attention from you Often it does not hurt for pt to do the wrong thing What side does the pt get out of the bed?

18. Log roll transfer Used S/P back or neck surgery Trunk is kept as straight as possible when going to the side of the bed. Does the pt have an trunk orthosis they should wear?

19. What if a pt needs to be moved up in W/C 1 or 2 person lift

20. Independent transfers

21. What lift to use with what pt??? SCI Total hip replacement CVA with poor standing balance CVA with fair or good standing balance Coma

22. Dangers Pt & you should always wear non-slip shoes Gait belt Lock the brakes Lock the bed If you are not sure how much help a patient requires, do a 2 person lift Feeding tubes and gait belts Don�t pull on a pt�s arms to lift them Skin tears Pt�s with judgment problems Consider position of hemiplegic arm

23. What if a pt falls Always try to prevent a fall Don�t leave pt alone in BR Always hold gait belt Always ask yourself, what would happen if pt started to fall right now? Where should you position your body when standing with pt? If a pt starts to call Try to call for help. If near a wall, push pt against wall and try to stabilize Slide pt to floor Cradle pt�s head

24. Once pt on floor, assess for injuries Are they breathing. If not, and if pt is not DNR, begin CPR Go get help Don�t get pt off the floor unless it is an absolute emergency to do so Don�t try to conceal what happened It is bad if a pt falls It is worse if you conceal it and don�t get appropriate medical attention Inform pt�s doctor immediately Report fall to nurse Report fall to your supervisor What if a pt falls (Cont.)

25. How to get someone up off the ground

26. Other tips Remember, our goal is usually to teach the pt to transfer themselves Go slowly. Most pt�s take longer to transfer than you think Use your voice to command pt to do what you need Only help pt as much as is necessary Use momentum to get pt to stand Nose over toes Pushers/extensor thrust The higher the surface, the easier it is to stand Move the pt to the edge of a seat before trying to get her to stand

27. Mechanical lifts Hoyer lifts Electric vs. hydraulic lifts The advantages is they are: Safety Less likely to injure you Disadvantages They don�t train pt to transfer themselves They are slower

30. Slings Toileting slings vs. closed slings Wrap around slings vs. traditional slings

35. Hoyer lift technique Roll sling � way Roll pt to 1 side and stuff rolled end of sling under pt Roll pt to opposite side and roll out sling under pt Spread legs of lift Attach chains to pt Shorter towards the head Attach chains inside to outside Begin lifting pt Verify all chains/straps are attached firmly W/C or chair may tip back when placing pt into chair

36. Sliding boards W/C is positioned 450 to pt Arm rest removed Pt sits at side of bed and leans away from W/C Sliding board is slid under pt Pt slides onto W/C You can use gait belt to pull pt if necessary You can use baby powder to make pt slide easier Always want to transfer on level ground or downhill