Methods of Patient Care1 Unit 2 Chapter 13 & 14 Transfer and Immobilization Techniques

Methods of Patient Care 1

Unit 2 Chapter 13 & 14

Transfer and Immobilization

Techniques


Transfer TechniquesChapter 13


Radiographer Responsibilities

Put the patient at ease Decrease level of embarrassment Set the tone for the patient’s experience Respect the patient’s right to privacy Protect patient and staff from injury Use necessary restraints safely Adhere to rules of radiation safety, fire safety,

and use and disposal of hazardous chemicals


Care of Patient’s Belongings

Describe to patient what clothing/items must be removed for exam

Show the patient where he/she may change, and how to put on hospital gown

Show patient where he/she may keep belongings (locker, belongings bag)


Care of Patient’s Belongings

Understand patient’s concern about leaving items behind

Place small items (rings, necklaces, earrings) in container marked with patient’s identification data

Document items removed/returned Every item is of value, respect patient’s

property


Body Mechanics

Back injuries from moving & lifting patients are the leading cause of injury to health care workers

Biomechanics- branch of science that applies the law of physics to living creatures.– Understanding can help prevent injury


Base of Support Base of Support is the

foundation on which a body rests.– IE. The feet and the space

between the feet when standing– Wide=Stable (BEST)– Narrow=Unstable

Good posture Body is in alignment, with all parts

in balance Permits bones & joints to work at

maximum efficiency with a minimal amount of strain on joints, tendons, ligaments, & muscles

Aids body systems to work efficiently


Center of Gravity

Center of Gravity – the hypothetical point at which all mass appears to be concentrated.

Stability can be achieved when the center of gravity is over the base of support.


Mobility vs. Stability Muscles

Mobility muscles – located in limbs– In transfer used

for lifting Stability muscles

– located in torso– In transfer used

for support


Body Mechanics Guidelines for picking up or lifting heavy

objects (patients) Let the patient do as much as possible Check chart for precautions/patient assessment Widen base of support Bend from the knees, not from the waist Pull rather than push Balance the weight over both feet; stand close to

the patient when bending knees Don’t twist body; change foot position instead Make sure floor area is clear of objects Never move a patient without enough assistance

to prevent injury to yourself & the patient


Moving & Transferring Patients

Establish the correct identity of the patient

Request pertinent information regarding the patient’s ability to follow directions

Request information concerning the patient’s ability to ambulate & any precautions to be taken concerning the patient’s mobility


Assessing the Patient’s Mobility Must use critical

thinking & problem solving to plan most effective manner of moving patient Expected outcome –

move patient without causing additional pain or injury to the patient or to yourself

Use interviewing & assessment skills


Assessing the Patient’s Mobility Patient’s general condition Range of motion & weight-bearing

ability Patient’s strength & endurance Patient’s ability to maintain balance Patient’s ability to understand what is

expected during the transfer Patient’s acceptance of the move Patient’s medication history


Moving & Transferring Patients Greet & identify patient

and provide an explanation of what is to occur

Move the patient to the department according to the necessary restrictions

Upon returning, notify nurse that patient has returned

Ask for assistance if needed


Moving & Transferring Patients

Assist the patient to bed Always lock wheels Assist patient from wheelchair Place patient’s bed in lowest position Side rails raised Put call button within reach


Assessing the Patient’s Mobility Rules for moving patients

Give only the assistance that the patient needs for comfort & safety

Always transfer a patient across the shortest distance

Lock all wheels on beds, carts & wheelchairs before the move begins

Generally, it is better to move a patient toward his or her stronger side while assisting on the patient’s weaker side


Methods of Moving Patients

Cart (aka. Stretcher or gurney)

Wheelchair

Ambulation (walking)


Wheelchair Transfers

1. Standby assist

2. Assisted standing pivot

3. Two-person lift

4. Hydraulic lift


Wheelchair Never allow a patient to get off a table

or onto a wheelchair without some assistance Patient may not be as strong as they think Sudden movement may cause dizziness

Orthostatic hypotension

Always transfer towards the strong side


Wheelchair – standby assist From supine position

Have patient turn to the side towards you with knees flexed

Place yourself in front of patient with one arm under shoulder and other across the knees

If patient can assist, have him push with upper arm when told to do so

On count of three, move or help patient to sitting position

Allow patient to sit on edge to get sense of balance


Wheelchair Stand at the patient’s side and take the

patient’s arm to help Put table or bed at lowest position Provide step stool Position wheelchair at a 45-degree angle

to the table. Move foot rests out of the way. Place locked wheelchair close enough so

that patient can be seated in the chair with one pivot


Wheelchair – 2-person lift

Stronger person lifts the patient’s torso– Directs the lift

Other person lifts patient’s feet. Lock wheelchair; Remove arm and leg

rests and if possible Have patient cross arms across chest


Wheelchair – Hydraulic lifts

Used for heavy patients

Requires use of a sling


Cart (Stretcher, gurney)

Bed to Cart; Cart to table Position cart alongside bed/table Patient’s strong (or less affected side)

towards the direction of the transfer Lock the wheels in place Let patient assist if possible Use moving devices as available


Cart (Stretcher, gurney) Moving devices include:

– Draw sheets or bed sheets*– Sheets of plastic*– Canvas or plastic over

rollers*– Slide board*

Reducing Friction* Requires 3 or more

“lifters”*– Mechanical lifts


Cart (Stretcher, gurney) Sheet transfer

To place sheet• Fold sheet in half lengthwise• Turn patient onto his side

away from you, place sheet under patient with fold against patient’s back

• Turn patient towards you, have an assistant unfold sheet beneath patient

• Return patient to a supine position



To transfer 3 – 4 people are

needed 1 person needed to

support head Roll sheet at the side of

the patient so hands can easily grasp it

Transfer patient in unison



Sliding board transfer < 150 #s - 2 people 150 – 375 #s – 4 375 – 500#s – 6 500 #s – requires

mechanical lift



Sliding board transfer Move the patient to the edge of the bed Move the cart up against bed, lock the

wheels Assist the patient to turn onto his or her

side, away from the cart, and place slider board under the sheet

Place the sheet over the board, and allow the patient to roll back onto the board



Slide patient with slide board onto cart Assist patient to roll after from the bed,

remove slide board Place sheet under patient, allow patient to

lie flat again


Log Roll

Necessary to turn a patient without flexing his or her neck or back

Requires 5 people Two assist with maintaining alignment of the torso Two assist with the feet One immobilizes head & neck Roll patient in one unit in unison


Mechanical Lift Several different types of lifts available Decreases number of work-related back

injuries Should be used as much as possible Needs a minimum of 2 people when

moving patients Must be used for patients > 500 #s Takes time to set up and move patient,

but prevents injuries


Mechanical Lift


Immobilization Techniques

Chapter 14


Use of Immobilizers & Restraints Immobilization - A method or device used to

minimize movement or assist in positioning a patient accurately– Reduces motion/improves radiographic quality– Reduces radiation exposure by reducing repeats– Keeps patient safe.

Simple vs complex methods/devices Examples of simple:

– positioning sponges– Sandbags

Examples of complex:– Backboard– Pigg-o-stat


Use of Immobilizers Examples of simple:

– positioning sponges– Velcro straps– Tape– Sandbags– Head clamps

Examples of complex:– Backboard– cervical collars– Splints– Sheets/mummy– Pigg-o-stat


Use of Immobilizers & Restraints Restraints – a device which restricts the

freedom of patient movement– Used to restrict movement– Used to protect the patient– Can only be ordered by a physician

Examples:– Straps– Posies– Velcro straps


Use of Immobilizers & Restraints Effective communication –

most effective method of avoiding the need to restrain/immobilize an adult patient

Reasons for application of immobilizers To control movement Remind a patient who is

sedated or confused to remain in a particular position

To prevent patient injury


Use of Immobilizers & Restraints

Never leave immobilized/restrained patients alone

Reassure patients that restraints are not a punishment.

Restraints (not immobilizers) can only be ordered by a physician.


Use of Restraints

Rules for application for restraints Patient must be allowed as much mobility

as safely possible Areas of the body where immobilizers are

applied must be padded to prevent injury to the skin beneath the device

Normal anatomic position must be maintained


Use of Restraints Restraints must be easy to remove

quickly if necessary Neither circulation nor respiration must

be impaired by the restraint Restraints must be removed every 2

hours After removal, the joints affected by the

immobilizer must be put through range of motion


Use of Restraints

Any use of restraints requires documentation of: – the type of used, – the time is was applied and removed, – the reason for its application, and – an assessment of the patient at each stage

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Methods of Patient Care1 Unit 2 Chapter 13 & 14 Transfer and Immobilization Techniques