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

2. Methods of Patient Care2 Transfer Techniques Chapter 13

3. Methods of Patient Care3 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

4. Methods of Patient Care4 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)

5. Methods of Patient Care5 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

6. Methods of Patient Care6 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

7. Methods of Patient Care7 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

8. Methods of Patient Care8 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.

9. Methods of Patient Care9 Mobility vs. Stability Muscles Mobility muscles – located in limbs –In transfer used for lifting Stability muscles – located in torso –In transfer used for support

10. Methods of Patient Care10 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

11. Methods of Patient Care11 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

12. Methods of Patient Care12 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

13. Methods of Patient Care13 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

14. Methods of Patient Care14 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

15. Methods of Patient Care15 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

16. Methods of Patient Care16 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

17. Methods of Patient Care17 Methods of Moving Patients Cart (aka. Stretcher or gurney) Wheelchair Ambulation (walking)

18. Methods of Patient Care18 Wheelchair Transfers 1. Standby assist 2. Assisted standing pivot 3. Two-person lift 4. Hydraulic lift

19. Methods of Patient Care19 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

20. Methods of Patient Care20 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

21. Methods of Patient Care21 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

22. Methods of Patient Care22 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

23. Methods of Patient Care23 Wheelchair – Hydraulic lifts Used for heavy patients Requires use of a sling

24. Methods of Patient Care24 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

25. Methods of Patient Care25 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

26. Methods of Patient Care26 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

27. Methods of Patient Care27 Cart (Stretcher, gurney)  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

28. Methods of Patient Care28 Cart (Stretcher, gurney) Sliding board transfer  < 150 #s - 2 people  150 – 375 #s – 4  375 – 500#s – 6  500 #s – requires mechanical lift

29. Methods of Patient Care29 Cart (Stretcher, gurney) 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

30. Methods of Patient Care30 Cart (Stretcher, gurney)  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

31. Methods of Patient Care31 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

32. Methods of Patient Care32 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

33. Methods of Patient Care33 Mechanical Lift

34. Methods of Patient Care34 Immobilization Techniques Chapter 14

35. Methods of Patient Care35 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

36. Methods of Patient Care36 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

37. Methods of Patient Care37 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

38. Methods of Patient Care38 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

39. Methods of Patient Care39 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.

40. Methods of Patient Care40 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

41. Methods of Patient Care41 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

42. Methods of Patient Care42 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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