Principles of transfers and assistive devices for movement

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Principles of transfers and assistive devices for
movement
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Transfer techniques

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

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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

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1 person lifts

• Stand pivot
• Knee to knee
• Your leg between their leg
• NDT

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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 patients strong side
• Sit pt on side of bed
• Bend pts knees to 900
• Block pts toes with your toes and knees with
  your knees
• Flex your knees and grab pts gait belt
• Give pt a count of 3 and tell pt have pt push up
  off bed

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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

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Bed to W/C 1 person liftalternate technique

• Same as previous technique but your knees do not
  touch pts knees.
• You position your feet between pts legs or as in
  next picture, your knees are covering 1 pts
  knees
• Your body is closer to pt

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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 patients strong side
• Sit pt on side of bed
• Bend pts 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

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2 person total lift bed to W/C

• Reclining W/C placed parallel to bed
• 1 person stands next to pts head
• This person should be the tallest
• This person reaches under pts axillas, crosses
  pts 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

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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 pts bottom toward W/C
  seat.
• Pt is not lifted. Only scooted.
• Use of gait belt vs. not

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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 pts 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

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Moving pt into bed
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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?

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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?

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What if a pt needs to be moved up in W/C

• 1 or 2 person lift

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Independent transfers
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What lift to use with what pt???

• SCI
• Total hip replacement
• CVA with poor standing balance
• CVA with fair or good standing balance
• Coma

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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
• Dont pull on a pts arms to lift them
• Skin tears
• Pts with judgment problems
• Consider position of hemiplegic arm

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What if a pt falls

• Always try to prevent a fall
• Dont 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 pts head

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What if a pt falls (Cont.)

• Once pt on floor, assess for injuries
• Are they breathing. If not, and if pt is not
  DNR, begin CPR
• Go get help
• Dont get pt off the floor unless it is an
  absolute emergency to do so
• Dont try to conceal what happened
• It is bad if a pt falls
• It is worse if you conceal it and dont get
  appropriate medical attention
• Inform pts doctor immediately
• Report fall to nurse
• Report fall to your supervisor

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How to get someone up off the ground
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Other tips

• Remember, our goal is usually to teach the pt to
  transfer themselves
• Go slowly. Most pts 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

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Mechanical lifts

• Hoyer lifts
• Electric vs. hydraulic lifts
• The advantages is they are
• Safety
• Less likely to injure you
• Disadvantages
• They dont train pt to transfer themselves
• They are slower

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Hoyer lift tranfers
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Slings

• Toileting slings vs. closed slings
• Wrap around slings vs. traditional slings

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Hoyer lift technique

• Roll sling ½ 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

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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

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