Transferring Patients With Knee Strokes: Safe Techniques And Practices

Patient transfers are a common way for healthcare professionals and caregivers to harm themselves. It is therefore important to know the proper transfer techniques to protect oneself and provide the best care for the patient. A transfer is a method of moving a patient from one surface to another, with the patient capable of helping with the transfer and able to bear weight on at least one leg. The most common patient transfers are from a bed to a stretcher or wheelchair. Successful patient transfers rely on understanding each patient's needs while adhering to evidence-based guidelines. For example, if a patient has a stroke, blocking their knee with yours during a transfer could result in a large hematoma.

Slide boards can be used for patients with paralysis or lower limb loss

Slide boards are an effective tool for transferring patients with paralysis or lower limb loss. They are particularly useful for patients who are unable to bear weight on their legs and need to be moved from one surface to another. This could include transfers from a bed to a wheelchair, bathtub, toilet, or car.

To use a slide board, first position the patient at the edge of the bed or surface. The sliding board should be placed under the patient's proximal thigh, with one end positioned on the destination surface. It is important to ensure that the patient does not hold onto the end of the sliding board to avoid pinching their fingers. Instead, they should place their hand 4-6 inches away from the board and use their arms to initiate a push-up and scoot across.

The therapist or caregiver should stand in front of the patient and provide assistance as needed. The patient should be guarded and supported during the transfer to ensure a smooth and safe transition. It is crucial to maintain proper body mechanics during the transfer to prevent injuries. This includes keeping the knees bent, using leg muscles instead of back muscles, and maintaining a neutral spine. Additionally, the patient's hands should not be used for support during the transfer, as this could damage the brachial plexus nerves.

Slide boards are designed to be sturdy and durable, often made of thickened plastic steel ABS, to provide a safe and smooth transfer for patients. The beveled edges on both sides and non-slip areas at each end of the board further enhance safety and prevent slipping during the transfer process.

When using a slide board, it is important to consider the patient's weight and the level of assistance required. For patients with paralysis, it is recommended to have a caregiver assist in holding the patient to prevent falls. Additionally, the transfer board should be used in conjunction with other safety measures, such as gait belts, to ensure the patient's stability and security during the transfer.

Safe patient transfers require understanding the patient's needs and following evidence-based guidelines

To achieve a successful and safe patient transfer, health workers must understand the patient's specific needs and conduct a thorough assessment. This includes checking for precautions, completing an assessment before moving and handling, confirming weight-bearing status, and determining the level of assistance and devices required. Encouraging patient participation is essential, as it empowers them and promotes respect. Patients should be engaged in the transfer process by seeking their input and involving them in decision-making.

Safe patient transfers also require health workers to follow evidence-based guidelines. This includes choosing the most efficient transfer method while considering patient and clinician safety. Research shows that injuries to health and social care workers frequently occur during patient transfers, so proper body mechanics and ergonomics are crucial. Safe patient handling programs and the use of assistive devices can help reduce the risk of injury for both patients and healthcare workers.

When performing a patient transfer, it is important to consider the patient's medical precautions, the number of people needed, the time needed, and the patient's ability to understand and follow directions. Additionally, environmental barriers or opportunities should be considered, such as removing clutter and ensuring enough room to move freely. Proper body mechanics should be utilized, including keeping the patient close, facing the health worker, and using leg muscles instead of back muscles. It is also important to avoid twisting or rotating the trunk and combining movements.

Overall, safe patient transfers require a comprehensive approach that considers the patient's needs, follows evidence-based guidelines, and utilizes appropriate equipment and techniques to ensure the safety and well-being of both the patient and the healthcare worker.

Transfers can be vertical (e.g. wheelchair to toilet) or horizontal (e.g. bed to stretcher)

Vertical and Horizontal Transfers

Transfers can be vertical or horizontal/lateral. A vertical transfer involves moving a patient from a seated-to-seated position (e.g. wheelchair to toilet) or from a supine-to-seated position (e.g. bed to wheelchair). A horizontal transfer involves moving a patient from one flat surface to another (e.g. bed to stretcher).

Vertical Transfers

When performing a vertical transfer, it is important to follow proper body mechanics to ensure the safety and comfort of both the patient and the healthcare provider. Here are some key considerations:

• Keep the patient close to you and facing you.
• Keep your knees bent and use your leg muscles instead of your back muscles whenever possible.
• Maintain a straight, neutral spine (avoid arching or curving your back).
• Place your feet shoulder-width apart with your heels firmly planted on the ground.
• Be mindful of the patient's weight and the level of assistance they need. Don't attempt more than you can handle.
• Avoid twisting or rotating your trunk. Instead, use pivots or steps to change direction.
• Avoid combining movements, such as rotating and bending at the same time.

Horizontal Transfers

Horizontal transfers often involve moving a patient from one flat surface to another, such as from a bed to a stretcher. Here are some key considerations for horizontal transfers:

• Keep the surfaces being transferred to and from as close together as possible.
• Have all the necessary equipment within arm's reach before initiating the transfer.
• Provide clear, concise, and short directions to the patient before and during the transfer.
• Demonstrate the desired movement to the patient before performing the transfer.
• Count to three before initiating the transfer to ensure synchronization and stability.
• Allow the patient's blood pressure to stabilize for a few seconds after changing positions (e.g. from lying to sitting or standing).
• Use a gait belt whenever possible to provide additional support and stability during the transfer.

Transfers are a high-risk manoeuvre and can cause harm to both patient and carer

How to Transfer a Patient with a Blocking Knee After a Stroke

Common Hazards

• Sudden changes in patient alertness: The patient may become suddenly unresponsive or agitated during the transfer, making it difficult to complete the manoeuvre safely.
• Improper body mechanics: Twisting or rotating the trunk can cause injury to the carer and patient. It is important to use proper body mechanics, such as keeping a straight, neutral spine and avoiding combining movements.
• Environmental complications: Slick floors, inappropriate footwear, or clutter in the transfer area can increase the risk of slips, trips, and falls.
• Patient's fear of falling: A patient who is afraid of falling may resist the transfer or move unpredictably, increasing the risk of injury.
• Not asking for help: If the carer attempts to transfer the patient without assistance when it is needed, it can increase the risk of injury to both parties.

Safe Transfer Techniques

To reduce the risk of harm during a transfer, it is important to follow safe transfer techniques:

• Use a gait belt: A gait belt should be used whenever possible to help support the patient and reduce the risk of falls.
• Check for colostomy bag or feeding tube: Before putting on a gait belt, always check for a colostomy bag or feeding tube to avoid dislodging or damaging these devices.
• Use proper body mechanics: Keep the patient close to you, facing you, and use your leg muscles instead of your back muscles whenever possible.
• Avoid twisting or rotating: Instead of twisting or rotating your trunk, use pivots or steps to change direction.
• Plan the transfer: Consider the patient's medical precautions, the number of people needed, the time needed, the patient's ability to understand directions, and any environmental barriers or opportunities.
• Use a sliding board: For patients who cannot bear weight on their legs, a sliding board can be used to transfer them from one surface to another.
• Block the patient's knees: When performing a squat pivot transfer, block the patient's knees with your knees to provide support and help guide their movement.
• Communicate timing: Count to three before initiating the transfer to ensure that both the carer and patient are ready.
• Use a pillowcase: When using a sliding board, place a pillowcase on the board to prevent skin tears and make the transfer easier.

A stand pivot transfer is useful when a patient can support their weight but can't achieve a full stand

A stand pivot transfer is a useful method to move a patient who can support their weight but cannot achieve a full stand. This technique is often used to help patients transfer from a wheelchair to a bed, toilet, or any other surface.

To perform a stand pivot transfer, the patient should be positioned at the edge of the wheelchair or bed to initiate the transfer. The therapist should then assist the patient in keeping their feet flat on the floor while bringing their head and trunk forward. The therapist should also aid the patient in maintaining the correct posture by ensuring their knees and feet are aligned, and their spine is kept straight and neutral.

The therapist should then instruct the patient to reach back for the surface before they begin to sit down. Once the stand pivot is performed, the therapist should assist as needed to ensure control when the patient lowers onto the destination surface.

It is important to note that the surfaces being transferred to and from should be as close together as possible, ideally at a 90-degree angle. Additionally, the patient's heels should be angled towards the destination surface, and their feet should be placed directly under their knees or slightly behind them.

The stand pivot transfer technique promotes patient independence and safety by allowing them to bear weight and spin to move their bottom from one surface to another. It is a useful method for patients who can support their weight but need assistance with transfers due to limited mobility.

Frequently asked questions