How to change depends on bedridden patients safely and with dignity

According to the National Association for Continence, millions of adults experience some form of incontinence, and for bedridden patients, proper care is crucial for health and dignity. Knowing how to change depends on bedridden patients is an essential skill for caregivers to ensure hygiene, prevent skin breakdown, and maintain the patient's comfort and respect. This comprehensive guide outlines the step-by-step process with expert techniques and best practices.

Quick Summary

Caregivers can change a bedridden patient's briefs safely by gathering supplies, protecting the bedding, and using a strategic rolling technique to ensure thorough cleaning and proper brief application. The process prioritizes hygiene, patient dignity, and skin health while minimizing discomfort.

Key Points

• Pre-Change Preparation: Gather all supplies, including gloves, wipes, and barrier cream, to ensure a smooth, uninterrupted process.

• Maintain Dignity: Communicate with the patient throughout the process and ensure privacy to show respect for their comfort and feelings.

• Use a Strategic Roll: The side-rolling technique is the most effective way to change a bedridden patient's brief with minimal movement and maximum hygiene.

• Prioritize Skin Health: Thoroughly clean the skin, let it air dry, and apply a barrier cream to prevent rashes and pressure sores.

• Choose the Right Product: Tab-style briefs are highly recommended for bedridden patients as they are easier to apply and remove than pull-ups.

• Inspect Regularly: Take the opportunity during each change to check the patient's skin for any redness or signs of irritation.

Essential Supplies and Preparation

Before beginning, gather all necessary items to avoid leaving the patient unattended during the change. Having everything within reach is crucial for an efficient and safe process.

• Clean Briefs: Ensure you have the correct size and absorbency level. Briefs with adjustable tabs are typically best for bedridden individuals.
• Disposable Gloves: Wear fresh, disposable medical gloves for each change to maintain hygiene.
• Protective Underpad (Chux): Use a disposable or washable underpad to protect the bedding from leaks and messes.
• Wipes or Washcloths: Use pre-moistened disposable wipes or warm, soapy water with a soft washcloth to clean the skin.
• Skin Barrier Cream: A protective cream is vital to prevent moisture-related skin irritation and rashes.
• Plastic Bag: A sealable plastic bag is needed for discreet and sanitary disposal of the soiled brief and wipes.
• Laundry Bag: Have a separate bag ready for any soiled clothing or linen.

A Step-by-Step Guide to the Rolling Technique

This method allows for a complete change with minimal patient movement, preserving their comfort and dignity.

1. Communicate and Provide Privacy: Inform the patient what you are doing, even if they are non-verbal. Close doors or curtains to ensure their privacy.
2. Position the Bed: If using an adjustable bed, raise it to a comfortable working height to protect your back. Lower the head of the bed until the patient is as flat as they can comfortably tolerate.
3. Loosen the Brief and Clean the Front: Unfasten the tabs of the soiled brief. Use a wipe to clean the patient's front, wiping from front to back to prevent infection.
4. Roll onto Side: Gently cross the patient's leg that is farthest from you over the other leg. With one hand on their shoulder and the other on their hip, gently roll them onto their side, away from you.
5. Remove the Soiled Brief: While the patient is on their side, roll the soiled brief inward from back to front, tucking the soiled part inside to contain any mess as you pull it away. Place the rolled-up brief into your prepared plastic bag.
6. Clean and Inspect the Back: Using fresh wipes, thoroughly clean the patient's buttocks and back, again wiping from front to back. Pay close attention to all skin folds and creases. Inspect the skin for any redness, irritation, or signs of pressure sores.
7. Apply Barrier Cream and Air Dry: Apply a thin, even layer of skin barrier cream to protect the skin from moisture. Allow the skin to air dry completely before proceeding.
8. Position the New Brief: With the patient still on their side, take the clean brief and fold it lengthwise. Tuck the folded side under their hip, so the rest of the brief is flat on the bed behind them. Smooth out the underlying underpad and sheet to eliminate wrinkles.
9. Roll Back and Secure: Gently roll the patient back onto their back, onto the new brief. Pull the brief through their legs and smooth out the front. Secure the tabs snugly but not too tightly to prevent leaks without causing discomfort. For a better fit, stick the top tabs pointing downward and the bottom tabs pointing upward.
10. Final Steps: Cover the patient, remove and dispose of your gloves and the plastic waste bag, and wash your hands thoroughly.

A Comparison of Brief Styles for Immobile Patients

Choosing the right incontinence product is a key part of effective care. For bedridden individuals, tab-style briefs are almost always the superior choice over pull-ups.

Feature	Tab-Style Briefs	Pull-Up Style Underwear
Application	Can be applied and removed while lying down using a rolling technique.	Requires the patient to stand or lift their hips significantly, which is often not possible for bedridden individuals.
Ease of Removal	Tabs can be easily unfastened for quick changes, even if soiled with solid waste.	Must be pulled down the legs, risking spills and cross-contamination if soiled.
Absorbency	Generally offer higher absorbency levels and are designed to contain heavy incontinence.	Typically lower absorbency, designed for more mobile individuals with lighter needs.
Skin Protection	Easier to apply barrier cream and inspect skin during changes. The design allows for a snug, leak-proof fit.	Difficult to apply and inspect skin thoroughly without significant movement, potentially increasing skin irritation.
Cost	Can be more expensive per brief, but provide better performance for immobile patients.	Often cheaper, but not suitable for the needs of bedridden patients.

Techniques for Heavy or Immobile Patients

For patients who cannot assist with rolling or are too heavy to manage alone, there are modified techniques to ensure a safe change.

• The Draw Sheet Method: Place a heavy, long towel or special draw sheet under the patient. When rolling, use the sheet to help maneuver the patient's hips more easily. This is also useful for adjusting the patient's position and smoothing sheets.
• Involving a Second Caregiver: When available, a second caregiver can provide invaluable assistance. One person can help support the patient during the roll, while the other focuses on the cleaning and brief application.
• Utilize Bed Controls: Take full advantage of an adjustable hospital bed. Raising the bed to a comfortable height and adjusting the head and foot positions can significantly reduce strain on the caregiver's back.

Conclusion

Changing incontinence briefs for bedridden patients is a delicate and important task. By using the proper techniques, gathering all necessary supplies beforehand, and communicating with empathy and respect, caregivers can ensure the process is safe, sanitary, and maintains the patient's dignity. Regularly checking for skin issues and using barrier cream are critical steps to prevent complications and keep the patient comfortable. Mastering this skill empowers caregivers and promotes a higher quality of life for those they assist. For additional guidance on skin care for individuals with incontinence, refer to authoritative resources like the MedlinePlus Medical Encyclopedia on Skin Care.

Frequently Asked Questions

What supplies are essential for changing a bedridden patient's briefs?

You will need a clean brief with tabs, disposable gloves, protective underpads (chux), moist wipes or a washcloth with soapy water, skin barrier cream, and a plastic bag for disposal.

How often should you change the depends on a bedridden patient?

Depends should be checked every 2-3 hours and changed immediately if soiled to prevent prolonged exposure to moisture, which can lead to skin irritation and breakdown.

What is the best way to roll a bedridden patient for a diaper change?

Gently cross the patient's leg and arm farthest from you over their body. Place one hand on their hip and the other on their shoulder, then roll them slowly and gently toward you or away from you, keeping their movements controlled.

How do you protect the bedding during a depends change?

Always place a waterproof or disposable underpad (chux) underneath the patient before starting the change. These pads are designed to absorb any leakage and protect the sheets.

Is it better to use wipes or a washcloth to clean the patient?

Both options are effective. Pre-moistened wipes are convenient, while a washcloth with warm, soapy water can offer a more thorough clean. The key is to be gentle and ensure the skin is dried completely afterward.

How can you prevent pressure sores in bedridden patients?

In addition to regular brief changes, you should reposition the patient every two hours, ensure sheets are smooth and wrinkle-free, and use a skin barrier cream to protect their skin.

What is the importance of a skin barrier cream?

A skin barrier cream provides a protective layer that shields the skin from moisture and irritants found in urine and feces. It is crucial for preventing diaper rash and protecting sensitive skin.