The Importance of Repositioning and Movement
Bed sores, or pressure ulcers, develop when a prolonged pressure on the skin cuts off blood supply to the underlying tissue. This commonly occurs over bony areas like the tailbone, hips, heels, and elbows. For individuals with limited mobility, consistent repositioning is the single most effective preventive measure. The routine aims to redistribute pressure and restore blood flow to vulnerable areas. Without this intervention, tissue damage can occur in just a few hours, leading to painful and potentially dangerous ulcers.
Understanding the Risks: Friction and Shear
Beyond sustained pressure, two other factors play a significant role in bed sore development: friction and shearing. Friction is the force created when two surfaces rub together, like when a patient is dragged across a bed sheet. Shearing is a more insidious force that occurs when skin and underlying tissue slide in opposite directions, often happening when the head of a bed is elevated. This can pinch off blood vessels and cause deep tissue injury. Understanding and mitigating these forces is crucial for a safe and effective patient-moving strategy.
Step-by-Step Techniques for Moving a Patient
Caregivers must master several techniques to move patients safely while minimizing friction and shear. Always communicate with the patient during the process to ensure their comfort and cooperation.
The Logroll Technique
For turning a patient onto their side, the logroll technique is a safe and effective method that keeps the spine aligned. It typically requires two caregivers.
- Positioning: Stand on either side of the bed. Place the patient's arms over their chest and cross their legs. The patient should be moved toward the caregiver who is further away from the side they are being turned to.
- Turning: The caregiver on the side the patient is rolling toward should place one hand on the patient's shoulder and one hand on their hip. The other caregiver should gently push the patient's hip and shoulder from the opposite side.
- Support: As the patient is turned, use pillows or foam wedges to support their back, keeping them in a 30-degree side-lying position. A pillow between the knees and ankles prevents bony areas from rubbing together.
Using a Draw Sheet
A draw sheet is a small, folded sheet placed under the patient to assist with repositioning. This method helps lift, rather than drag, the patient, thereby reducing friction.
- Setup: Place the draw sheet across the bed, from the patient's shoulders to their thighs.
- Repositioning: Two caregivers, one on each side, roll the sheet up tightly to form a handle. On the count of three, they lift the patient in unison and move them up or sideways in the bed. This controlled lift prevents dragging.
Transferring to a Chair or Wheelchair
Moving a patient from a bed to a chair requires careful planning to prevent injury to both the patient and the caregiver.
- Preparation: Lower the bed to a safe height and lock the wheels. Position the wheelchair at a 45-degree angle to the bed with its wheels locked. Place a gait belt around the patient's waist.
- The Pivot: Assist the patient to a sitting position on the edge of the bed. The caregiver stands in front of the patient, using the gait belt to maintain a secure grip. On the caregiver's cue, the patient stands and pivots toward the wheelchair.
- Seating: Once the patient's back is facing the chair, they slowly lower themselves down with the caregiver's support. Ensure the patient is seated correctly, with their back against the chair's backrest.
Essential Equipment and Devices
Proper equipment can significantly reduce the physical strain on caregivers and improve patient safety. Special surfaces can help distribute pressure more evenly.
- Specialized Mattresses: Air-fluidized mattresses or alternating pressure air mattresses constantly adjust to relieve pressure points and promote blood flow.
- Supportive Cushions and Wedges: These can be used in beds and chairs to offload pressure from bony prominences and separate body parts, such as knees and ankles.
- Assistive Devices: Devices like trapeze bars, gait belts, and patient lifts provide safe assistance for moving and transferring patients.
A Comparison of Repositioning Methods
| Method | Purpose | Key Benefit | Caregiver Effort | Risk of Friction/Shear | Best for |
|---|---|---|---|---|---|
| Logroll | Turning a patient onto their side | Maintains spinal alignment | High (2 caregivers recommended) | Low | Patients needing side-lying position |
| Draw Sheet | Moving a patient up or sideways | Reduces friction and dragging | Moderate (2 caregivers recommended) | Very Low | Patients who cannot assist in movement |
| Bed-to-Chair Transfer | Assisting patient to a seated position | Promotes mobility and independence | Varies based on patient's strength | Moderate (if not done correctly) | Patients with some upper body strength |
| HoverMat/Sling | Transferring between surfaces | Eliminates manual lifting | Low | Very Low | Immobile or heavier patients |
Other Critical Factors for Bed Sore Prevention
Beyond movement, an effective prevention strategy includes other vital components:
- Regular Skin Checks: Inspect the patient's skin daily for signs of redness, warmth, or tenderness, especially over bony areas. These are early warning signs of pressure damage.
- Hydration and Nutrition: A balanced diet rich in protein and adequate hydration supports skin elasticity and overall health, aiding in tissue repair. For more information on supportive diets, visit the National Pressure Ulcer Advisory Panel at https://npiap.com/.
- Hygiene and Moisture Control: Keep the patient's skin clean and dry. Incontinence and excessive moisture can increase the risk of skin breakdown. Use moisture-barrier creams as needed.
Conclusion
Mastering how to move a patient to prevent bed sores is a fundamental aspect of high-quality caregiving. By implementing a consistent repositioning schedule, utilizing the right techniques and equipment, and addressing nutritional and hygiene needs, caregivers can significantly reduce the risk of painful pressure ulcers. Proactive and mindful care is the cornerstone of protecting a patient's skin integrity and ensuring their well-being. Always consult a healthcare provider to tailor a prevention plan specific to the patient's unique needs and condition. Training and vigilance are your most powerful tools in this critical task.
