- Published on
Clinical Procedures - Assisting a Patient to Change Position in Bed (Glide Sheet)
Equipment
• Single-patient use, multi-directional slide sheet/glide sheet:
• May be heavy-duty plastic or fabric
• Half size: fits under average-sized patient from shoulder to knee
• Full size: head to toe
• Minimum of 2 staff.
Procedure
• Ensure patient is aware of the procedure, understands, and has given consent, if able
• Patient should be lying flat in bed
• D Check patient is suitably clothed/covered
• Discuss desired end position of patient with the other handlers)
• Move the bed to waist height to prevent staff injuries:
• Staff should not have to overstretch to complete the manoeuvre
• Ensure the brakes on bed are secure
• Staff should stand either side of the bed facing each other
• Staff should ensure they are wearing appropriate low-heeled, properly fitting footwear, and that laces are not trailing
• To place glide sheet under patient, roll patient on bed sheet over to one side of the bed. Either:
• 1 staff member leans over patient and pulls the bottom sheet to roll patient onto one side
• If possible, encourage the patient to roll themselves onto one side.
• The handler nearest the patient should hold sheet (and patient on their side) whilst the glide sheet is inserted by the other handler
• Place the glide sheet between mattress and bottom sheet
• The second handler should hold the glide sheet and push as far as possible under bottom sheet and the patient rolls back onto their back
• Repeat manoeuvre from the other side until glide sheet is fully under the patient
• Once the sheet is in place, agree which handler will give command to move patient
• Both handlers should grip the bed sheet, with both hands, as close to patient as possible
• Place both feet firmly on the floor
• On command of 'Ready, Steady, Move', both handlers grip bottom sheet and gently move patient to previously agreed position
• Place pillows appropriately for the patient's revised position
• Reverse patient movement procedure (onto his/her side)
to remove glide sheet.
Procedures Tips
• Do not rush. Ensure sufficient time is available to explain the manoeuvre to the patient and safely complete the manoeuvre
• Ensure the patient is informed regarding the manoeuvre
• Check bed area for any furniture/equipment that could be moved to allow more space to complete the manoeuvre
• Always check that IV fluids, catheters, drains, and other devices are safe and not likely to be pulled out during procedure
• Check with qualified staff any changes in the patient's condition prior to the manoeuvre
• Check with staff whether the patient has any history of cognitive problems, violence, or aggression or has any health problems which may prevent or impact upon the manoeuvre
• If appropriate, ensure bed rails are put back into place following procedure to prevent patient falling from bed
Replace glide/slide sheet next to patient's bed-head, checking it is labelled for the named patient only
• Consult physiotherapists and/or ward staff if unsure of any of the above.
Documentation
• All patients should have assessments carried out within 24 hours of admission and placed in their file
• Any issues or concerns should be documented in the patient's notes to ensure other ward staff are aware of problems.
Equipment
• Single-patient use, multi-directional slide sheet/glide sheet:
• May be heavy-duty plastic or fabric
• Half size: fits under average-sized patient from shoulder to knee
• Full size: head to toe
• Minimum of 2 staff.
Procedure
• Ensure patient is aware of the procedure, understands, and has given consent, if able
• Patient should be lying flat in bed
• D Check patient is suitably clothed/covered
• Discuss desired end position of patient with the other handlers)
• Move the bed to waist height to prevent staff injuries:
• Staff should not have to overstretch to complete the manoeuvre
• Ensure the brakes on bed are secure
• Staff should stand either side of the bed facing each other
• Staff should ensure they are wearing appropriate low-heeled, properly fitting footwear, and that laces are not trailing
• To place glide sheet under patient, roll patient on bed sheet over to one side of the bed. Either:
• 1 staff member leans over patient and pulls the bottom sheet to roll patient onto one side
• If possible, encourage the patient to roll themselves onto one side.
• The handler nearest the patient should hold sheet (and patient on their side) whilst the glide sheet is inserted by the other handler
• Place the glide sheet between mattress and bottom sheet
• The second handler should hold the glide sheet and push as far as possible under bottom sheet and the patient rolls back onto their back
• Repeat manoeuvre from the other side until glide sheet is fully under the patient
• Once the sheet is in place, agree which handler will give command to move patient
• Both handlers should grip the bed sheet, with both hands, as close to patient as possible
• Place both feet firmly on the floor
• On command of 'Ready, Steady, Move', both handlers grip bottom sheet and gently move patient to previously agreed position
• Place pillows appropriately for the patient's revised position
• Reverse patient movement procedure (onto his/her side)
to remove glide sheet.
Procedures Tips
• Do not rush. Ensure sufficient time is available to explain the manoeuvre to the patient and safely complete the manoeuvre
• Ensure the patient is informed regarding the manoeuvre
• Check bed area for any furniture/equipment that could be moved to allow more space to complete the manoeuvre
• Always check that IV fluids, catheters, drains, and other devices are safe and not likely to be pulled out during procedure
• Check with qualified staff any changes in the patient's condition prior to the manoeuvre
• Check with staff whether the patient has any history of cognitive problems, violence, or aggression or has any health problems which may prevent or impact upon the manoeuvre
• If appropriate, ensure bed rails are put back into place following procedure to prevent patient falling from bed
Replace glide/slide sheet next to patient's bed-head, checking it is labelled for the named patient only
• Consult physiotherapists and/or ward staff if unsure of any of the above.
Documentation
• All patients should have assessments carried out within 24 hours of admission and placed in their file
• Any issues or concerns should be documented in the patient's notes to ensure other ward staff are aware of problems.
- Published on
Clinical Procedures – Pericardiocentesis
Equipment
• Echocardiogram machine and sterile probe cover
• Pericardial drain kit (14 gauge needle, syringe, guidewire, pigtail catheter and drain)
• Sterile drape and towels
• lodine solution
• Sterile gloves and gown
• Local anaesthetic (1% lidocaine)
• 2 x 10mL syringe
• Orange/blue/green needles
• Sterile gauze
• 50mL syringe
• 3-way tap
• Suture, scissors, sticky dressing (e.g. Tegaderm®).
You will also need:
• IV access
• ECG monitoring
• Access to 'crash' trolley (defibrillator and emergency drugs).
Procedure
• Introduce yourself, explain the procedure, and obtain informed written consent
• Ensure IV access, ECG monitoring, normal clotting, and access to resuscitation equipment
• (Consider light sedation)
• Position patient supine with 20-30° head tilt
• Ensure all equipment is sterile and laid out on sterile trolley
• Wash hands using surgical scrub technique and put on the sterile gown and gloves
• Clean and drape site at the inferior border of the sternum:
• The point of needle insertion is immediately below and to the left of the xiphisternum
• Confirm location of effusion using echocardiogram machine with sterile probe cover
• Infiltrate overlying skin and subcutaneous tissue with 1% lidocaine. (Always aspirate before each injection.)
• Attach the 10mL syringe attached to the 14G needle
• Insert the needle between the xiphisternum and left costal margin advancing slowly at 35° to the patient and aiming towards the patient's left shoulder. Aspirate continuously as the needle advances:
• Pericardial fluid is usually aspirated at about 6 8cm depth
Depending on the size of the pericardial effusion and indication for the procedure, you may wish to attach the 50mL syringe and aspirate fluid to send for diagnostic purposes
• A modified Seldinger technique should now be used to insert the pericardial drain
• Once pericardial fluid is aspirated, hold the needle in position, remove the syringe, and insert the guidewire slowly through the needle into the pericardial space
• Remove the needle, holding the wire in place at all times
• Pass the catheter over the wire into the pericardial space
• Once the catheter position is confirmed on echo, remove the wire and attach the 3-way tap and drain bag
• Suture the drain in place and dress to maintain sterility
• Request a CXR to exclude iatrogenic pneumothorax.
Documentation
• Date, time, and place
• Name and grade of person who performed the procedure (and anyone who supervised)
• Consent obtained (enclose copy of consent form)
• Aseptic technique used and volume of anesthetic used
• Approach taken and anatomy confirmed by echocardiogram
• Any difficulties, i.e. "first pass' or 'second attempt' etc.
• Appearance of pericardial fluid aspirated
• Volume of pericardial fluid aspirated.
Indications
• Treatment of cardiac tamponade
• Symptomatic pericardial effusion
• Diagnostic pericardiocentesis
• During CPR to exclude cardiac tamponade as a reversible cause of cardiac arrest.
Contraindications
• Cardiac tamponade secondary to cardiac trauma or aortic dissection (surgical intervention is preferable)
• Recurrent pericardial effusions (surgical pericardial window indicated).
Risks
• Pneumothorax
• Myocardial perforation
• Cardiac tamponade
• Coronary artery laceration
• Cardiac arrhythmias
• Intra-abdominal trauma (especially to liver)
• Haemorrhage
• Infection
• Acute pulmonary oedema
• Failure of procedure
• Death.
Procedure Tips
• Pericardiocentesis should be performed by a trained doctor (either cardiologist or thoracic surgeon usually) preferably in a sterile environment (theatre or the cardiac catheterization lab) and under echocardiographic guidance, with access to full resuscitation equipment
• The only exception is during cardiopulmonary resuscitation when pericardiocentesis is performed as an emergency to exclude cardiac tamponade as a reversible cause of cardiac arrest
• Always check the patient's clotting before commencing pericardiocentesis
• The clinician who performed the procedure should confirm the position of the drain using echo
• Always request a post-procedure chest radiograph to exclude iatrogenic pneumothorax.
Equipment
• Echocardiogram machine and sterile probe cover
• Pericardial drain kit (14 gauge needle, syringe, guidewire, pigtail catheter and drain)
• Sterile drape and towels
• lodine solution
• Sterile gloves and gown
• Local anaesthetic (1% lidocaine)
• 2 x 10mL syringe
• Orange/blue/green needles
• Sterile gauze
• 50mL syringe
• 3-way tap
• Suture, scissors, sticky dressing (e.g. Tegaderm®).
You will also need:
• IV access
• ECG monitoring
• Access to 'crash' trolley (defibrillator and emergency drugs).
Procedure
• Introduce yourself, explain the procedure, and obtain informed written consent
• Ensure IV access, ECG monitoring, normal clotting, and access to resuscitation equipment
• (Consider light sedation)
• Position patient supine with 20-30° head tilt
• Ensure all equipment is sterile and laid out on sterile trolley
• Wash hands using surgical scrub technique and put on the sterile gown and gloves
• Clean and drape site at the inferior border of the sternum:
• The point of needle insertion is immediately below and to the left of the xiphisternum
• Confirm location of effusion using echocardiogram machine with sterile probe cover
• Infiltrate overlying skin and subcutaneous tissue with 1% lidocaine. (Always aspirate before each injection.)
• Attach the 10mL syringe attached to the 14G needle
• Insert the needle between the xiphisternum and left costal margin advancing slowly at 35° to the patient and aiming towards the patient's left shoulder. Aspirate continuously as the needle advances:
• Pericardial fluid is usually aspirated at about 6 8cm depth
Depending on the size of the pericardial effusion and indication for the procedure, you may wish to attach the 50mL syringe and aspirate fluid to send for diagnostic purposes
• A modified Seldinger technique should now be used to insert the pericardial drain
• Once pericardial fluid is aspirated, hold the needle in position, remove the syringe, and insert the guidewire slowly through the needle into the pericardial space
• Remove the needle, holding the wire in place at all times
• Pass the catheter over the wire into the pericardial space
• Once the catheter position is confirmed on echo, remove the wire and attach the 3-way tap and drain bag
• Suture the drain in place and dress to maintain sterility
• Request a CXR to exclude iatrogenic pneumothorax.
Documentation
• Date, time, and place
• Name and grade of person who performed the procedure (and anyone who supervised)
• Consent obtained (enclose copy of consent form)
• Aseptic technique used and volume of anesthetic used
• Approach taken and anatomy confirmed by echocardiogram
• Any difficulties, i.e. "first pass' or 'second attempt' etc.
• Appearance of pericardial fluid aspirated
• Volume of pericardial fluid aspirated.
Indications
• Treatment of cardiac tamponade
• Symptomatic pericardial effusion
• Diagnostic pericardiocentesis
• During CPR to exclude cardiac tamponade as a reversible cause of cardiac arrest.
Contraindications
• Cardiac tamponade secondary to cardiac trauma or aortic dissection (surgical intervention is preferable)
• Recurrent pericardial effusions (surgical pericardial window indicated).
Risks
• Pneumothorax
• Myocardial perforation
• Cardiac tamponade
• Coronary artery laceration
• Cardiac arrhythmias
• Intra-abdominal trauma (especially to liver)
• Haemorrhage
• Infection
• Acute pulmonary oedema
• Failure of procedure
• Death.
Procedure Tips
• Pericardiocentesis should be performed by a trained doctor (either cardiologist or thoracic surgeon usually) preferably in a sterile environment (theatre or the cardiac catheterization lab) and under echocardiographic guidance, with access to full resuscitation equipment
• The only exception is during cardiopulmonary resuscitation when pericardiocentesis is performed as an emergency to exclude cardiac tamponade as a reversible cause of cardiac arrest
• Always check the patient's clotting before commencing pericardiocentesis
• The clinician who performed the procedure should confirm the position of the drain using echo
• Always request a post-procedure chest radiograph to exclude iatrogenic pneumothorax.
- Published on
Clinical Procedures – Cleaning An Open Wound
Indications
• Wounds presenting to the Emergency Department.
Contraindications
• Major injuries: vascular compromise, tendon rupture, nerve injury, open factures or joints. These require senior advice and possibly specialist referral.
Risks
• Infection, failure to decontaminate wound
• Haemorrhage, scar, further surgery.
Procedure Tips
• Instead of using a syringe, a normal saline bag and giving set can be used
• For finger lacerations, a digital nerve block provides good analgesia:
• Don't use adrenaline as this can infarct the digit!
• In an ATLS scenario, open wounds should be photographed and covered with an antiseptic-soaked dressing and bandage. The photograph will allow wound inspection by others, without the need to remove bandages and contaminate the wound further
• D Always x-ray glass and metal wounds
• Small superficial wounds with no evidence of contamination on inspection or from the history can be closed with interrupted non-absorbable sutures:
• Patients need to be given information on wound care, signs of infection, and when the sutures should be removed
• Superficial face and head wounds can be closed with skin glue
•In some centres, facial wounds are only sutured by maxillofacial specialists to improve cosmetic results. Check your local policy.
Documentation
• Time, date, mechanism of injury
• Vaccination status
• Sensation and pulses
• Analgesia
• Check for nerve, tendon, and vascular injuries
• Draw diagram of wound site and inspection findings
• How much wash was used?
• If sutured, which suture and when should it be taken out?
• Signature, printed name, and contact details.
The treatment of open wounds depends on:
• Depth and area
• Contamination
• Tissue loss (e.g. vascular, tendon, or nerve damage)
• Other (open fractures or joints, compartment syndrome).
Equipment
• Anaesthetic (local or general)
• Gloves, mask, and eye protection
• 2 x kidney dish (1 for cleaning solutions, 1 below the wound to collect used wash)
• 50mL syringe
• Swabs
• Forceps, scalpel, scissors
• Normal saline or antiseptic solution
• Sterile drapes.
Procedure
Wound cleaning
• Take swabs of wound for microbiology if visibly contaminated or history suggestive
• Clean wound with copious amounts of normal saline and/or water-based antiseptics using syringe
• Clean wound with swabs from the centre outwards to prevent further wound contamination:
• Do not use high-pressure irrigation (can push debris deeper).
Inspection and removal of gross contamination
• Photograph wound with adjacent ruler to document size
• Look for gross contamination and remove with forceps.
Deep palpation
• Methodically check each area visually and with deep palpation to avoid missing contaminants and tissue injuries
• Use forceps and wound retraction to examine all areas
• Look for any damage to blood vessel, nerves, and tendons
• Move the joints above and below the injury whilst looking at the tendon as it moves. D Tendon injuries are easily missed if the wound was incurred in a different position to the resting state (e.g. in clenched fist injury)
If deep tracts are palpated, the wound may need to be extended into the skin above it to allow adequate drainage.
Excision of dead tissue
• Cut away any dead tissue until healthy tissue is visible.
Maintaining drainage
• Any cavity must be adequately drained. In the emergency department, a wick is used rather than a drain
• Siting a drain:
• Identify the most dependent part of the cavity
• Use artery forceps to identify the depth of the tract
• With scissors, taper and cut a corrugated drain to fit into the tract
•Pass the tip of the forceps from the tract base so they can be seen at the skin surface
• Make an incision over the forceps to allow the drain to be sited
• Grasp the tip of the drain with the forceps and ease it into the wound
• To stop the drain dislodging, a loose suture can be placed into the skin and either around the drain or sutured through one of its corrugations. (This depends on the type of drain used.)
• Finally, wash the wound with antiseptic solution
• A pack can be placed into the wound and cavities, to keep small tracts open and allow drainage
• A loose suture can be placed to keep the pack in place.
• Contaminated wounds and bites should not be sutured closed due to high infection risk and the need for adequate drainage.
Dressing
• A non-stick dressing should be placed over the wound and edges, followed by gauze and bandage or tape
• Further wound inspection and debridement is required at 48-96 hours.
Examine sooner in heavily contaminated wounds.
Indications
• Wounds presenting to the Emergency Department.
Contraindications
• Major injuries: vascular compromise, tendon rupture, nerve injury, open factures or joints. These require senior advice and possibly specialist referral.
Risks
• Infection, failure to decontaminate wound
• Haemorrhage, scar, further surgery.
Procedure Tips
• Instead of using a syringe, a normal saline bag and giving set can be used
• For finger lacerations, a digital nerve block provides good analgesia:
• Don't use adrenaline as this can infarct the digit!
• In an ATLS scenario, open wounds should be photographed and covered with an antiseptic-soaked dressing and bandage. The photograph will allow wound inspection by others, without the need to remove bandages and contaminate the wound further
• D Always x-ray glass and metal wounds
• Small superficial wounds with no evidence of contamination on inspection or from the history can be closed with interrupted non-absorbable sutures:
• Patients need to be given information on wound care, signs of infection, and when the sutures should be removed
• Superficial face and head wounds can be closed with skin glue
•In some centres, facial wounds are only sutured by maxillofacial specialists to improve cosmetic results. Check your local policy.
Documentation
• Time, date, mechanism of injury
• Vaccination status
• Sensation and pulses
• Analgesia
• Check for nerve, tendon, and vascular injuries
• Draw diagram of wound site and inspection findings
• How much wash was used?
• If sutured, which suture and when should it be taken out?
• Signature, printed name, and contact details.
The treatment of open wounds depends on:
• Depth and area
• Contamination
• Tissue loss (e.g. vascular, tendon, or nerve damage)
• Other (open fractures or joints, compartment syndrome).
Equipment
• Anaesthetic (local or general)
• Gloves, mask, and eye protection
• 2 x kidney dish (1 for cleaning solutions, 1 below the wound to collect used wash)
• 50mL syringe
• Swabs
• Forceps, scalpel, scissors
• Normal saline or antiseptic solution
• Sterile drapes.
Procedure
Wound cleaning
• Take swabs of wound for microbiology if visibly contaminated or history suggestive
• Clean wound with copious amounts of normal saline and/or water-based antiseptics using syringe
• Clean wound with swabs from the centre outwards to prevent further wound contamination:
• Do not use high-pressure irrigation (can push debris deeper).
Inspection and removal of gross contamination
• Photograph wound with adjacent ruler to document size
• Look for gross contamination and remove with forceps.
Deep palpation
• Methodically check each area visually and with deep palpation to avoid missing contaminants and tissue injuries
• Use forceps and wound retraction to examine all areas
• Look for any damage to blood vessel, nerves, and tendons
• Move the joints above and below the injury whilst looking at the tendon as it moves. D Tendon injuries are easily missed if the wound was incurred in a different position to the resting state (e.g. in clenched fist injury)
If deep tracts are palpated, the wound may need to be extended into the skin above it to allow adequate drainage.
Excision of dead tissue
• Cut away any dead tissue until healthy tissue is visible.
Maintaining drainage
• Any cavity must be adequately drained. In the emergency department, a wick is used rather than a drain
• Siting a drain:
• Identify the most dependent part of the cavity
• Use artery forceps to identify the depth of the tract
• With scissors, taper and cut a corrugated drain to fit into the tract
•Pass the tip of the forceps from the tract base so they can be seen at the skin surface
• Make an incision over the forceps to allow the drain to be sited
• Grasp the tip of the drain with the forceps and ease it into the wound
• To stop the drain dislodging, a loose suture can be placed into the skin and either around the drain or sutured through one of its corrugations. (This depends on the type of drain used.)
• Finally, wash the wound with antiseptic solution
• A pack can be placed into the wound and cavities, to keep small tracts open and allow drainage
• A loose suture can be placed to keep the pack in place.
• Contaminated wounds and bites should not be sutured closed due to high infection risk and the need for adequate drainage.
Dressing
• A non-stick dressing should be placed over the wound and edges, followed by gauze and bandage or tape
• Further wound inspection and debridement is required at 48-96 hours.
Examine sooner in heavily contaminated wounds.
- Published on
Clinical Procedures - Backslabs
Plaster backslabs are used as immediate splints for fractures until definitive treatment is performed and are also used to protect the fracture fixation post-surgery.
Equipment
• Stockinette
• Padding:
• 10cm × 1 roll = above or below elbow backslab
• 15cm x 2 rolls = below knee backslab
• Plaster of Paris bandages
• Bowl or bucket of water (lukewarm, 25-35°C)
• Crepe bandage
• Scissors.
Risks
• Circulatory and nerve impairment, compartment syndrome, pressure sores, joint stiffness.
Procedure Tips
• Backslab application is a 2-person procedure
• Ensure the plaster fits well. A loosely applied cast will not provide adequate splintage and can rub, causing soreness
• D Ensure the plaster does not cause constriction. In the early stages following fractures, the limb may swell, further restricting blood and nervous supply to the limb
• Ensure bony prominences are adequately padded.
Documentation
• Date, time, indication, informed consent obtained
• Neurovascular status of limb
• Procedure performed
• Plan of further management
• Patient given instructions to contact staff if they experience increasing pain, if extremities change colour (e-g. become blue), or develop 'pins and needles' or numbness
• Signature, printed name, and contact details.
Procedure: Below Knee
Used for fractures/dislocations at the ankle and fractures of the foot.
• Use a padded knee rest if available to hold the knee at an angle of 10-15°
• Hold the ankle at 90° with the foot in a neutral position
• Cut a length of the stockinette from just below the knee to the toes and apply onto the patient
• Apply a layer of padding over the stockinette:
• The padding should extend from just below the knee to
the toes
• Start the padding from one end, rolling it around the limb evenly, overlapping half of the previous turn each time
• Measure a slab of 10 layers of 15cm plaster of Paris from just below the back of the knee down to the base of the toes
• Fold the plaster slab and dip it into the water holding the ends
• Removed the plaster from the water, squeeze gently, and straighten it out
• Fan out the upper end of the slab to fit the calf area
• Place from just below the knee along the posterior surface of the lower leg, underneath the heel, and down to the base of the toes
• Mould and smooth the plaster to fit the contours of the leg with the palms of your hands
• Cut two side slabs 10 × 20cm long (length dependent on size of patient) made from 6 layers of plaster
• Dip these in water and apply either side of the ankle joint:
• A U-slab may be used instead of the side slabs. A 10cm wide U-slab (made of 6 layers of plaster) should be applied down one side of the leg under the heel of the foot and up the other side. Great care must be taken not to let the slabs overlap anteriorly
• Finally, turn the stockinette back over the top and bottom edges of the plaster.
Procedure: Below Elbow
Used for fractures/dislocations at the forearm (including
Colle's-type injuries) and fractures of the hand.
• Cut a length of the stockinette from just below the elbow to the knuckles; cut a small hole for the thumb
• Apply the stockinette to the patient
• Apply a layer of padding over the stockinette:
• The padding should extend from the elbow to the knuckles of the back of the hand and show the palmar crease, allowing flexion of the fingers
• The thumb should be completely free
• Start the padding from one end, rolling it around the limb evenly and overlapping half of the previous turn each time
• Cut a length of plaster from below the elbow to the knuckles from a plaster of Paris slab dispenser 15cm or
20cm wide (dependent on size of patient), or by forming a slab from 15cm or 20cm plaster of Paris bandage using 5 layers
• Fold the plaster and dip it into the water holding the ends
• Removed the plaster from the water, squeeze gently, and straighten it out
• Carefully position the slab on the limb over the padding from just below the elbow, down the dorsal surface of the limb to the knuckles
• Mould and smooth the plaster to fit the contours of the forearm with the palms of your hands
• Turn the stockinette back over the edge of the plaster cast at either end
• Finally, apply the roll of crepe bandage over the plaster and the overturned stockinette to hold the plaster in place as it sets.
Procedure: Above Elbow
Used for fractures/dislocations at the forearm and elbow, also supracondylar fractures of the humerus.
• Place the limb in a position of 90° flexion at the elbow
• Cut a length of the stockinette from the axilla to the knuckles of the hand; cut a small hole for the thumb
• Apply the stockinette to the patient
• Apply a layer of padding over the stockinette:
• The padding should extend from the axilla to the knuckles of the back of the hand and show the palmar crease, allowing finger flexion
• The thumb should be completely free
• Start the padding from one end, rolling it around the limb evenly and overlapping half of the previous turn each time
• Prepare a 10cm or 15cm plaster of Paris slab (dependent on patient size), using 5 layers. The slab should be long enough to extend from the axilla to the knuckles of the hand
• Fold the plaster and dip it into the water holding the ends
• Removed the plaster from the water, squeeze gently, and straighten it out
• Carefully position the slab on the limb over the padding running down the posterior surface of the limb over the back of the elbow
• Mould and smooth the plaster to fit the contours of the forearm with the palms of your hands
• Prepare two 10cm-wide slabs of 5 layers of 25cm length (adjust length according to size of patient). Place these on each side of the elbow joint to reinforce it
• Turn the stockinette back over the edge of the plaster cast at either end
• Finally, apply the roll of crepe bandage over the plaster and the overturned stockinette to hold the plaster in place as it sets.
Plaster backslabs are used as immediate splints for fractures until definitive treatment is performed and are also used to protect the fracture fixation post-surgery.
Equipment
• Stockinette
• Padding:
• 10cm × 1 roll = above or below elbow backslab
• 15cm x 2 rolls = below knee backslab
• Plaster of Paris bandages
• Bowl or bucket of water (lukewarm, 25-35°C)
• Crepe bandage
• Scissors.
Risks
• Circulatory and nerve impairment, compartment syndrome, pressure sores, joint stiffness.
Procedure Tips
• Backslab application is a 2-person procedure
• Ensure the plaster fits well. A loosely applied cast will not provide adequate splintage and can rub, causing soreness
• D Ensure the plaster does not cause constriction. In the early stages following fractures, the limb may swell, further restricting blood and nervous supply to the limb
• Ensure bony prominences are adequately padded.
Documentation
• Date, time, indication, informed consent obtained
• Neurovascular status of limb
• Procedure performed
• Plan of further management
• Patient given instructions to contact staff if they experience increasing pain, if extremities change colour (e-g. become blue), or develop 'pins and needles' or numbness
• Signature, printed name, and contact details.
Procedure: Below Knee
Used for fractures/dislocations at the ankle and fractures of the foot.
• Use a padded knee rest if available to hold the knee at an angle of 10-15°
• Hold the ankle at 90° with the foot in a neutral position
• Cut a length of the stockinette from just below the knee to the toes and apply onto the patient
• Apply a layer of padding over the stockinette:
• The padding should extend from just below the knee to
the toes
• Start the padding from one end, rolling it around the limb evenly, overlapping half of the previous turn each time
• Measure a slab of 10 layers of 15cm plaster of Paris from just below the back of the knee down to the base of the toes
• Fold the plaster slab and dip it into the water holding the ends
• Removed the plaster from the water, squeeze gently, and straighten it out
• Fan out the upper end of the slab to fit the calf area
• Place from just below the knee along the posterior surface of the lower leg, underneath the heel, and down to the base of the toes
• Mould and smooth the plaster to fit the contours of the leg with the palms of your hands
• Cut two side slabs 10 × 20cm long (length dependent on size of patient) made from 6 layers of plaster
• Dip these in water and apply either side of the ankle joint:
• A U-slab may be used instead of the side slabs. A 10cm wide U-slab (made of 6 layers of plaster) should be applied down one side of the leg under the heel of the foot and up the other side. Great care must be taken not to let the slabs overlap anteriorly
• Finally, turn the stockinette back over the top and bottom edges of the plaster.
Procedure: Below Elbow
Used for fractures/dislocations at the forearm (including
Colle's-type injuries) and fractures of the hand.
• Cut a length of the stockinette from just below the elbow to the knuckles; cut a small hole for the thumb
• Apply the stockinette to the patient
• Apply a layer of padding over the stockinette:
• The padding should extend from the elbow to the knuckles of the back of the hand and show the palmar crease, allowing flexion of the fingers
• The thumb should be completely free
• Start the padding from one end, rolling it around the limb evenly and overlapping half of the previous turn each time
• Cut a length of plaster from below the elbow to the knuckles from a plaster of Paris slab dispenser 15cm or
20cm wide (dependent on size of patient), or by forming a slab from 15cm or 20cm plaster of Paris bandage using 5 layers
• Fold the plaster and dip it into the water holding the ends
• Removed the plaster from the water, squeeze gently, and straighten it out
• Carefully position the slab on the limb over the padding from just below the elbow, down the dorsal surface of the limb to the knuckles
• Mould and smooth the plaster to fit the contours of the forearm with the palms of your hands
• Turn the stockinette back over the edge of the plaster cast at either end
• Finally, apply the roll of crepe bandage over the plaster and the overturned stockinette to hold the plaster in place as it sets.
Procedure: Above Elbow
Used for fractures/dislocations at the forearm and elbow, also supracondylar fractures of the humerus.
• Place the limb in a position of 90° flexion at the elbow
• Cut a length of the stockinette from the axilla to the knuckles of the hand; cut a small hole for the thumb
• Apply the stockinette to the patient
• Apply a layer of padding over the stockinette:
• The padding should extend from the axilla to the knuckles of the back of the hand and show the palmar crease, allowing finger flexion
• The thumb should be completely free
• Start the padding from one end, rolling it around the limb evenly and overlapping half of the previous turn each time
• Prepare a 10cm or 15cm plaster of Paris slab (dependent on patient size), using 5 layers. The slab should be long enough to extend from the axilla to the knuckles of the hand
• Fold the plaster and dip it into the water holding the ends
• Removed the plaster from the water, squeeze gently, and straighten it out
• Carefully position the slab on the limb over the padding running down the posterior surface of the limb over the back of the elbow
• Mould and smooth the plaster to fit the contours of the forearm with the palms of your hands
• Prepare two 10cm-wide slabs of 5 layers of 25cm length (adjust length according to size of patient). Place these on each side of the elbow joint to reinforce it
• Turn the stockinette back over the edge of the plaster cast at either end
• Finally, apply the roll of crepe bandage over the plaster and the overturned stockinette to hold the plaster in place as it sets.
- Published on
Clinical Procedures - Incision and Drainage
Equipment
• Mask, eye protection, and gloves
• Antiseptic solution and drapes
• Scalpel
• Microbiology swab
• Forceps
• Curette
• 2 x kidney dish (1 dirty, 1 for wash solution)
• 50mL syringe
• Swabs
• Normal saline
• Ribbon pack e.g. Aquacel®.
Procedure
• Introduce yourself, confirm the patient's identity, explain the procedure, and obtain informed written consent
• Position patient to allow easy access to abscess area
• Wear mask and protective glasses as the pus can be under pressure and spray!
• Clean hands with surgical scrub method and put on sterile gloves
• Clean and drape area appropriately
• Hold kidney dish below abscess to collect pus
• Make an incision with the scalpel over 'pointed' area or most fluctuant point of abscess:
• Try to incise along natural skin lines. This can be difficult when there is distortion of tissue due to abscess swelling
• Take microbiology swab of pus
• Extend incision to allow good drainage of the cavity
• Insert a gloved finger and gently break down any loculations
• Perform a curettage of the wound to remove the thick abscess capsule if present
• Excise any necrotic skin using forceps and scalpel
• Wash the cavity with normal saline until wash runs clear.
The volume needed depends on the size of the abscess
• Pack wound loosely with ribbon pack and apply dressing
• Clean area around the wound
• If the patient is systemically unwell, immunocompromised, or if cellulitis is spreading from the abscess area, a course of IV antibiotics will need to be given.
Follow-up
• The pack should be changed at 24 hours and the wound inspected
• If sending the patient home, ask district nurses or practice nurse to assess and change pack.
Documentation
• Date, time, indication, informed consent obtained
• Site and size of abscess, cellulitis, and observations
• Anaesthetic technique (e.g. local or general)
• Incision technique
• Findings (dimensions of cavity, loculations, amount of pus)
• Microbiology swab taken?
• Haemostasis achieved?
• Volume of wash solution used
• Type of pack used
• Follow-up instructions and antibiotics (if needed)
• Advice given to patient
• Signature, printed name, and contact details.
Indications
• Painful swollen area
• Spreading cellulitis
• Systemically unwell
• Failure of antibiotic treatment.
Contraindications
• Pulsatile swelling (e.g. false or true aneurysm).
Risks
• Spread or recurrence of infection, bleeding
• Scar
• Further surgery.
Procedures Tips
Necrotizing fasciitis/Fournier's gangrene
• Greatest risk in immunocompromised and peri-anal or scrotal wounds
• Possible signs include:
• Systemically unwell
• Rapidly spreading erythema ‡ skin necrosis
• Surgical emphysema
• Easy passage of finger between skin and fascia planes
• Yellowish-green necrotic fascia.
Perianal abscesses
• Perform a digital rectal examination feeling for a 'grain of rice' in the anal canal suggesting a fistula opening or bulge from a collection of pus
• Perform a rigid sigmoidoscopy looking for pus or rectal tumours
• If a fistula is suspected, probing for a tract may create false tracts
• Follow-up microbiology:
• If skin bacteria (e.g. S. aureus or S. epidermidis), the abscess is probably secondary to an infected skin follicle
• If gut bacteria, (e.g. E. coli), the abscess is probably due to an infected peri-anal gland. Increased chance of fistula formation and follow-up to check wound healing ‡ referral to colorectal specialist is advised.
Groin abscesses
• Suspect false aneurysm if the patient has been attempting IV injections at the site
• Check for pulsatility and request ultrasound to investigate further.
Equipment
• Mask, eye protection, and gloves
• Antiseptic solution and drapes
• Scalpel
• Microbiology swab
• Forceps
• Curette
• 2 x kidney dish (1 dirty, 1 for wash solution)
• 50mL syringe
• Swabs
• Normal saline
• Ribbon pack e.g. Aquacel®.
Procedure
• Introduce yourself, confirm the patient's identity, explain the procedure, and obtain informed written consent
• Position patient to allow easy access to abscess area
• Wear mask and protective glasses as the pus can be under pressure and spray!
• Clean hands with surgical scrub method and put on sterile gloves
• Clean and drape area appropriately
• Hold kidney dish below abscess to collect pus
• Make an incision with the scalpel over 'pointed' area or most fluctuant point of abscess:
• Try to incise along natural skin lines. This can be difficult when there is distortion of tissue due to abscess swelling
• Take microbiology swab of pus
• Extend incision to allow good drainage of the cavity
• Insert a gloved finger and gently break down any loculations
• Perform a curettage of the wound to remove the thick abscess capsule if present
• Excise any necrotic skin using forceps and scalpel
• Wash the cavity with normal saline until wash runs clear.
The volume needed depends on the size of the abscess
• Pack wound loosely with ribbon pack and apply dressing
• Clean area around the wound
• If the patient is systemically unwell, immunocompromised, or if cellulitis is spreading from the abscess area, a course of IV antibiotics will need to be given.
Follow-up
• The pack should be changed at 24 hours and the wound inspected
• If sending the patient home, ask district nurses or practice nurse to assess and change pack.
Documentation
• Date, time, indication, informed consent obtained
• Site and size of abscess, cellulitis, and observations
• Anaesthetic technique (e.g. local or general)
• Incision technique
• Findings (dimensions of cavity, loculations, amount of pus)
• Microbiology swab taken?
• Haemostasis achieved?
• Volume of wash solution used
• Type of pack used
• Follow-up instructions and antibiotics (if needed)
• Advice given to patient
• Signature, printed name, and contact details.
Indications
• Painful swollen area
• Spreading cellulitis
• Systemically unwell
• Failure of antibiotic treatment.
Contraindications
• Pulsatile swelling (e.g. false or true aneurysm).
Risks
• Spread or recurrence of infection, bleeding
• Scar
• Further surgery.
Procedures Tips
Necrotizing fasciitis/Fournier's gangrene
• Greatest risk in immunocompromised and peri-anal or scrotal wounds
• Possible signs include:
• Systemically unwell
• Rapidly spreading erythema ‡ skin necrosis
• Surgical emphysema
• Easy passage of finger between skin and fascia planes
• Yellowish-green necrotic fascia.
Perianal abscesses
• Perform a digital rectal examination feeling for a 'grain of rice' in the anal canal suggesting a fistula opening or bulge from a collection of pus
• Perform a rigid sigmoidoscopy looking for pus or rectal tumours
• If a fistula is suspected, probing for a tract may create false tracts
• Follow-up microbiology:
• If skin bacteria (e.g. S. aureus or S. epidermidis), the abscess is probably secondary to an infected skin follicle
• If gut bacteria, (e.g. E. coli), the abscess is probably due to an infected peri-anal gland. Increased chance of fistula formation and follow-up to check wound healing ‡ referral to colorectal specialist is advised.
Groin abscesses
• Suspect false aneurysm if the patient has been attempting IV injections at the site
• Check for pulsatility and request ultrasound to investigate further.
- Published on
Clinical Procedures – Handling Belt ( Assisting Patient to Stand)
A handling belt is used to assist a patient to stand, especially when transferring from chair to bed.
Minimal assistance (patient able to cooperate and understand instructions).
Equipment
• Handling belt: single-webbed design with clipped buckle:
• To fit up to 115cm (45") waist (single use)
• 1 (or 2) members of staff required.
Procedure
• Before you start the move, ensure the patient has been assessed as able to weight bear
• Ensure the immediate area is clutter free
• Ensure the patient has full understanding of the manoeuvre:
•At each stage ensure patient is aware of the procedure and your expectations
• Encourage the patient to move forward in the chair:
• Assist the patient to move forward if they are unable
• Stand beside the chair with feet slightly apart:
• If 2 staff are present, 1 should stand on either side
• Agree who will give commands if 2 staff involved
• Place the belt around the patient's waist and tighten to a point where it will not slip up, or down:
• Check that it is safely secured in the buckle and comfortable for the patient
• Grip the belt externally with one hand:
• That is, do not put your hand(s) through belt
• Place your other hand on the patient's shoulder or chest
• Advise patient to stand on command: 'Ready, Steady, Stand:
• If 2 staff involved, command can be split, as agreed
• On 'Stand' command, as the patient rises, move your weight from your back foot to front, taking some of the patient's weight:
• The move should require only minimal effort for staff.
A handling belt is used to assist a patient to stand, especially when transferring from chair to bed.
Minimal assistance (patient able to cooperate and understand instructions).
Equipment
• Handling belt: single-webbed design with clipped buckle:
• To fit up to 115cm (45") waist (single use)
• 1 (or 2) members of staff required.
Procedure
• Before you start the move, ensure the patient has been assessed as able to weight bear
• Ensure the immediate area is clutter free
• Ensure the patient has full understanding of the manoeuvre:
•At each stage ensure patient is aware of the procedure and your expectations
• Encourage the patient to move forward in the chair:
• Assist the patient to move forward if they are unable
• Stand beside the chair with feet slightly apart:
• If 2 staff are present, 1 should stand on either side
• Agree who will give commands if 2 staff involved
• Place the belt around the patient's waist and tighten to a point where it will not slip up, or down:
• Check that it is safely secured in the buckle and comfortable for the patient
• Grip the belt externally with one hand:
• That is, do not put your hand(s) through belt
• Place your other hand on the patient's shoulder or chest
• Advise patient to stand on command: 'Ready, Steady, Stand:
• If 2 staff involved, command can be split, as agreed
• On 'Stand' command, as the patient rises, move your weight from your back foot to front, taking some of the patient's weight:
• The move should require only minimal effort for staff.
- Published on
Clinical Procedures - Assisting a Patient to Stand
Moderate assistance is required from the patient.
Equipment
• 1 (or 2) members of staff.
Procedure
• D Before beginning the procedure, ensure the patient has been assessed as able to weight bear
• Ensure the immediate area is clutter free
• Ensure the patient has full understanding of the manoeuvre, and what is expected of them
• Encourage the patient to move forward in the chair, and give assistance if required
• Stand at the side of the chair, slightly behind the patient with feet apart and balanced
• Ensure the patient, and any other staff are aware of which command to respond to, e.g. 'ready, steady, stand'
• With one hand in an open-palmed position, place your arm nearest the patient around the patient's lower back, reaching as long and as low as is comfortable
• Place the other hand at the front of the patient's shoulder
• On the 'stand' command, as the patient rises from the chair, move your position forward such that you are standing next to the patient when upright, to aid their balance
• Get the patient to help as much as possible during the manoeuvre, e.g. pushing down on the arms of the chair if available
• If the patient is unsteady and unable to complete the manoeuvre, gently lower the patient back into the chair and re-assess the situation.
Procedure Tips
• This procedure is only possible with cooperative patients who are able to weight bear, and are able to understand basic commands
• This procedure can be carried out with 1 or 2 people, dependant on the mobility of the patient
• It is important to allow sufficient time for the procedure, so that the patient understands the process
• It is important to encourage the patient's independence, and a good method to achieve this is to ask them how they would carry out this manoeuvre at home
• Include the patient in all decision-making about the procedure, e.g. they may feel comfortable using a Zimmer frame or similar walking aid
• Check bed area for any furniture/equipment that could be moved to allow more space to complete the manoeuvre
• Always check that IV fluids, catheters, drains, and other devices are safe and not likely to be pulled out during procedure
• Check with qualified staff for any changes in the patient's condition prior to the manoeuvre
• Check with staff whether the patient has any history of cognitive problems, violence, or aggression or has any health problems which may prevent or impact upon the manoeuvre.
Documentation
• All patients should have had a moving/handling assessment completed by a physiotherapist in the first 24 hours after admission.
• Any issues raised following the move should be documented in notes
• Full assessment should be completed prior to each move if the patient's condition has changed.
Moderate assistance is required from the patient.
Equipment
• 1 (or 2) members of staff.
Procedure
• D Before beginning the procedure, ensure the patient has been assessed as able to weight bear
• Ensure the immediate area is clutter free
• Ensure the patient has full understanding of the manoeuvre, and what is expected of them
• Encourage the patient to move forward in the chair, and give assistance if required
• Stand at the side of the chair, slightly behind the patient with feet apart and balanced
• Ensure the patient, and any other staff are aware of which command to respond to, e.g. 'ready, steady, stand'
• With one hand in an open-palmed position, place your arm nearest the patient around the patient's lower back, reaching as long and as low as is comfortable
• Place the other hand at the front of the patient's shoulder
• On the 'stand' command, as the patient rises from the chair, move your position forward such that you are standing next to the patient when upright, to aid their balance
• Get the patient to help as much as possible during the manoeuvre, e.g. pushing down on the arms of the chair if available
• If the patient is unsteady and unable to complete the manoeuvre, gently lower the patient back into the chair and re-assess the situation.
Procedure Tips
• This procedure is only possible with cooperative patients who are able to weight bear, and are able to understand basic commands
• This procedure can be carried out with 1 or 2 people, dependant on the mobility of the patient
• It is important to allow sufficient time for the procedure, so that the patient understands the process
• It is important to encourage the patient's independence, and a good method to achieve this is to ask them how they would carry out this manoeuvre at home
• Include the patient in all decision-making about the procedure, e.g. they may feel comfortable using a Zimmer frame or similar walking aid
• Check bed area for any furniture/equipment that could be moved to allow more space to complete the manoeuvre
• Always check that IV fluids, catheters, drains, and other devices are safe and not likely to be pulled out during procedure
• Check with qualified staff for any changes in the patient's condition prior to the manoeuvre
• Check with staff whether the patient has any history of cognitive problems, violence, or aggression or has any health problems which may prevent or impact upon the manoeuvre.
Documentation
• All patients should have had a moving/handling assessment completed by a physiotherapist in the first 24 hours after admission.
• Any issues raised following the move should be documented in notes
• Full assessment should be completed prior to each move if the patient's condition has changed.
- Published on
Clinical Procedures - Assisting a Patient to Roll Whilst Lying
Equipment
• 1 (or 2) members of staff.
Procedure
• Ensure the bed/trolley is at waist height and that the brakes are on, to avoid staff injuries
• > If the manoeuvre is being carried out with 1 member of staff, always roll the patient towards you:
• D If 2 members of staff are available, they should stand either side of the bed/trolley
• Ensure adequate explanation is given to the patient
• Ensure the patient's head is facing the way the patient will be moving
• Place the patient's distant arm across their chest, and flex their distant hip and knee
• Place an open-palmed hand on the patient's shoulder, and your other hand on the patient's hip or knee:
• Staff may find it more comfortable to put one of their knees on the bed, to avoid stretching or bending
• On the command 'Ready, Steady, Roll', move back slightly, aiding the patient to roll towards you
• Once the patient is on their side, they can be made comfortable with pillows
• It is also important to ensure the patient is secure, by making use of bedrails.
Procedure Tips
• Before carrying out the procedure ensure the area around the bed trolley is clear of any obstacles
• Ensure there is adequate space on the bed/trolley for the patient to roll onto
• It is important to have the correct number of staff available to carry out the manoeuvre
• Do not rush and leave enough time to explain the procedure to the patient and other members of staff involved
• It is important to have assessed the patient prior to carrying out this technique, to discover any contraindications to the patient lying on their side (e.g. problems with the patient's head and neck control, or any potential difficulties such as the patient's size):
• More members of staff will be required for larger patients.
Risks
• Be aware of any attachments that need to move with the patient, e.g. drains or catheters, to avoid disconnection during the procedure.
Documentation
• All patients should have assessments carried out within 24 hours of admission. Care plan to be maintained/consulted as appropriate.
• Any issues or problems with manoeuvre should be documented in the notes.
Equipment
• 1 (or 2) members of staff.
Procedure
• Ensure the bed/trolley is at waist height and that the brakes are on, to avoid staff injuries
• > If the manoeuvre is being carried out with 1 member of staff, always roll the patient towards you:
• D If 2 members of staff are available, they should stand either side of the bed/trolley
• Ensure adequate explanation is given to the patient
• Ensure the patient's head is facing the way the patient will be moving
• Place the patient's distant arm across their chest, and flex their distant hip and knee
• Place an open-palmed hand on the patient's shoulder, and your other hand on the patient's hip or knee:
• Staff may find it more comfortable to put one of their knees on the bed, to avoid stretching or bending
• On the command 'Ready, Steady, Roll', move back slightly, aiding the patient to roll towards you
• Once the patient is on their side, they can be made comfortable with pillows
• It is also important to ensure the patient is secure, by making use of bedrails.
Procedure Tips
• Before carrying out the procedure ensure the area around the bed trolley is clear of any obstacles
• Ensure there is adequate space on the bed/trolley for the patient to roll onto
• It is important to have the correct number of staff available to carry out the manoeuvre
• Do not rush and leave enough time to explain the procedure to the patient and other members of staff involved
• It is important to have assessed the patient prior to carrying out this technique, to discover any contraindications to the patient lying on their side (e.g. problems with the patient's head and neck control, or any potential difficulties such as the patient's size):
• More members of staff will be required for larger patients.
Risks
• Be aware of any attachments that need to move with the patient, e.g. drains or catheters, to avoid disconnection during the procedure.
Documentation
• All patients should have assessments carried out within 24 hours of admission. Care plan to be maintained/consulted as appropriate.
• Any issues or problems with manoeuvre should be documented in the notes.
- Published on
Clinical Procedures - Transferring a Patient Using a Log Roll
Use this technique to transfer patients in whom a cervical spine injury is suspected or confirmed. The following assumes that the patient's neck is immobilized in a brace or blocks.
Equipment
• Minimum 5 members of staff
• Patient transfer board or 'Patslide®
Procedure
• D The most senior member of the team should take charge of the patient's head and neck and initiate commands
• Ensure adequate explanation is given to the patient, and to all members of staff involved
• Place destination bed/trolley alongside origin bed/trolley
• Check bed is at waist height to prevent staff injuries
• 1 member of staff should position themselves at the head-end of the patient; the other 3 should be spread alongside the patient, at the origin side. The final member of staff should be at the destination side
• Check brakes on bed secure
• The person responsible for the patient's head should have one hand either side of the patient's head, supporting the patient's shoulders
• The person responsible for the patient's upper body should have one hand on the patient's distant shoulder, and the other on the lateral aspect of the patient's chest
• The person responsible for the patient's pelvis should have one hand on the lateral aspect of the patient's pelvi and the other under the patient's distant thigh
• The person responsible for the patient's lower legs should have both hands under the distant calf
• On the command 'Ready, Steady, Roll' the 3 members of staff at the side of the patient will slowly move backwards with straight arms, rolling the patient towards them
• The member of staff responsible for the patient's head will move sideways, ensuring alignment of the patients spine is preserved and that the neck is not rotated at all
• Staff at the bed/trolley onto which patient is to be transferred, put transfer board onto patient's bed/trolley
• On the command 'Ready, Steady, Roll' the 4 members of staff at the patient roll the patient back flat, keeping the neck straight
• 1 member of staff should now move around the bed such that there are 2 on each side and 1 at the head.
• On command of 'Ready, Steady, Move'
• Handlers should move the patient gently across on transfer board keeping the head and neck immobilized.
Procedures Tips
• Ensure sufficient time available to safely complete the manoeuvre
• Check bed area for any furniture/equipment that could be moved
• Staff should wear suitable (preferably low-heel) footwear and non-restrictive clothing
• D It is vital to have the correct amount of staff available
Do not rush, and leave enough time to explain the procedure to all present
• D It is essential that the patient's body be kept in alignment, and the manoeuvre is carried out in one smooth and controlled movement.
Risks
• Potential injuries to patient or staff arising from trailing leads, drains, etc.
• Disconnection of equipment during manoeuvre:
• Watch out for IV pumps, syringe drivers, catheters.
Documentation
• All patients should have assessments carried out within 24 hours of admission
• Care plan should be maintained/consulted as appropriate
• If there are any issues with equipment or manoeuvre, advise nurse in charge, document in notes, and complete an appropriate incident form.
Use this technique to transfer patients in whom a cervical spine injury is suspected or confirmed. The following assumes that the patient's neck is immobilized in a brace or blocks.
Equipment
• Minimum 5 members of staff
• Patient transfer board or 'Patslide®
Procedure
• D The most senior member of the team should take charge of the patient's head and neck and initiate commands
• Ensure adequate explanation is given to the patient, and to all members of staff involved
• Place destination bed/trolley alongside origin bed/trolley
• Check bed is at waist height to prevent staff injuries
• 1 member of staff should position themselves at the head-end of the patient; the other 3 should be spread alongside the patient, at the origin side. The final member of staff should be at the destination side
• Check brakes on bed secure
• The person responsible for the patient's head should have one hand either side of the patient's head, supporting the patient's shoulders
• The person responsible for the patient's upper body should have one hand on the patient's distant shoulder, and the other on the lateral aspect of the patient's chest
• The person responsible for the patient's pelvis should have one hand on the lateral aspect of the patient's pelvi and the other under the patient's distant thigh
• The person responsible for the patient's lower legs should have both hands under the distant calf
• On the command 'Ready, Steady, Roll' the 3 members of staff at the side of the patient will slowly move backwards with straight arms, rolling the patient towards them
• The member of staff responsible for the patient's head will move sideways, ensuring alignment of the patients spine is preserved and that the neck is not rotated at all
• Staff at the bed/trolley onto which patient is to be transferred, put transfer board onto patient's bed/trolley
• On the command 'Ready, Steady, Roll' the 4 members of staff at the patient roll the patient back flat, keeping the neck straight
• 1 member of staff should now move around the bed such that there are 2 on each side and 1 at the head.
• On command of 'Ready, Steady, Move'
• Handlers should move the patient gently across on transfer board keeping the head and neck immobilized.
Procedures Tips
• Ensure sufficient time available to safely complete the manoeuvre
• Check bed area for any furniture/equipment that could be moved
• Staff should wear suitable (preferably low-heel) footwear and non-restrictive clothing
• D It is vital to have the correct amount of staff available
Do not rush, and leave enough time to explain the procedure to all present
• D It is essential that the patient's body be kept in alignment, and the manoeuvre is carried out in one smooth and controlled movement.
Risks
• Potential injuries to patient or staff arising from trailing leads, drains, etc.
• Disconnection of equipment during manoeuvre:
• Watch out for IV pumps, syringe drivers, catheters.
Documentation
• All patients should have assessments carried out within 24 hours of admission
• Care plan should be maintained/consulted as appropriate
• If there are any issues with equipment or manoeuvre, advise nurse in charge, document in notes, and complete an appropriate incident form.
- Published on
Clinical Procedures - Aiding a Falling Patient
• It is essential that if a patient falls, the member of staff must not try to catch the patient, but must allow them to fall. as there is no safe method for this situation
• Allowing the patient to fall may feel contrary to the staff's natural instincts to help but trying to catch a patient will only result in injury to staff
• Instead, every attempt must be made to reduce injury to the patient (e.g. moving objects out of the patient's way if possible).
Procedure
Falling in a forward direction
• If a member of staff is walking with a patient as they fall in a forward direction, the member of staff must allow the patient to fall.
Falling towards a member of staff
• If the fall is towards the member of staff, it may be possible to control the patient's movements safely to minimize injury to them
• The member of staff should move close to the patient, standing directly behind them with their leg closest to the patient flexed. Then they should gently guide the patient's body down their flexed leg to the floor.
Procedure Tips
• The risk of falling should be minimized by only performing tasks appropriate to the patient's ability (e.g. only allow patients to walk if they are fully mobile)
• Use equipment to reduce the risk of falls i.e. Zimmer frames or walking sticks
• A patient falling is an unpredictable and sudden event. However, the member of staff should take every care to maintain a good posture at all times, avoiding twisting or stretching
• D If present when a patient falls, the member of staff should immediately call for assistance, to ensure an adequate number of staff are present if the situation turns into an emergency.
Documentation
• All patients should have assessments carried out within 24 hours of admission and placed in their file
• Any fall or issues should be documented in the patient's notes to ensure other ward staff are aware of problems.
• It is essential that if a patient falls, the member of staff must not try to catch the patient, but must allow them to fall. as there is no safe method for this situation
• Allowing the patient to fall may feel contrary to the staff's natural instincts to help but trying to catch a patient will only result in injury to staff
• Instead, every attempt must be made to reduce injury to the patient (e.g. moving objects out of the patient's way if possible).
Procedure
Falling in a forward direction
• If a member of staff is walking with a patient as they fall in a forward direction, the member of staff must allow the patient to fall.
Falling towards a member of staff
• If the fall is towards the member of staff, it may be possible to control the patient's movements safely to minimize injury to them
• The member of staff should move close to the patient, standing directly behind them with their leg closest to the patient flexed. Then they should gently guide the patient's body down their flexed leg to the floor.
Procedure Tips
• The risk of falling should be minimized by only performing tasks appropriate to the patient's ability (e.g. only allow patients to walk if they are fully mobile)
• Use equipment to reduce the risk of falls i.e. Zimmer frames or walking sticks
• A patient falling is an unpredictable and sudden event. However, the member of staff should take every care to maintain a good posture at all times, avoiding twisting or stretching
• D If present when a patient falls, the member of staff should immediately call for assistance, to ensure an adequate number of staff are present if the situation turns into an emergency.
Documentation
• All patients should have assessments carried out within 24 hours of admission and placed in their file
• Any fall or issues should be documented in the patient's notes to ensure other ward staff are aware of problems.
