Bariatric woes

Hoozdo, ADN · Jun 27, 2006

We have a bariatric pt that I am having problems caring for. On night shift it is usually 2 nurses and no CNA on my floor. I dont' know how to turn/reposition/pull and otherwise provided the minimum standards of care for a 480 pound pt with just one other person to help. The pt is on a specialty bed that is so high off the ground that I have to stand on a stool to be able to do trach/oral care, and because it is a specialty bed, the "draw sheet" is the flimsy kinair brand blue pad. Something about how you can't use a regular draw sheet with the air mattress. The pt is almost twice as wide as the pad, you have to lift her abdomen to reach the blue pad.
No lifts available in my building that can handle greater than 350 pounds. I ended up calling another floor to borrow help, but later that floor had a code situation and couldn't send help, poor pt had to lay in stool until early dayshift arrived, almost 1 1/2 hours, poor thing, because without a true draw sheet, the 2 of us literally could not get her turned on her side without additional help. Did I mention pt prob has cdif? :stone
Does anyone have any ideas for a draw sheet that isn't contraindicated in a kinair bed that will actually be large enough to be effective? Or know of any way to move this pt. I'm short, 5'1" and my arms are too short to reach all the way across this pt without standing on my tiptoes balancing on the stool, and laying on the pt. I'm terrified I am going to herniate yet another disk in my back, or loose my balance and fall off the darn stool.

I am faced with this problem all the time in my ICU. We are very busy and running short staffed and when patients are sedated they are just dead weight. We use specialty beds too. I have used draw sheets on the specialty beds......how else are you going to move that patient up in bed? Those blue pads are not strong enough to withstand pulling 250+ lb patients. With just two people to roll that pt and clean him up - you might have to use an ugly hold. Take one knee and put it up - grab the arm on the same side. Grab the knee and pull the pt over to you which will roll him to the side. In that manner you are not using your back as much, but the patient's joints will take a beating. Of course, before you do this make sure the patient will not roll on his ETT, aline or central line tranducers, or any other equipment!

For the C. Diff problem, after about two change of linens, I would place a Flexiseal or rectal bag. At my facility we don't need a Dr. order to do this.

I am interested to know how other nurses manage to roll large, dead weight patients with minimal personnel. We don't have lifts.

elthia · Jun 27, 2006

The problem is the pt isn't sedated, she's wide awake, extremely anxious and won't let you pull her arm to pull her over...Thanks for the suggestion though.

Retired R.N. · Jun 27, 2006

We have a bariatric pt that I am having problems caring for. On night shift it is usually 2 nurses and no CNA on my floor. I dont' know how to turn/reposition/pull and otherwise provided the minimum standards of care for a 480 pound pt with just one other person to help. ...

This is a problem that needs to go to the Nursing Office. Who is the chief nurse in charge of the entire nursing department on night shift? If (s)he can't help you tonight, then you need to go a step higher tomorrow morning and present the problem to the DON. You need to be a strong, assertive advocate for patient and staff safety. Document, document, and document!

Tweety, BSN, RN · Jun 27, 2006

Sounds like you're doing the best that you can. In those cases I just use the sheet as the draw sheet. Fortunately I work in a large unit with plenty of help, but sometimes gathering together 3 or 4 people requires a wait.

Reaching over the patient on a stool on your tip toes is endangering yourself. You're going to hurt your back. Wait for help.

Sorry, I guess I'm not much help. Good luck.

LCRN · Jun 27, 2006

We have a "skin care protocol" and if a patient is having loose, incontinent stool and is at risk for skin break down or already has skin breakdown we use appliances--> let me explain.

1. Recal Pouches do work if applied correctly...at our place we usually get about 3 days out of them but we are tedious in application with skin prep and the smallest size tegaderms in the areas that tend to lift up for added security. We tend to irrigate them q 12h to make sure their patent. We only apply pouches if the patient has NO breakdown, No redness and skin that will be able to withstand the pouch adhesive.

2. My personal favorite is the ZAZZI- this is used for bariatric patients as well as uncontrolled stool. With some bari patients we intentionally liquify their stool by giving them lactulose so they can use this device which is similar to a rectal foley but rather than having a balloon being filled with air inside the rectal vault it is filled with air so it's soft and flexible and can remain in a patient for up to 28 days per the company. You can provide retention enemas and medications right through a stopcock that is provided, there is also a water flush port. Our facility likes it. We also use it with patients that have sever decubitus ulcers/c-diff with breakdown/colitis/and for strict I/O at certain docs requests. (the zazzi is contraindicated with any lower intestinal surgery or resections)

3. The rectal foley which at our facility is the good ole standby, we use this for short term use. The 30cc balloon is filled with water. Usually we only insert this if the patient is already having loose stools, we wouldn't intentionally liquify someones stool just to insert this because is it a short term solution. This is because the balloon filled with water in the rectal vault can cause necrosis after time and practitioners adding a little more water to stop the stool from leaking :)

I know how you feel because I am also quite short at 5'0 and am familiar with the bed that you are talking about. I hope this information helps you- If your facility is going to take patients over a certain weight they should provide you with mechanical lifts or the staff to be able to safely lift them. I would definetely bring this up to upper management. Above all your concern is the patient as you pointed out! Good luck with your concerns!!!!

For our skin care protocol we also start patients on MVI/Zinc/Vit C (if renal dose adjustments are made) Once again I hope some of this info was helpful it has seemed to make a difference at my place!

rstewart · Jun 27, 2006

Whether the nurse is 3 ft tall or 8ft tall there is no safe way to manually handle patients of that size.

In my opinion, hospitals which refuse to provide appropriate beds, supplies and lifting/transfer equipment should lose government funding because there is no way to adequately care for bariatric patients particularly.

Allowing a patient to lay in stool for an hour and a half is inhumane; neither should nurses be expected to perform tasks which are known to cause injury.

Hospitals decry government regulations but this all too common scenerio is but one example of why no manual lifting laws, pt/nurse ration laws etc. are necessary.

lannisz · Jun 27, 2006

Whether the nurse is 3 ft tall or 8ft tall there is no safe way to manually handle patients of that size.
In my opinion, hospitals which refuse to provide appropriate beds, supplies and lifting/transfer equipment should lose government funding because there is no way to adequately care for bariatric patients particularly.
Allowing a patient to lay in stool for an hour and a half is inhumane; neither should nurses be expected to perform tasks which are known to cause injury.
.

Exactly. Please do not try to move this pt yourself or with only 2 people. It is unsafe for you. It can also be very painful for the pt if done without enough people on each side. I worked at a small community hospital a couple years ago that was doing bariatric surgeries (and shouldn't have been if you ask me...it wasn't safe in terms of having an ICU etc) For a pt that size we always used 4-6 people to move them and it was the rule to wait until you had enough staff to help. I was on night shift too.

Nurse Ratched, RN · Jun 27, 2006

http://www.wrightproductsinc.com/

Would this help?

GooeyRN, ADN, BSN, CNA, LPN, RN · Jun 27, 2006

You and the patient are in a bad situation. I feel for you and the patient.

I hope that this issues is resolved soon.

fathernurse2b · Jun 27, 2006

I'm am the coordinator of the back safety program at our hospital. This sounds like a problem that starts with administration. We have beds at our hospital that has a "turn assist" feature. The beds inflates on one side and deflates on the other and this with help in turn any size pt. This transfer is hard because it sounds like your patient is not cooperative. One thing you could do is use a larger draw sheet. You and your partner both stand on the same side and with the sheet underneath the patient you and your parter grab the excess from the other side and pull the patient over(be sure to brace yourself against the bed so you can protect your back) and while the pt is on the rail someone go to the other side and do your nursing stuff. The is a high risk transfer especially with a patient of size and only two people doing the transfer.

prmenrs, RN · Jun 27, 2006

If you have any sort of "incident report" or "quality variance" or "risk management" form, fill it out. Every time you're compromising patient care and your OWN health and safety by not having the personnel and/or equipment you need to care for this pt.

This way, you're putting the hospital on notice of what is really a dangerous situation. If you hurt your back (or anything else), you should have every right to sue them because you did not have the support to do what you need to. And the pt/family have a potential suit if there is any negative outcome.

I'm not the legal expert, but, seems to me, the hospital is risking a lot when nurses don't have what they need to do their jobs.

Good luck!