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How NOT to suck at turning a Pt, esp. w/ trach/vent??

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by allthesmallthings allthesmallthings (Member) Member

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Hi, there.  I need help learning best (or just good!) technique for turning my patients in their beds, especially the trach/vent patients.  Of course, it's just me (one-person turn) turning them.

(Yes, yes, I suck - I've been a nurse for a while, but worked in hospital, and had second person to help with turning patients in bed for incontinence/bed baths/putting onto hoyer pads, etc.  Somehow, I did not learn well the technique, back in nursing school, and it shows! I'm inefficient and awkward at turning my quadriplegic patients by myself, and I'm genuinely uncomfortable turning the trach/vent patients, afraid that I'm going to pull on their vent tubing and pull out their trachs. I wind up having to turn my patients multiple times to get sheets/pants/diapers/hoyer slings underneath them correctly, and I take forever to get things done with them.)  

Anyway, I want to not suck at it anymore. I've watched youtube videos/nursing education videos, but these don't show quadriplegic patients, or trach/vent patients, or one person doing turns on these types of patients. They show two people turning a "patient" who's about 30 years old and assists in her own turn. Really??

Please help!  Thanks. 

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kdodge is a ADN, BSN, RN and specializes in Hematology/Oncology- adults and peds.

6 Posts; 54 Profile Views

Two words... draw sheets. Honestly, these have saved me and my back so many times over the years. While the best way would be to have help from another person, even a family member, draw sheets can be your saving grace when trying to turn a patient solo and still being able to worry about their airway.

My advice is to take two unfitted sheets and fold them in half so that you have plenty of room to grab when you're on the opposite side of the patient. Place one under their hips/butt and the other under their shoulders/ upper back. When you go to reposition/turn them, set up your pillows on the side that they need to be placed, move the "handles" of your draw sheet so that you can grab it when you go to the other side of the patient.

Work on one major area at a time... normally starting with the shoulders. Grab the drawsheet and pull so that you rotate the patient enough to reach over them and place the support pillow under their shoulders or hips and then let them relax back into position. Mind you, this works best if there are no pillows supporting the side that you are trying to turn them to.

You can place pillows on your side (if there are side rails make sure that they are up) so that the patient doesn't hit the rails.

Doing it this way means that you can easily assess and fix any issues with the trach/vent that may occur during repositioning because you're on the same side as your patient.

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amoLucia specializes in LTC.

5,183 Posts; 45,873 Profile Views

Don't know if you guys have seen them but they make bed pads in various sizes that have CANVAS LOOPED HANDLES that you grab and pull. Not disposable but REAL fabric like padded mattress covers. You launder them like regular bed linens. And they come in various size with more handles as the size increases. (Check out Amazon.)

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Orion81RN has 7 years experience.

767 Posts; 7,980 Profile Views

I completely suck at this too. I've never been able to roll up chux, linen and a diaper together and fit it under the pt so that they only have to turn a couple times. So my guy has to turn a lot. My pt is 6'5 and no muscle control due to ALS. So it's tricky too. With a vent. 

We have him on a long cloth underpad and place 2 chux on that. What I do, the way someone showed me, is I pull him toward me by grabbing the pad. Turn his head to the direction I'm turning him. Bend his knee and turn him away from me. So if I'm turning him to his right, I'm standing on his left. I put his right arm and hand out to his side near the rail so he doesn't lay on it when I turn him. I place his left hand on his stomach. With his left leg bent, I then turn him to the left. My left hand pushing his left hip/upper leg area, my right hand pushing his left shoulder, turning him. I lean over and make sure his face isn't too smushed. I clean him up, roll him back toward me, put the rail up and go to the other side. I pull him toward me again and repeat.  

He often urinates when he's on his side, so I frequently will have cleaned him, placed new chux, just for him to pee on it in the middle of all it. 🤦‍♀️

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Orion81RN has 7 years experience.

767 Posts; 7,980 Profile Views

On 9/22/2019 at 8:05 PM, allthesmallthings said:

Thanks, orion81...you took some time w that reply! That's helpful. 🙂

For some reason, I haven't been able to edit my posts recently. I meant if I'm standing on his left I'm turning him to his right by holding his left hip area and left shoulder.

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kdodge is a ADN, BSN, RN and specializes in Hematology/Oncology- adults and peds.

6 Posts; 54 Profile Views

On 9/22/2019 at 2:42 PM, Orion81RN said:

He often urinates when he's on his side, so I frequently will have cleaned him, placed new chux, just for him to pee on it in the middle of all it. 🤦‍♀️

Try placing a diaper, if you have it, around him so that he urinates into that and you don't have to place a brand new chuck right after you've already moved him? Or you can fold an extra chuck and do the same thing... saves you some extra time, rolling, and your back.

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Orion81RN has 7 years experience.

767 Posts; 7,980 Profile Views

On 9/25/2019 at 10:14 PM, kdodge said:

Try placing a diaper, if you have it, around him so that he urinates into that and you don't have to place a brand new chuck right after you've already moved him? Or you can fold an extra chuck and do the same thing... saves you some extra time, rolling, and your back.

I do. Both ways.  Somehow he pees around it. 🤦. I'm like "How?! I had a diaper rolled up (or a folded chux acting like a diaper) an extra chux folded under, and one draped over his leg when turning him. Urine still manages to escape somehow. Like his penis falls to the side if you can imagine what I mean. It usually happens when turning him from his side back onto his back. That's when the diaper or chux gives way enough for his penis to pop out. 

I also make sure to apply pressure to his bladder and get him to urinate before any turns. 

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kdodge is a ADN, BSN, RN and specializes in Hematology/Oncology- adults and peds.

6 Posts; 54 Profile Views

13 hours ago, Orion81RN said:

I also make sure to apply pressure to his bladder and get him to urinate before any turns. 

Smart! Does anyone know if I could do this on my infant boy patients to make sure they don't pee on me while I'm changing them?

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SirJohnny has 8 years experience and specializes in LTC & Private Duty Pediatrics.

399 Posts; 7,622 Profile Views

Keep practicing.  It's hard at first, but you will get good at it after a few weeks.

If patient is obese (> 300 lbs), screw it and tell agency you need a CNA in there with you.

Leave if agency refuses.  They are the ones making all the money, not you.

 

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