Lift recommendations for patients following flap repair

Nurses General Nursing

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Specializes in Med-surg, ortho, tele, float.

I have a general question - On the floor I work we have several patients that have had flap repairs to coccyx/buttocks (patients with paraplegia) that are on a specific schedule of assiting to chair 3-4 times a day. I am getting push back from mgmt on the use of the lifts to transfer these pts. (I have actually been told not to use a lift.) What have you done to move these patients w/o hurting your self or the patient? If the traditional sling cannot be used due to the location of wounds, do you have any recommendations for alternative types of slings - material, cut, construction etc.?

thanks,

JoanKay

Specializes in Hospice / Psych / RNAC.

How do these people transfer at home? This is where you take your que. The other thing is are they quads, paras, complete, in-complete etc... how independent are they. As you see it's very difficult to assign a specific type of transfer to all of the patients in the unit who have had flap surgery.

The best way is to have them transfer the way they transfer at home. Using a hoyer to lift them when they don't use it at home doesn't make sense. The quads maybe use a hoyer at home but a para shouldn't be using it to transfer at home. The goal is independence with everything. Also, it's physically impossible to transfer someone in a sling without putting pressure on the coccyx. A perfect opportunity to shear the sierra out of a person's behind.

Until the patients are strong enough to help you with the transfer or be able to transfer by themselves they need to be a 2 man assist if not more depending. Most paras transfer without assist at home.

Check out what type of cushion they are using while in the chair. How often are they re-positioning themselves while in the chair. What is the B&B situation and do they have the proper materials for it (keeping dry, barrier cream, etc...). There are others but you get the drift.

Nobody wants to have flap surgery and once they have had it the goal is to not have to do it again.

Specializes in Med-surg, ortho, tele, float.

I like the idea of asking the patient - because that puts them at the front of the care decisions. Most of the patients that I work with need 100% assistance to transfer from bed to wheelchair.

My concern is the expectation that I am - even with the assistance of 1-2 people - expected to fully lift pts ranging in weight from 150 to 350. I am hoping to learn about safe ways to use a lift or another means of transfer that does not involve me having to lift a patient. I do not have a back problem - and I want to keep it that way.

Specializes in Hospice / Psych / RNAC.

Then you are working with quads? Paras shouldn't need that much assistance even after major surgery.

Also why aren't they having PT/OT?

Specializes in Cardiac, PCU, Surg/Onc, LTC, Peds.

I would ask the surgeon and physical therapist recommendations. It's probably not a good idea to lift these patients with a hoyer lift as you'll probably cause a dehis by putting so much pressure on the suture lines. I've had many patients on strict bedrest for up to 2 months and not able to lift the HOB >30°.

Specializes in Spinal Cord injuries, Emergency+EMS.
Then you are working with quads? Paras shouldn't need that much assistance even after major surgery.

Also why aren't they having PT/OT?

how much experience do you have with SCI patients ?

how much experience do you have the SCI population of patients who were injured 30 -50 years ago, rehabbed at the that time on the assumption of a 15 -20 year lifespan and have totally knackered shoulders ?

PT input - yes but in an /old/ SCI unless you all agree to learn some new transfer techniques then the PT is just their maintenance regime

OT input - a paraplegic has most of their OT input following their initial injury and barring periodical reassessments for cushion and chair 'fit ' won't necessarily have a huge amount to do with the OTs should they get readmitted ....

prolonged (weeks to a month or more) bed rest follwing a sore repair is entirely normal - especially given how slowly major incisions in neurogenic skin heal.

Specializes in Med-surg, ortho, tele, float.

I generally work on the weekends - PT/OT are as precious as rubies and will only come for trauma cases. I was hoping to have a great new idea for transferring patients that would not involve me hurting myself. I guess I'll go back to finding someone else to lift for me.

Specializes in ICU.

Ask the surgeon, they can be very particular. Some even give orders on transfers, when it's OK, what to use.

Specializes in LTC,Hospice/palliative care,acute care.

We use a standing lift.

Specializes in Cardiac, PCU, Surg/Onc, LTC, Peds.
We use a standing lift.

The patient has to be able to bear some weight to use a standing lift. Not a wise idea for use on a paraplegic.

To the OP, please, please ask your surgeon the pts restictions and what is okay for your patients. It won't be a good day for you when a complication arises from this if you explain to the surgeon, "well I just used the advice from an anonymous nursing forum so I thought it'd be okay".

ETA: there are the old fashioned type of slings that we used with the manual hoyers. I think they've been outlawed, LOL, but they were one piece and had places at each 4 corners to connect to the manual lift. It was perfect for moving to a geri-chair as it didn't sit the pt up but kept them in a semi-lying position. This type would be perfect for flap repairs as it wouldn't put pressure or strain the suture lines.

Specializes in Spinal Cord injuries, Emergency+EMS.
We use a standing lift.

which is fine for SOME paraplegics but a 'standing hoist' is not a standing frame ...

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