mobility issue- please help!

[nursekoll]

I know there has to be someone out there with a similar problem, I'm looking for suggestions on how to safely transfer a non-weight bearing student out of a wheelchair to sit on a toilet. This student has muscular dystrophy and can not bear weight or lock knees at all (we have a sit-to-stand lift, but can't use it with this student's ability). The student weighs over 90 lbs and is getting difficult to lift manually with a gait belt and 2 staff assist. We have an old mechanical/crank hoyer type lift, but the sling is an issue- how do we get the pull-up down once the sling is on? I have thought of using the hoyer to move the student to the flat cot, then rolling to remove the pants, then re-lifting to the toilet. This would be a long process if the urge to "go" is there (sometimes it is, sometimes it isn't). Help, what has worked for you in similar situations?

[OpinionatedCNA, CNA]

That's a tough one, in my experience it's impossible to put someone one the toilet with a hoyer lift. To be honest it sounds like he isn't continent for the most part, would it be okay to just wait until he's gone and change him on the cot? Or transfer him onto the cot and put him on a bedpan?

I'm still concerned that it will be a huge struggle to get the pants down and back up while in the sling, since usually the pull-up is wet and needs changed. (removing shoes & pants.)

Can your facility buy diapers with tabs? Or have the family buy them and bring one or two for him to change into? Because you don't have to take the pants and shoes all the way off; you can easily tear the pull up at the seams and pull it off, then put the diaper on.

Isn't there a risk of overheating and skin breakdown with 2 briefs?

I am not entirely sure but I am under the impression that at most facilities two diapers are a big nono because of the implication the CNAs aren't changing them enough, or purposefully putting two diapers on so they can basically neglect them and not have to deal with the bed soaking through. But in this case that doesn't really apply if two diapers is gonna save your back some then do it.

[OldDude]

I'm still scratching my head about this one...it seems by your post the student is incontinent or has accidents. Does the child actually urinate or have a BM while on the toilet at school?

[ArryOtter]

Can you explain to the mom that the staff is having some difficulty and ask what she does at home? For some of our special needs kiddos we've had mom come in and physically show us what they do at home to make sure the student is as comfortable as possible. If they're incontinent and not using the toilet at all, we'd generally just change on a cot.

[tining, BSN, RN]

We have this Rifton Lift. "life jacket" comes in different sizes and slings for legs. Once they are in the air you can get the pants off easy.

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[Alex Egan, LPN, EMT-B]

OldDude. I

I have seen this with my MD kids before. Parents and providers are all going ho about potty training when it is age appropriate, the child is more mobile, and smaller and easier to move. Then the kid gets bigger, the disease progresses and suddenly transferring to toilet 6-8 times a day is quite the project.

Sorry to say usually child and caregivers just agree it's easier to be incontinent. It has been my experience that MD kids and those with long term disabilities don't typically have the body modesty to care much. Also an unplanned trip to the floor out of the bottom of the lift sling usually makes being changed in bed a very appealing plan.

[nursekoll, BSN, RN]

yes, about half the time the student actually uses the toilet. Most of the time the pull up is also wet at the time of toileting. I'm just trying to find the best solution for everyone. Mom just changes the pull-up at home, she can't easily get him to the toilet either, although they do have a lift at home.

[OldDude]

OK...I have an idea...don't laugh at me until you try it. This student is a boy. He wears pullups under his pants. Take him to the cot, remove his pants, and put him back in the wheelchair in the pullup. Roll the wheelchair to where it is facing forward to the toilet. Adjust his legs so you can get wheelchair as close to the toilet as possible and lock the wheels. Slide him forward onto the toilet where he is hugging the back of the toilet. This will put him sitting mostly on his hamstrings. Tear the pullup off and let him do his business. Afterwards he'll be clean for the return trip to the wheelchair and back to the cot for a new pullup and to put his pants back on.

The gist is to cut out the lifting/standing/turning/transfer from and to the wheelchair for toileting. If there is a snag with his wheelchair you might have a "toileting" chair for the trip from the cot to the toilet and back to the cot.

Like I say...give it a try before you LOL back at me:woot:

[nursekoll, BSN, RN]

^^ This might actually work. I'll have to try it out with the power wheelchair legs, not sure how easily they swing out of the way. It might still be a little bit of lifting to get him onto the toilet, but not a total lift like we have been doing. We have a slide board for to and from the cot/wheelchair.

Thanks for the idea!

[OldDude]

Keep us informed...it can be a learning experience for everyone...you never know who is gong to enroll tomorrow.

[nursekoll, BSN, RN]

Update: PT came for an eval and we decided as a team that the best and safest option for staff and student is to use the mechanical lift with full sling to move the student to the cot for changes. Muscle weakness is progressing and his upper body strength can't reliably support himself on the toilet anymore. This kid has really gone down hill this year :'-( thank you for all your suggestions!