mobility issue- please help!

  1. 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?
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    About nursekoll, BSN, RN

    Joined: Jan '16; Posts: 40; Likes: 53

    21 Comments

  3. by   XingtheBBB
    Do you have the type of sling with the open bottom for toileting? Not the hole in the bottom but the U shape that leaves the whole bottom hanging out. I had a home care child that required some practiced wiggling, but I could get clothing out of the way with the sling in place.
  4. by   wearingmanyhats
    was just going to say this ^^ I worked a LONG time in LTC. It is the sort of sling that you transfer with, and then remove so that the person isn't sitting on the mesh all day. just the first site that came up when I googled. Hoyer 4-Point Padded U-Sling | Hoyer Slings
  5. by   nursekoll
    Right now we don't have any sling that will fit this kid, so I'll check out the u-shaped one. 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.)
  6. by   wearingmanyhats
    if they are usually wet, then I believe the best action is to transfer to a bed/cot and roll and change like we would with someone who was lying in bed.
  7. by   Alex Egan
    These are great suggestions. However what you really need is a PT/OT consult and recommendation, then that recommendation entered into the care/educational plan so that the required equipment and training MUST be provided. What you have here is a staff and student safety issue.
  8. by   OldDude
    What do they do at home?
  9. by   nursekoll
    We have had the PT and OT evaluate earlier this year, they recommended a padded, multiple-handled gait belt at that time. Also some leg braces to correct contractures. The family refuses to use the leg braces at home, we use them at school as tolerated. This student seems to be declining and getting heavier since the last team meeting. I'll see if they can re-assess. Staff that normally helps this student just recently reported that it is getting more difficult.

    At home, mom uses the floor to change, not sure the student is often (or ever) put up on a toilet at home, but she wants us to do it at school ;-)

    Side note: Mom is trying to get a bowel regimen started and occasionally gives Miralax right before school. That's always fun. . .
  10. by   Mango Juice
    I think we have the same student! We have the U shaped sling for the hoyer. When the student is in their chair, we are able to slide their pants down and put the sling under their legs. We transport to a bedside commode and wiggle the briefs down as much as possible before lowering the student. We end up transferring the student to a cot after toileting to pull up the pants and then to their chair, so it us quite the process.

    One thing that helps us (no matter what the process) is having 2 briefs on so you can just tear one off and have a dry one underneath.

    I am interested to see other replies as this is something we are always trying to improve as well (especially because the student has not been very successful with toilet training either).
  11. by   Beth1978
    Quote from Mango Juice
    I think we have the same student! We have the U shaped sling for the hoyer. When the student is in their chair, we are able to slide their pants down and put the sling under their legs. We transport to a bedside commode and wiggle the briefs down as much as possible before lowering the student. We end up transferring the student to a cot after toileting to pull up the pants and then to their chair, so it us quite the process.

    One thing that helps us (no matter what the process) is having 2 briefs on so you can just tear one off and have a dry one underneath.

    I am interested to see other replies as this is something we are always trying to improve as well (especially because the student has not been very successful with toilet training either).
    Isn't there a risk of overheating and skin breakdown with 2 briefs?
  12. by   Have Nurse
    I agree with Alex.
  13. by   LikeTheDeadSea
    PT/OT consult absolutely, get that info on the IEP asap for everyone's safety.
    Plus, if "Oh that's not in the budget" gets tossed around, you'll be able to squish it.
  14. by   OpinionatedCNA
    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?

    Quote from nursekoll
    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.

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