Manual vs mechanical handling of plus-size patients | Anita Rush Webinar
Anita Rush is a registered nurse and specialises in the care of plus-sized patients. In this article she shares her experience of managing the care of bariatric patients, including how good use of equipment solutions, such the VENDLET Bari, can;
- enable a safe reduction in care package costs
- protect the musculoskeletal health of caregivers
- boost patient safety and dignity.
Let’s take a look at some of her top considerations when caring for plus-size patients:
1. Plus-sized individuals are at a higher risk of skin and tissue damage
There are lots of factors that put bariatric patients at a higher risk of skin and tissue damage. Their skin and tissue also take longer to heal. Common causes of tissue damage in plus-size people include;
- Bad posture: if a patient is sitting at the wrong angle in bed, their capillaries could be occluded, which in turn could cause damage at the sacrum.
- Lymphoedema: Lymphoedema in the legs is sometimes caused by a pannus* resting on the legs.
- Sweating: sweat can cause a build-up of moisture between the skin folds. There is equipment that can help with this, including vapour-permeable mattresses, which can help prevent moisture build-up.
*An apple pannus, or simply pannus, is a hanging mass of skin and subcutaneous fat. This is also known as an ‘abdominal apron’.
2. Different body shapes have different requirements
For example, people with pear body shapes and bulbous gluteal (excessive buttock tissue that creates a protruding shelf) may have specific seating requirements.
On the other hand, apple body shapes may have a pannus which you will need to consider when preparing to manually handle the patient.
Things to consider when preparing to manually handle an apple-shaped person include:
- Venous return: when a pannus is resting on the legs, it can inhibit venous return (blood flow back to the heart). Consider using pillows or positioning cushions to lift the pannus off the legs, enabling blood flow.
- Breathing problems: people with apple-shaped bodies often can’t lie flat. A profiling bed will help you put the patient into a comfortably semi-upright position.
- Impact weight: the force that is exerted onto a mass when it hits a hard surface is more than the weight of the mass itself. For example, if a ten-stone person fell and hit a hard surface, the impact weight exerted onto the person when they hit that surface could be as much as 20 stone. So, when you’re repositioning a person in bed and they have a large pannus, if that pannus was to hit the surface of the mattress during a turn, the impact weight could cause a severe injury to the pannus, and could even cause it to split.
To avoid injury, it’s important to use positioning aids such as the LEJRELET wedge to reduce the impact weight of excess fat and skin during repositioning.
3. The width of the bed
When repositioning a bariatric patient in bed, the width of the bed (as plus-size patients typically use wider beds) can mean that carers find themselves reaching and stretching over the bed to get to the patient. This puts carers at risk of musculoskeletal injury and inhibits them from having full control of the patient when repositioning.
A mechanical turning system, such as the VENDLET, can help with this, as it can gently move the patient closer to the side of the bed that the carer is working, eliminating the need for reach and stretch.
What is the VENDLET?
The VENDLET is an in-bed patient turning system that can be installed on most community profiling beds (click here to see the compatibility list). Its fully mechanised side rails allow for quick and simple turning and positioning in bed, and can be used for all handling tasks in bed with zero manual handling.
4. Unrealistic care packages?
A bariatric person may require as many as six carers for each care visit. However, lots of organisations may struggle to deliver this level of care in the community. Anita mentioned that a common scenario in which her expertise is sought is when organisations are trying to reduce the care packages of people with tissue viability problems.
Good use of equipment is the only way to achieve this. The question is: what type of solution is the most suitable?
Manual, mechanical or automated?
Silk sheets and slide sheet can reduce the effort required by carers, but the same number of cares will be needed. Therefore, this is not an effective solution when trying to reduce a care package.
If the service user needs to be repositioned very frequently, an automated solution may be a good option. However, if the patient also requires personal care, such as dressing changes, pad changes or cleaning, carers will still be needed. In this situation, a mechanical turning aid will be the only solution to reduce the care package.
Here are two real-life scenarios where the VENDLET mechanical turning system has been successfully implemented;
Scenario 1 – an independent user
The first scenario was a more independent patient. The VENDLET was installed five years ago (as of 2020) and the patient had remained independent in their own home.
For independent patients who can bend their legs, move their arms and, to a certain degree, reposition themselves in bed, the VENDLET has the potential to completely eradicate the need for carers.
In the example that Anita gave, a client of hers had complained that carers were waking them during the night. The client had asked if there was a way they could independently get in and out of their own bed for toileting calls.
As well as the VENDLET, the equipment that the patient needed to do this included:
To see the demonstration of how the patient could use this equipment to get in and out of bed, you can watch from 21 minutes in on the webinar recording at the top of this page.
Here are step-by-step instructions on how an independent plus-size patient can get themselves in and out of bed with the use of specialist equipment;
- The patient sets the adjustable bed into a low position
- The patient sits on the edge of the bed, with their buttocks on top of the turn table
- The patient raises the height of the bed
- The patient uses the rope ladder to swivel themselves around, so they are fully in the bed – with their feet and body facing the foot of the bed (the tubular slide sheet which was pre-positioned at the foot of the bed and the turn table helped to reduce friction during this movement)
- The patient uses the rope ladder to gently lower their torso until their head is on the pillow
- The patient is now in a supine position
- To move into a side line position, the patient uses the VENDLET hand control to gently tilt the sheet, and therefore tilt and roll their body until they are lying on their side
- The patient has now rolled off the turntable and could therefore remove it if they wished
To get out of bed, the patient would follow exactly the same steps, in reverse.
Scenario 2 – a completely dependent person
In this scenario, which was based on a patient in Berkshire, the real-world cost savings associated with the reduction in the care package for the organisation in question was £116,800 per year.
Browse our online case studies for more information on how the VENDLET has improved the quality of life for patients and saved thousands for the organisations charged with providing their care. There is also a downloadable PDF version on each case study page.
To discuss specific cases, please get in touch with the Felgains team. We can talk through the individual requirements of your client and calculate the potential cost-savings for the reduced care package.
The Felgains team demonstrated how two carers could reposition a completely dependent person in bed, with zero manual handling. You can see the demonstration by watching from 28 minutes in on the webinar recording at the top of this page.
How to reposition a completely dependent person in bed for personal care tasks – step-by-step instructions – turning onto the patient’s left side;
- Raise the bed to a safe working height (i.e. high enough for you to rest your hand on the mattress without moving your shoulders)
- Use the VENDLET to move the patient to the opposite side of the bed to where you are working
- Place the LEJRELET Pad High rectangular pressure relief positioning cushion to the side of the patient’s left leg
- Place a tubular padded slide sheet so it covers the LEJRELET cushion and the patient’s left leg – leaving the right leg exposed.
- If the patient has a pannus – to prevent it crashing onto the mattress surface, place the LEJRELET wedge next to the left side of the abdomen (with the thin end of the wedge nearest the patient)
- Use the VENDLET’s hand control to lift the right-hand (red) side rail
- Use the VENDLET to revolve the red side rail – this will spool the sheet in and gently tilt the patient until they roll onto their side
- Gently guide the patient while the VENDLET is turning them to ensure the patient’s right leg and pannus settle gently onto the LEJRELET cushions. This requires no manual effort.
The patient is now in a stable sidelying position. You now need to simply lower the red side rail to allow full access to the patient’s body for personal care tasks such as cleaning skin folds or changing dressings, pads etc.
5. Looking to reduce care packages? Make sure you do a risk assessment
Mechanical turning systems can boost a patient’s dignity and quality of life, safeguard the musculoskeletal health of carers, and garner significant financial savings. However, if you’re looking to reduce a care package, do complete a thorough risk assessment first. There are some care tasks that will still require a minimum number of carers.
For example, as Anita said, each leg in a human body accounts for 15.7% of our body weight, and this increases in patients with lymphatic legs. So, the amount of people and equipment needed to lift lymphatic legs should be included in your risk assessment.
In conclusion, mechanical turning systems such as the VENDLET have the potential to transform the lives of plus-size patients and their families.
As well as protecting them from injuries associated with poor manual handling, it safeguards the musculoskeletal health of their carers. Also, reducing the number of carers needed reduces levels of intrusion for both the patients and their families. And for more independent patients, the VENDLET could eradicate the need for carers altogether.
To discuss whether the VENDLET could be suitable for your client or loved-one, please do contact us.