When transferring a patient from a wheelchair to the x ray table which action would you do first

Center of Gravity

Center of gravity is a hypothetical point at which all the mass appears to be concentrated (Fig. 13-2); gravitational forces appear to act on the entire body from this specific point. In humans aligned in the anatomic position, the center of gravity is at approximately sacral level two, with slight variations between men and women. Moving heavy objects is relatively easy and safe if the object is held close to the mover’s center of gravity. Stability can be achieved when a body’s center of gravity is over its base of support (Fig. 13-3, A). Instability results when the center of gravity moves beyond the boundaries of the base (see Fig. 13-3, B). For safe, stable lifting, the center of gravity always must be over the base of support.

FIGURE 13-2 The center of gravity for most people is located at approximately S-2.

FIGURE 13-3 A, A body is stable when its center of gravity rests over its base of support. B, A body is unstable when its center of gravity is not over its base of support. In the picture, the child is standing on his left heel. The right foot is off the ground, and the center of gravity is just anterior to S-2 considerably posterior to the left heel. The child is unstable and likely to fall.

Mobility and Stability Muscles

The body contains muscles that are designed for mobility and other muscles that are designed for stability. Mobility muscles are found in the limbs. Typically, these muscles have long white tendons and cross two or more joints. Examples include the biceps muscles, which flex the elbow, and the hamstring muscles, which flex the knee (Fig. 13-4). Stability muscles are found in the torso. Typically, stability muscles are large expanses of red muscle belly and provide postural support. Two examples are the latissimus dorsi, girthing the back, and the rectus abdominis, supporting the abdomen. For effective patient moving and handling, clinicians should use white mobility muscles for lifting and red postural muscles for support. Lifting should be done by bending and straightening the knees. The back should be kept straight or in a position of slightly increased lumbar lordosis.

FIGURE 13-4 Mobility muscles include the biceps brachii and the hamstring group. Postural muscles include the rectus abdominis and the erector spinae muscles.

Principles of Lifting

When performing a transfer, let patients do as much of the work as possible (Box 13-1). Before attempting a transfer, always ask patients whether they can move independently. Patients often can transfer on their own or with minimal assistance. If assistance is required, let the patient help. This approach minimizes trauma to the patient and avoids stress on the clinician. In addition, this approach enhances rapport and mutual respect between the patient and the technologist.

Box 13-1

Principles for Safe Transfers

Let the patient do as much of the transfer as possible.

Check the chart for precautions, such as non–weight-bearing status and joint disease, before executing the transfer, to minimize patient discomfort and harm.

Establish a wide base of support for your stability.

Hold the patient’s center of gravity close to your own center of gravity for a better mechanical advantage.

Hold the patient with a transfer belt around the patient’s waist to minimize stress on the patient’s shoulder girdle.

Lift the patient with your legs. Avoid back bending.

Avoid trunk twisting during transfer.

Never lift more than you safely can. Ask for assistance when needed.

Watch the patient for signs of orthostatic hypotension, and take precautions to minimize its effects.

Patients may be unsure whether they need assistance. Patients sometimes believe that they are capable of transferring themselves when they are incapable. Before executing the transfer, check the patient’s chart and verify whether he or she has a restricted weight-bearing status. Be especially protective of patients with diagnoses such as lower extremity or pelvic girdle fracture; painful, inflamed, or unstable joints; or any weakened or debilitated condition. Patients with cognitive impairments, such as dementia, may overestimate their transfer abilities and require assistance. Offer assistance as required. Allow ample time and handle patients with a firm and gentle grasp. Identify yourself and give your title. Inform the patient of what you are going to do and how you intend to proceed. For example, tell the patient your name and that you are a radiologic technologist who is going to help him or her move from the wheelchair to the table. List the specific steps for doing this activity: scoot your pelvis to the front of the wheelchair, put your hands on the arms of the wheelchair, lean forward with your nose over your toes, stand up, reach for and hold the table with the hand closest to the table, pivot so you are standing with your pelvis against the table, and sit down gently on the table. Let patients perform as much of the transfer as they can. Execute the transfer slowly with grace and control so the patient will feel secure.

When lifting a patient, the technologist should stand with feet apart to increase the base of support. The patient’s center of gravity (S-2) should be held close to the clinician’s center of gravity (S-2). This positioning provides the best mechanical advantage for lifting. Some patients may be wearing bathrobes or hospital gowns. Loose clothing inhibits the clinician’s ability to hold a patient securely. One solution is to place a transfer belt around the patient’s waist. Transfer belts are usually made of webbing or muslin and can provide a good grip with minimal trauma to the patient. Taking a transfer belt is a good practice when planning to perform transfers. When lifting patients, keep the back stationary and let the legs do all of the lifting and avoid any twisting.

Technologists should be aware of orthostatic hypotension, which is a drop in blood pressure that occurs when a person stands. A slight drop in blood pressure occurs normally when any person rises quickly from a recumbent to an upright position. This condition becomes increasingly serious when patients have been in bed for long periods and have a debilitated status. These weakened patients tend to have blood vessels with decreased vasomotor tone, compromised lymph vessels, and other circulatory problems. As a result, blood pressure may be affected. Rising too quickly can deprive patients of oxygen-rich blood to the brain. Symptoms of orthostatic hypotension include dizziness, fainting, blurred vision, and slurred speech.

To minimize the severity of orthostatic hypotension have the patient stand slowly and talk during the transfer. Ask patients open questions. For example, “How are you feeling?” or “Where are you coming from?” The questions do not matter, but the patients’ answers do. Listen to the patient’s speech. Slowing or slurring of words may indicate decreased blood flow to the brain. If signs occur, slow the speed of the transfer and ask the patient to take slow, deep breaths. Provide additional verbal and physical assistance as needed. If a patient reports symptoms, let him or her pause and take deep breaths for a few moments until he or she feels better. Do not send symptomatic patients on their way and risk having them faint on the way to their rooms.

Wheelchair Transfers

Radiologic technologists use four types of wheelchair transfers: (1) standby assist, (2) assisted standing pivot, (3) two-person lift, and (4) hydraulic lift. Begin by determining whether the patient has a strong side and a weak side or whether both sides are equal. Look at the patient. A long-leg cast, a severe foot deformity, or a lower extremity amputation clearly indicates a unilateral problem. For less easily observed transfer precautions, check the patient’s chart, ask the patient, or inquire of staff about restricted weight-bearing status, generalized weakness, arthritic conditions, or cognitive impairment. If the patient has a strong side and a weak side, always position the patient so that he or she transfers toward the strong side. If patients have equal strength on both sides, the transfer direction may be determined by convenience or space limitations. In all wheelchair transfers, be sure that the wheelchair wheels are locked and that the footrests are removed or folded away so they do not obstruct patient movement.

Standby Assist Transfer

Some patients have the ability to transfer from a wheelchair to a table on their own. Position the wheelchair at a 45-degree angle to the table (Fig. 13-5). Talk to the patient before he or she moves to determine how much, if any, assistance is required. Divide the transfer into single-step components, and talk the patient through each step. Perform the following tasks and give the following commands to the patient to provide assistance for a wheelchair-to-table transfer:

1. Task: Move the wheelchair footrests out of the way.

2. Task: Be sure that the wheelchair wheels are locked.

3. Command: “Sit on the edge of the wheelchair seat.”

4. Command: “Push down on the arms of the chair” (to assist in rising).

5. Command: “Nose over toes and stand up slowly.”

6. Command: “Reach out and hold onto the table with the hand closest to the table.”

7. Command: “Turn slowly until you feel the table behind you.”

8. Command: “Hold onto the table with both hands.”

9. Command: “Sit down.”

FIGURE 13-5 Angle the wheelchair to be 45 degrees from the table.

If the table is too high for the patient to sit comfortably, after step 6 give the patient a footstool. Provide assistance as needed for the patient to step up on the stool and sit on the table.