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Transfer Techniques

Planning plays a major role in safe effective client transfers.


You must determine to what extent the client is able to help with the transfer.
If the client is totally dependent or is heavy, the caregiver will need other
staff members to help.
LISTS OF POTENTIAL HAZARDS IN CLIENT TRANSFERS AND PREVENTIVE
MEASURES
FALLING
Assess clients size and ability to assist
Ask for help from other staff members if needed
If client starts to fall, lower gently to the floor while protecting the head
If client has fallen, assess thoroughly for signs of injury
SKIN

DAMAGE
Use a transfer board or draw sheet
Lift client instead of sliding across surfaces
Pad surfaces that may cause injury (e.g., bed rails)

FOOT INJURY
Place nonskid slippers on client
Do not tuck sheets/blankets tightly over feet
Ensure that feet do not become tangled in side rails, chair legs, or other
equipment
DISLODGING CLIENT
Assess for presence of all tubes and care equipment lines (e.g., catheters, IV
lines)
Determine if equipment must be temporarily disconnected during the transfer
Reconnect equipment promptly when transfer is completed
Keep the urinary drainage bag at a level lower than the bladder
A. Transferring from Bed to Chair
A client may need to be moved from the bed to a chair, commode, or wheelchair.
A wheelchair is a means of transportation for clients unable to support their weight
while standing. Safety instructions for use of a wheelchair include the need to keep
the wheels locked when not deliberately moving and to move the footrests out of
the way when getting in and out of the wheelchair.
Wheelchair Technique
When pushing a wheelchair, back into and out of elevators.
Back slowly down wheelchair ramps.
Push the wheelchair ahead of you when going up ramps.
If going through a self-closing door, back the wheelchair out of the room. You
can keep the door open by backing against the door. The wheelchair can then
be guided out of the room.
Lock brakes when the wheelchair is standing still.
Intravenous infusion bags can be placed on portable IV poles attached to the
wheelchair during transport.
Urinary drainage bags can be placed on the lower body of the wheelchair
during transport.
Coil the drainage tubing so the catheter is not tugged during transport.
Empty urinary drainage bag prior to wheelchair transfer.
Keep the urinary drainage bag below the level of the clients urinary bladder.
B. Transferring from Bed to Stretcher
Some clients (e.g., those who are too weak to sit upright, those who are
unconscious, or those with injuries prohibiting the erect position) must lie flat during
transfers.

In such situations, a stretcher (gurney) is used to facilitate client transfer. Stretchers


have several safety features, including side rails, safety belts/straps, and locking
wheels. You should caution clients to move carefully while on the stretcher as it is
narrower than the bed. Reassure the client that side rails will be used to prevent
falls.

Assistive Devices
There are several devices available for helping with client transfers. Slide boards or
transfer boards assist the bed-wheelchair transfer by bridging the same level space
between the bed and the wheelchair. Note that specialized wheelchairs with
removable armrests are used with slide boards. As the client becomes more
independent, the slide board can be used to transfer from wheelchair to car.
Other transfer appliances include stretchers (gurneys) and hydraulic lifts. The
hydraulic (Hoyer, mechanical) lift is used for moving immobile clients who are
obese. A client may be transferred to a chair, wheelchair, bedside commode,
stretcher, or scale using a hydraulic lift.
The manufacturers equipment instructions should be followed and the weight limits
must not exceed the manufacturers specifications. Two staff members are needed
to safely operate a hydraulic lift. Hydraulic lifts are not for use with clients who have
spinal cord injury as spinal alignment is not maintained during use of the lift.
Action
Rationale
Transferring a Client from Bed to Chair
Equipment
Bed
Wheelchair/commode/chair
1. Inform client about desired purpose
and destination.
2. Assess clients ability to assist with
the transfer and for presence of
cognitive or sensory deficits.
3. Lower the bed.
4. Allow client to dangle for a few
minutes.
5. Bring wheelchair close to the side of
the bed, toward the foot of the bed.
6. Lock wheelchair brakes and elevate
the foot pedals.
7. Assist client to side of bed until feet
touch the floor.
8. Assess client for dizziness. Remain in
front of client until dizziness has
subsided. Apply gait belt if necessary.
9. Reach under clients axillae and place
hands on clients scapulae (or grasp gait
belt).
10. Assist the client to a standing
position and provide support.
11. Pivot client so clients back is toward

1. Reduces client anxiety and increases


cooperation.
2. Promotes safety.

3. Reduces distance client has to step


down, thus decreasing risk of injury.
4. Allows time for assessing clients
response to sitting; reduces possibility of
orthostatic hypotension.
5. Minimizes transfer distance.
6. Provides stability.
7. Provides guidance and helps client
maintain balance.
8. Reduces risk of falling.
Reduces risk of falling by maintaining
client stability during transfer.
9. Maintains client stability and reduces
pressure on axillae.
10. Helps client stand safely and gives
time to assess status.
11. Moves client into proper position to

the wheelchair.
12. Instruct client to place hands on the
arm supports of the wheelchair.

be seated.
12. Allows client to gain balance and
judge distance to seat.

13. Bend at the knees, easing the client


into a sitting position.
14. Assist client to maintain proper
posture.

13. Increases stability and minimizes


strain on back.
14. Broadest, and therefore safest, base
of support is with client seated as far
back on the seat as possible.

15. Secure the safety belt, place clients


feet on feet pedals, and release brakes.

15. Ensures client safety; prepares client


for movement.

Transferring a Client from Bed to Stretcher with Minimum Assistance


Equipment
Bed
Stretcher
1. Inform client about desired purpose
1. Reduces client anxiety and increases
and destination.
cooperation.
2. Raise the height of bed and lock
2. Reduces distance caregiver must
brakes of bed.
bend, thus preventing back strain;
.
prevents bed from moving.
3. Instruct client to move to side of bed
3. Decreases risk of client falling.
close to stretcher. Have client use
trapeze bar if available.
Lower side rails of bed and stretcher.
4. Stand at outer side of stretcher and
4. Diminishes the gap between bed and
push it toward bed. Lock wheels of
stretcher; secures the stretcher position.
stretcher.
5. Instruct client to move onto stretcher
5. Promotes client independence.
with assistance as needed.
6. Cover client with sheet or bath
6. Promotes comfort; protects privacy.
blanket.
7. Elevate side rails on stretcher and
7. Prevents falls.
secure safety belts about client. Release
brakes of stretcher.
8. Stand at head of stretcher to guide it
8. Pushing ensures proper body
when pushing.
mechanics (if client are in large assistive
devices)
Transferring a Client from Bed to Stretcher with Maximum Assistance
Equipment
Bed
Stretcher
Pillows
Lift sheet
1. Inform client about desired purpose
1. Reduces client anxiety and increases
and destination.
cooperation.
2. Elevate height of bed.
2. Decreases amount of bending for
caregiver, thus reducing risk of back
injury.
3. Assess amount of assistance required 3. Promotes client independence;
for transfer. Usually two to four staff
assures that enough staff is present
members are required for the maximum
before beginning transfer.
assisted transfer.
4. Lock wheels of bed and stretcher.
4. Prevents falls.
5. Have one caregiver stand close to
5. Supports clients head during the

clients head.
6. Logroll the client and place a lift sheet
under the clients back, trunk, and upper
legs. The lift sheet can extend under the
head if client lacks head control abilities.
7. If urinary drainage bag is present,
empty it and move it to side of bed
closest to stretcher.
8. Move client to edge of bed near
stretcher.
9. Caregiver on non-stretcher side of
bed holds the lift sheet across the
clients chest.
10. Place pillow overlapping the bed and
stretcher.
11. Position client on stretcher and
cover with a sheet or bath blanket.

move.
6. Prevents flexion and rotation of
clients hips and spine; maintains correct
body alignment.

12. Secure safety belts and elevate side


rails of stretcher.
13. If IV pole is present, move it from
bed IV pole to stretcher IV pole after
client transfer.
Wheelchair
1. Pushing a wheelchair into and out
of elevators
2. Going up/down on ramps.
3. Getting in/out of a self closing
door

12. Prevents falls.

NAME:

7. Prevents risk of urinary infection.

8. Prevents dragging, which causes


shearing force.
9. Protects the client from falling.

10. Protects head from injury.


11. Promotes comfort and provides for
privacy.

13. Prevents tubing from being pulled


and IV from being dislodged.
Techniques
4. Transporting patients with:
a. Urinary bag
b. IV infusion bag

SCORE SHEET TRANSFER TECHNIQUES

DATE:
Transferring a Client from Bed to Chair
5
1. Inform client about desired purpose and destination.
2. Assess clients ability to assist with the transfer and for presence
of cognitive or sensory deficits.
3. Lower the bed.
4. Allow client to dangle for a few minutes.
5. Bring wheelchair close to the side of the bed, toward the foot of
the bed.
6. Lock wheelchair brakes and elevate the foot pedals.
7. Assist client to side of bed until feet touch the floor.
8. Assess client for dizziness. Remain in front of client until dizziness
has subsided. Apply gait belt if necessary.
9. Reach under clients axillae and place hands on clients scapulae.
10. Assist the client to a standing position and provide support.
11. Pivot client so clients back is toward the wheelchair.
12. Instruct client to place hands on the arm supports of the
wheelchair.
13. Bend at the knees, easing the client into a sitting position.
14. Assist client to maintain proper posture.
15. Secure the safety belt, place clients feet on feet pedals, and
release brakes.
Transferring a Client from Bed to Stretcher with Minimum
5
Assistance
1. Inform client about desired purpose and destination.

2. Raise the height of bed and lock brakes of bed.


3. Instruct client to move to side of bed close to stretcher. Have
client use trapeze bar if available. Lower side rails of bed and
stretcher.
4. Stand at outer side of stretcher and push it toward bed. Lock
wheels of stretcher.
5. Instruct client to move onto stretcher with assistance as needed.
6. Cover client with sheet or bath blanket.
7. Elevate side rails on stretcher and secure safety belts about client.
Release brakes of stretcher.
8. Stand at head of stretcher to guide it when pushing.
Transferring a Client from Bed to Stretcher with Maximum
Assistance
1. Inform client about desired purpose and destination.
2. Elevate height of bed.
3. Assess amount of assistance required for transfer. Usually two to
four staff members are required for the maximum assisted transfer.
4. Lock wheels of bed and stretcher.
5. Have one caregiver stand close to clients head.
6. Logroll the client and place a lift sheet under the clients back,
trunk, and upper legs. The lift sheet can extend under the head if
client lacks head control abilities.
7. If urinary drainage bag is present, empty it and move it to side of
bed closest to stretcher.
8. Move client to edge of bed near stretcher.
9. Caregiver on non-stretcher side of bed holds the lift sheet across
the clients chest.
10. Place pillow overlapping the bed and stretcher.
11. Position client on stretcher and cover with a sheet or bath
blanket.
12. Secure safety belts and elevate side rails of stretcher.
13. If IV pole is present, move it from bed IV pole to stretcher IV pole
after client transfer.
Wheelchair Techniques
1. Pushing a wheelchair into and out of elevators
2. Going up/down on ramps.
3. Getting in/out of a self closing door
4. Transporting patients with:
a. Urinary bag
b. IV infusion bag