 Logrolling a Patient

 Prepared by: Liwayway G. Timpoc, RN, MAN

 The “logrolling” technique is a maneuver that involves moving the
patient’s body as one unit so that the spine is kept in alignment, without
twisting or bending. This technique is commonly used to reposition
patients who have had spinal or back surgery or who have suffered back
or neck injuries.
 If the patient is being logrolled due to a neck injury, do not use a fluffy
pillow under the patient’s head.
 However, the patient may need a cervical collar in place for the move; a
bath blanket or small pillow under the head may be used to keep the
spinal column straight.
 The patient’s neck should remain straight during the procedure and after
positioning.
 The use of logrolling when repositioning the patient helps to maintain
neck and spine alignment.
 Three caregivers, or more as appropriate, are needed to accomplish this
safely.
 Do not try to logroll the patient without sufficient help.
 Do not twist the patient’s head, spine, shoulders, knees, or hips while
logrolling.
EQUIPMENT:

 • At least two additional persons to help

 • Friction-reducing sheet to facilitate smooth movement, if not already
in place; a drawsheet may be substituted if a friction-reducing sheet is
not available
 • Small pillow for placement between the legs
 • Wedge pillow or two pillows for behind the patient’s back
 • PPE, as indicated
ASSESSMENT:
 Assess for conditions that would contraindicate logrolling, such as
unstable neurologic status, severe pain, or the presence of drains.
 Assess the patient’s baseline neurologic status.
 Assess for paresthesia and pain.
 Assess for the need to use a cervical collar.
 If the patient is complaining of pain, consider medicating the patient
before repositioning.
NURSING DIAGNOSIS:
 Determine the related factors for the nursing diagnosis based on the
patient’s current status.
 Appropriate nursing diagnoses may include:
 • Risk for Injury
 • Acute Pain
 • Impaired Physical Mobility
 • Impaired Tissue Integrity
 • Risk for Impaired Skin Integrity
 • Impaired Skin Integrity
OUTCOME IDENTIFICATION AND PLANNING:

 The expected outcome when the patient is moved via logrolling is that
the patient’s spine remains in proper alignment, thereby reducing the
risk for injury.
 Other outcomes may include the following:
 patient verbalizes relief of pain,
 patient maintains joint mobility,
 and patient remains free of alterations in skin and tissue integrity.
IMPLEMENTATION

 ACTIION
 RATIIONALE
 1. Review the medical record and nursing plan of care for
activity orders and conditions that may influence the patient’s
ability to move or to be positioned. Assess for tubes, IV lines,
incisions, or equipment that may alter the positioning
procedure. Identify any movement limitations.
 Reviewing the medical record and care plan validates the correct patient and correct
procedure. Checking for equipment and limitations reduces the risk for injury during
the transfer.
 2. Perform hand hygiene and put on PPE, if indicated.
 Hand hygiene and PPE prevent the spread of microorganisms. PPE is required based
on transmission precautions.
 3. Identify the patient.
 Identifying the patient ensures the right patient receives the intervention and helps
prevent errors.

 4. Close curtains around bed and close the door to the room, if
possible. Explain the purpose of the logrolling technique and
what you are going to do, even if the patient is not conscious.
Answer any questions.
 This ensures the patient’s privacy. Explanation relieves anxiety and facilitates
cooperation.
 5. Place the bed at an appropriate and comfortable working height,
usually elbow height of the caregiver (VISN 8 Patient Safety
Center, 2009).
 Having the bed at the proper height prevents back and muscle strain.
 6. Position at least one caregiver on one side of the bed and the two
other caregivers on the opposite side of the bed. If a cervical collar
is not in place, position one caregiver at the top of the bed, at the
patient’s head. Place the bed in flat position. Lower the side rails.
Place a small pillow between the patient’s knees.
 Using three or more people to turn the patient helps ensure that the spinal column
will remain in straight alignment. A pillow placed between the knees helps keep the
spinal column aligned.
 7. If a friction-reducing sheet is not in place under the patient,
take the time to place one at this time, to facilitate future
movement of the patient. (See the Unexpected Situations below
for information on placing a friction-reducing sheet.)
 Use of a friction-reducing sheet facilitates smooth movement in unison and
minimizes pulling on patient’s body. A drawsheet may be used if friction-reducing
sheets are not available.
 8. If the patient can move the arms, ask the patient to cross the
arms on the chest. Roll or fanfold the friction-reducing sheet
close to the patient’s sides and grasp it. In unison, gently slide
the patient to the side of the bed opposite to that which the
patient will be turned.
 Crossing arms across the chest keeps the arms out of the way while rolling the
patient. This also encourages the patient not to help by pulling on the side rails.
Moving the patient to the side opposite to that which the patient will be turned
prevents the patient from being uncomfortably close to the side rail. If the patient is
large, more assistants may be needed to prevent injury to the patient.
 9. Make sure the friction-reducing sheet under the patient is
straight and wrinkle free.
 Drawsheet should be wrinkle free to prevent skin breakdown. Rolling the drawsheet
strengthens the sheet and helps the nurse hold on to the sheet.
 10. If necessary, reposition personnel to ensure two stand on
the side of the bed to which the patient is turning. The third
helper stands on the other side. Grasp the friction-reducing
sheet at hip and shoulder level.
 Proper positioning of personnel provides even division of support and pulling forces
on the patient to maintain alignment.
 11. Have everyone face the patient. On a predetermined signal,
turn the patient by holding the friction-reducing sheet taut to
support the body. The caregiver at the patient’s head should
firmly hold the patient’s head on either side, directly above the
ears. Turn the patient as a unit in one smooth motion toward
the side of the bed with the two nurses. The patient’s head,
shoulders, spine, hips, and knees should turn simultaneously
(Figure 1).
 Holding the patient’s head stabilizes the cervical spine. The patient’s spine should
not twist during the turn. The spine should move as one unit.
 12. Once the patient has been turned, use pillows to support
the patient’s neck, back, buttocks, and legs in straight
alignment in a side-lying position. Raise the side rails, as
appropriate.
 The pillows or wedge provide support and ensure continued spinal alignment after
turning.
 13. Stand at the foot of the bed and assess the spinal
column. It should be straight, without any twisting or
bending. Place the bed in the lowest position. Ensure that the
call bell and telephone are within reach. Replace covers. Lower
bed height.
 Inspection of the spinal column ensures that the patient’s back is not twisted or bent.
Lowering the bed ensures patient safety.
 14. Reassess the patient’s neurologic status and comfort level.
 Reassessment helps to evaluate the effects of movement on the patient.

 15. Remove PPE, if used. Perform hand hygiene.

 Removing PPE properly reduces the risk for infection transmission and
contamination of other items. Hand hygiene prevents transmission of
microorganisms.
EVALUATION:
 The expected outcome is met when the patient remains free of
injury during and after turning and exhibits proper spinal
alignment in the side-lying position.
 Other expected outcomes are met when the patient states that
pain was minimal on turning, the patient demonstrates
adequate joint mobility, and the patient exhibits no signs or
symptoms of skin breakdown.
DOCUMENTATION:
 Document the time of the patient’s change of position,
use of supports, and any pertinent observations,
including neurologic and skin assessments.
 Document the patient’s tolerance of the position change.

Many facilities provide areas on bedside flow sheets to

document repositioning.
Sample Documentation:
 11/15/12 1120 Patient logrolled with four-person assist.
Placed on left side. Patient pushed PCA button prior to
turning. Dressing over middle of back from base of neck
to lumbar region clean, dry, and intact; no redness
noted on back or buttocks. —B. Traudes, RN
UNEXPECTED SITUATIONS AND ASSOCIATED INTERVENTIONS:

 • Patient requires repositioning using logrolling, but a

drawsheet or friction-reducing sheet is not in place under the
patient: Placement of a drawsheet or friction-reducing sheet
will facilitate future patient movement and should be put into
place before the patient occupies the bed. If this was not done,
take time to put one in place. This requires careful movement
using logrolling and a minimum of three caregivers. Stabilize
the cervical spine by holding the patient’s head firmly on either
side directly above the ears.
UNEXPECTED SITUATIONS AND ASSOCIATED INTERVENTIONS:

 Patient requires repositioning using logrolling, but you are

working alone: If assistance is not available, wait for at least
one additional caregiver for assistance. Do not attempt to
reposition the patient alone. At least three caregivers are
necessary to perform logrolling to reposition a patient; four or
more caregivers for a large patient.
https://www.youtube.com/watch?v=zIVzUqrLzqo