Chapter 13 Biomechanics and Ergonomics PDF

Chapter 13 Biomechanics and Ergonomics 1 Objectives (1 of 3) ˜ ˜ ˜ ˜ List four factors that account for the reduction of injuries that occur during handling and moving patients. Explain the contributing factors that account for the reduction of injuries that occur during handling and moving patients...

Chapter 13 Biomechanics and Ergonomics 1 Objectives (1 of 3) ˜ ˜ ˜ ˜ List four factors that account for the reduction of injuries that occur during handling and moving patients. Explain the contributing factors that account for the reduction of injuries that occur during handling and moving patients. Define concepts of body mechanics used in moving and handling a patient. Describe the cause, signs, symptoms, and treatment of orthostatic hypotension. 2 Objectives (2 of 3 ) ˜ ˜ ˜ ˜ ˜ ˜ Describe the basic principles of proper lifting and transfer techniques. Explain four types of wheelchair-to-bed transfers. Demonstrate four types of wheelchair-to-bed transfers. Explain a standard cart transfer procedure. Demonstrate a standard cart transfer procedure. Identify five standard patient positions. 3 Objectives (3 of 3) ˜ ˜ ˜ ˜ Explain how the three types of commonly attached medical equipment may influence how to position a patient. Describe how to position a patient and equipment to limit the risk of developing a work-related musculoskeletal disorder (WRMSD). List the symptoms associated with the different stages of WRMSD. Explain the importance of ambidextrous scanning in ultrasound. 4 Work Related Musculoskeletal Disorders (WRMSD) ˜ Radiologic and medical imaging sciences professionals can be particularly vulnerable to workrelated injuries. Ø Ø Ø ˜ ˜ ˜ Lifting patients Rolling patients Manipulating and positioning equipment Medical sonographers have the highest rate of WRMSDs. Ergonomic tissue injuries related to health and condition of connective tissues. Muscle Designs. Ø Ø Stability muscles Mobility muscles 5 Body Mechanics ˜ ˜ ˜ ˜ The purpose of a patient transfer is to safely move a patient from one place to another. Safety involves both the patient and the people doing the transfer. The application of proper lifting and transfer techniques increases job safety. Radiologic and medical imaging sciences professionals who use proper transfer techniques can reduce their injuries and minimize low back pain. 6 Good Body Mechanics ˜ ˜ ˜ ˜ ˜ ˜ Use good posture. Always keep your body’s line of balance close to your center of gravity (below waistline). Hold object close to body. Bend your knees. Don’t twist your trunk. Push rather than pull. 7 Proper Patient Handling Requirements ˜ ˜ ˜ ˜ ˜ Good base of support. Awareness of one’s center of gravity. Use of correct muscles for mobility. Use of muscles to maintain stability. Pay attention to condition of orthostatic hypotension in patient. 8 Base of Support (1 of 3) ˜ ˜ ˜ A wide base of support is essential for stability. The base of support is the foundation on which a body rests. Base of support is the area between the feet, including the plantar surface area, in a standing position. 9 Base of Support (2 of 3) ˜ ˜ A wider stance improves your base of support. Standing with both feet flat on the floor improves the base of support. See Figure 13.1 in the textbook for more information Fig. 13.1 Variations in base of support: normal; wide; narrow. 10 Base of Support (3 of 3) ˜ ˜ Standing with feet apart to increase the base of support improves stability. Standing on “tiptoes” decreases surface area in contact with the floor and narrows the base of support. 11 Center of Gravity (1 of 2) ˜ ˜ ˜ ˜ A hypothetical area of the body where the mass of the body is concentrated; gravity works from this area. Typically at level of second sacral segment Holding heavy objects close to your center of gravity permits easier and safer transfer. Stability can be achieved when a body’s center of gravity is over its base of support. See Figure 13.2 in the textbook for more information Fig. 13.2 The center of gravity for most people is located at approximately S-2.. 12 Lifting Principles (1 of 4) ˜ ˜ ˜ ˜ 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. Allow ample time, and handle patients gently. Always inform the patient of what you are going to do and how you intend to proceed. 13 Lifting Principles (2 of 4) ˜ ˜ ˜ When performing a transfer, let patients do as much of the work as possible. Before executing the transfer, check the patient’s chart and verify whether he or she has a restricted weight-bearing status. Patients with cognitive impairments, such as dementia, may overestimate their transfer abilities and require assistance. 14 Lifting Principles (3 of 4) ˜ ˜ ˜ ˜ Execute the transfer slowly enough for the patient to feel secure. The patient’s center of gravity should be held close to the mover’s center of gravity. Taking a transfer belt is a good practice when planning to perform transfers. Secure loose clothing on the patient. 15 Lifting Principles (4 of 4) ˜ ˜ ˜ ˜ Let patients perform as much of the transfer as they can. When lifting patients, keep the back stationary and let the legs do all of the lifting. Twisting should be avoided. After the patient is standing, help him or her to pivot around to a bed or X-ray table and to sit down. 16 Orthostatic Hypotension (1 of 2) ˜ ˜ ˜ A sudden drop in blood pressure caused by a change in a patient’s body position. More pronounced in patients who have been bedridden for extended periods. Symptoms of orthostatic hypotension include dizziness, fainting, blurred vision, and slurred speech. 17 Orthostatic Hypotension (2 of 2) ˜ ˜ ˜ To minimize the severity of orthostatic hypotension, have the patient stand slowly. Encourage the patient to talk during the transfer by asking simple questions. Do not send a symptomatic patient away and risk having the patient faint on the way to their room. 18 Transfer Techniques Require Teamwork! ˜ Someone needs to take charge of the transfer. Ø Ø Ø ˜ Calls the transfer “play” Controls timing of transfer Synchronizes transfer events See Figure 13.6 B in the textbook for more information Reviews procedures with team members Fig. 13.6 (B) At the command of the person supporting the patient’s upper body, the patient is lifted to clear the wheelchair and moved as a unit to the desired place... Copyright © 2016, 2012, 2007, 2003, 1999, 1994 by Saunders, an imprint of Elsevier Inc. 19 19 Wheelchair Transfers ˜ ˜ ˜ ˜ Determine patient’s strong and weak sides. Always position the patient so that he or she transfers toward the strong side. Lock wheelchair locks and move footrests out of the way. Four types of wheelchair transfers 1. 2. 3. 4. Standby assist Assisted standing pivot Two-person lift Hydraulic lift 20 Standby-Assist Transfer ˜ ˜ Used for patients who have the ability to transfer from a wheelchair to a table on their own Provide movement instructions to the patient continually during transfer. See Figure 13.4 in the textbook for more information Fig. 13.4 Angle the wheelchair to be 45° from the table.. 21 Assisted Standing Pivot Transfer See Figure 13.5 in the textbook for more information Fig. 13.5 An assisted standing pivot transfer is used when transferring a patient from a wheelchair to a table. (A) Use a transfer belt to hold the patient securely. (B) Have the patient sit on the edge of the wheelchair seat. Provide assistance as needed. (C) Have the patient push down on the arms of the wheelchair to assist in rising. (D) Bend at the knees, keeping your back straight, and grasp the transfer belt with both hands. (E) As the patient rises to standing, rise also by straightening your knees. (F) When the patient is ready, pivot toward the table until the patient can feel the table against the back of the thighs. (G) Ask the patient to hold onto the table with both hands and to slowly sit down. 22 Two-Person Lift See Figure 13.6 in the textbook for more information Fig. 13.6 Two-person lift. (A) The first person asks the patient to cross his or her arms over the chest. The person making the transfer stands behind the patient, reaches under the patient’s axillae, and grasps the patient’s crossed forearms. The assistant squats in front of the patient and cradles the patient’s thighs in one hand and the patient’s calves in the other. (B) At the command of the person supporting the patient’s upper body, the patient is lifted to clear the wheelchair and moved as a unit to the desired place.. 23 Hydraulic Lifts ˜ o ˜ ˜ ˜ Used when patients are too heavy to lift manually. Uses the power of hydraulic fluid to handle extreme weights: o Release valve mechanism Feature adjustable base of support. Employs a lifting, transfer sling. Most lifts have standard features: Ø See Figure 13.7 in the textbook for more information Familiarize yourself with these features. 24 Hydraulic Lift Techniques ˜ Patients need to be seated or recumbent on a lift sling, before using this type of lift. See Figure 13.8 A in the textbook for more information Fig. 13.8 A Check position and length of chain segments. 25 Hydraulic Lift Sending a patient back to the ward to return sitting on a sling is better than risking injury to the patient, the mover, or both by attempting transfer without using a sling. Communication is critical to lift success, particularly with patient’s nurse. See Figure 13.8 A B in the textbook for more information 26 Cart Transfers ˜ ˜ ˜ ˜ ˜ Make sure cart wheels are locked and immovable. Allow patient to assist with move on the basis of the patient’s ability and condition. Cart transfers usually require three people. Use transfer aids. For the actual lateral transfer, both transfer surfaces must be side to side, as close as possible, and at the same height. 27 Cart-to-Table Transfer See Figure 13.9 in the textbook for more information Typically uses a transfer assist device Roll patient away from table. Position device under patient and draw sheet. Roll patient back and ensure they are on device with draw sheet. Ø Gently pull draw sheet and patient onto table. Ø Ø Ø Ø 28 Patient Transfer with Draw Sheet See Figure 13.10 A in the textbook for more information See Figure 13.10 B in the textbook for more information Cart-to-table transfer without a moving device. (A) Begin by rolling up the draw sheet on both sides of the patient. (B) The person directing the transfer supports the patient’s head and upper body from the far side of the radiographic table. An assistant supports the patient’s pelvic girdle from the cart side. A second assistant supports the patient’s legs from the tableside. The patient’s arms can be crossed over the chest to avoid injury or getting in the way. 29 Skin Damage from Transfers ˜ ˜ ˜ ˜ Can occur in as little as 1 to 2 hours. May occur going from one surface type to a different surface type. Caused by several mechanical factors. Elderly patients are particularly vulnerable to skin damage. 30 Patient Positioning Considerations ˜ ˜ ˜ ˜ ˜ ˜ Talk with the patient and explain what you are going to do. Let the patient assist as much as possible. Check with patient before any move is attempted. Roll patient toward you. Provide positioning sponges to help the patient maintain correct positioning. Work as a transfer team! 31 Common Recumbent Patient Positions ˜ ˜ ˜ ˜ ˜ Supine Prone Lateral Sims Fowler See Figure 13.11 in the textbook for more information Fig. 13.11 Patient positioning. 32 WRMSKD’s and Sonography (1 of 2) ˜ ˜ ˜ ˜ ˜ Head facing forward with proper cervical spine alignment. Maintaining an upright spine without twisting or bending the trunk. Hands and arms should be positioned in front of the body, without excessive reaching. Arm abduction should be less than thirty degrees. Elbow flexion should be at ninety degrees. 33 WRMSKD’s and Sonography (2 of 2) ˜ ˜ ˜ ˜ ˜ Forearms should be close to the body, positioned parallel to the floor, and well supported. When sitting, feet should be supported by the floor, a chair rung, or the ultrasound machine. When sitting, hips and knees should be positioned at 90 degrees. When standing, the weight should be evenly distributed over both feet with a wide base of support. Sonographers should avoid: Ø Ø Ø Prolonged static postures. Excessive reaching. Awkward wrist, elbow, and shoulder positions. 34 Ultrasound Triangle See Figures 13.12 A B in the textbook for more information The relationship between sonographer, patient, ultrasound machine and viewing monitor needs to be adjusted specifically for each situation to create an optimum “Triangle”. 35 Sonographic Posture See Figures 13.13 A B in the textbook for more information Correct scanning posture is important to reducing WRMSKD’s when scanning 36 Sonographic Posture See Figure 13.15 in the textbook for more information See Figure 13.16 in the textbook for more information 37 Transducer Biomechanics ˜ ˜ ˜ ˜ Sonography is very manpower dependent. Hand-eye-patient coordination is essential. Ambidextrous. scanning common Ergonomic injuries to hand and wrist common. See Figure 13.17 C in the textbook for more information Improper “clutching” of probe is very poor hand and wrist biomechanics 38 Conclusion (1 of 2) ˜ ˜ ˜ ˜ ˜ Communication with patient and team members is critical to safe and efficient transfers. Work as a transfer team with a clear leader during the transfer. Let the patient assist with transfers if possible. Use a broad base of support, and maintain your center of gravity over base during lift. Use transfer and positioning aids when possible. 39 Conclusion (2 of 2) ˜ ˜ ˜ ˜ Become proactive with your own. biomechanics to prevent WRMSKD’s Practice selected stretching exercises to reduce injury. Notify supervisors early if you suspect a workrelated injury. Incorporate good working biomechanics as a working lifestyle. 40