Positioning a Client in Bed
See Turn and Position a Client in Bed in the Skills Checklists on page 422 for the specific steps of this skill.
A client needs to change position frequently to protect their skin. A pressure injury can start in as little as one to two hours for clients in bed and unable to move. Clients who sit in chairs and cannot move can get pressure injuries in even less time because the pressure on the skin is greater.
A client confined to bed should change position at least every 2 hours. A person confined in a chair or wheelchair should shift their weight in the chair at least every 15 minutes for 15 seconds and change position at least every hour.
The following are general tips to remember when repositioning a client.
- Make sure there is room in the bed to roll the client.
- Ask the client to look in the direction they are being rolled.
- Do not roll the client by pulling or pushing on their arm.
- Refer to Module 7: Mobility on page 135 for tips on assisting a client to move safely.
Preventing Friction to the Skin
Friction is caused when skin is rubbed against or dragged over a surface. Even slight rubbing or friction on the skin may cause a pressure injury – especially for those clients with weakened skin. A caregiver must take special care when transferring and positioning a client. A client must always be:
- lifted – not dragged when transferring;
- positioned in a chair or bed correctly so they cannot slide down; and
- positioned on smooth linen or clothing; wrinkles can add pressure on the skin.
Skin Care Tips for Positioning a Client Confined to a Bed or Chair
A special mattress that contains foam, air, gel, or water may be used. A doctor or the case manager (if the client has one) can help the client get special equipment. Check any special mattress daily to make sure it is working properly.
Do not use doughnut-shaped cushions. They reduce blood flow and cause tissue to swell. This increases the risk of a client getting a pressure injury. Choose a position that spreads weight and pressure most evenly, and that is comfortable for the client Use pillows or wedges to keep knees or ankles from touching each other or the bed (to prevent heel sores).
Place pillows under the client’s legs from mid-calf to ankle to keep a client’s heels off the bed if a
client can’t move at all.
Never place pillows directly behind the knee. It can affect blood circulation and/or increase the risk of blood clots.
Sometimes the weight of blankets can cause pressure on the top of the feet, so a special piece of equipment known as a bed cradle may be used. The bed cradle also allows air circulation to assist in keeping the feet dry.
Be cautious about raising the head of a bed. This puts more pressure on the tailbone and allows the client to slide, increasing the risk for a pressure injury. Lying flat can be a problem for clients who have difficulty breathing. If this is the case, the head of the bed should not be raised at more than a 30° angle, unless necessary for breathing. This information should be included in the client’s service plan. Avoid positioning a client directly on the hipbone when they are lying on their side. Tuck pillows behind a client’s back when in this position.