Changing clothes for a person who is bedridden requires a careful, methodical approach to ensure their comfort, maintain their dignity, and prevent injury to both the patient and the caregiver. The process involves specialized techniques that account for limited mobility, potential medical devices, and the need for hygiene. Mastering these steps allows caregivers to perform this necessary daily task safely and respectfully for individuals with limited or no ability to assist themselves.
Preparing the Environment and Patient
Before initiating the clothing change, the caregiver must prepare the physical environment and the patient to ensure a smooth and safe procedure. This preparation includes gathering all necessary supplies, such as clean clothing, gloves, and a designated laundry receptacle, and placing them within easy reach. Patient privacy is maintained by closing the door, drawing the curtains, and covering the patient with a bath blanket or sheet to expose only the section of the body being worked on. Caregiver safety is addressed by adjusting the bed height to a comfortable working level, typically around the caregiver’s waist. The bed wheels should be locked to prevent any movement while the caregiver is maneuvering the patient.
Step-by-Step Guide for Upper Body Clothing
Removing and applying upper body garments, such as shirts or hospital gowns, requires careful attention, especially if the patient has weakness or injury on one side. A standard guideline dictates that when removing clothing, the garment should be taken off the strong, unaffected side first, and then gently slipped off the weak or injured side last. This sequence minimizes movement and manipulation of the less mobile limb.
When dressing the patient, the process is reversed: the clean sleeve is first placed onto the weak or compromised arm, followed by the strong arm. This method allows the caregiver to use the patient’s stronger side to help maneuver the garment over their head and torso. For shirts that pull over the head, the neck opening should be stretched gently and passed over the face, supporting the head as needed.
The patient’s arm should be supported throughout the process to avoid pulling on the shoulder joint or causing hyperextension. To manage the clothing beneath the patient’s back, the caregiver can ask the patient to slightly lift their hips if possible, or gently roll them to one side. This slight turn allows the caregiver to smooth the garment across the back, ensuring there are no wrinkles that could cause pressure points.
Managing the Change for Lower Body Clothing
Changing lower body garments, such as pants or undergarments, involves distinct techniques focused on minimizing spinal and hip rotation. The process typically requires the caregiver to work the garment up to the patient’s thighs while the patient is lying flat before utilizing a lateral movement technique.
The logrolling method is employed to safely raise the patient’s hips off the mattress to fully remove or apply the garment. This technique involves placing the patient’s arms across their chest and their knee on the side farthest from the caregiver bent, then gently rolling the patient as a single unit onto their side. This keeps the spine and hips aligned, which is particularly important for patients with back or hip precautions.
While the patient is turned onto their side, the caregiver can pull the pants or undergarments down or up over the hip furthest from them. After returning the patient to a flat position, the caregiver moves to the other side of the bed and repeats the rolling process to complete the removal or application of the garment over the second hip. This two-step rolling process prevents shearing forces on the skin and ensures the clothing is smoothed out completely.
Techniques for Dealing with Medical Devices and Soiled Garments
Specific challenges arise when a patient has medical devices, such as intravenous (IV) lines, or when clothing is soiled and requires specialized handling. For a patient with an IV line, the clothing change must proceed without disconnecting the line or pulling on the catheter insertion site. If the garment does not have snaps or Velcro at the shoulder, the sleeve should be removed from the arm without the IV line first.
To remove the sleeve from the IV arm, the entire sleeve is gathered over the patient’s hand, and the IV bag is carefully removed from its pole and passed through the sleeve opening. Keep the IV bag elevated above the patient to maintain the proper flow dynamics. The same reverse process is used to put on the clean garment, feeding the IV bag and tubing through the sleeve of the clean gown before re-hanging the bag.
In the event of heavily soiled clothing, hygiene and contamination control become the primary concern. The soiled garment should be removed immediately and contained without shaking or touching the caregiver’s uniform. For garments that are difficult to remove without excessive patient movement, it is safer to use trauma shears or strong scissors to cut the garment away from the body. Soiled clothing should be placed directly into a designated biohazard bag or laundry receptacle to prevent the spread of microorganisms.