Moving an immobile individual in bed is a necessary and challenging part of caregiving. Repositioning a heavy person carries a high risk of injury to the caregiver if performed incorrectly. Proper technique and preparation are essential to protect both the person being moved and the caregiver. Utilizing body weight leverage and simple aids allows moves to be performed safely and effectively, ensuring the comfort and health of the bed-bound person.
Prioritizing Caregiver Safety and Body Mechanics
Protecting your body starts with a foundational stance that shifts effort away from the back muscles. The goal is to maximize the use of the larger, stronger muscle groups in the legs and hips to generate movement and lift. To create a stable base of support, the feet should be staggered about shoulder-width apart, with one foot slightly ahead of the other. The knees should be bent, and the back should remain straight, avoiding any bending at the waist.
Before initiating any movement, prepare the environment and the patient. Adjust the bed height to approximately the caregiver’s waist level to allow for a straight back posture and reduce strain. All wheels on the bed must be locked, and side rails on the working side should be lowered so the caregiver can stand close to the person. Clear communication, such as counting “one, two, three,” encourages the person to assist and brace themselves, making the maneuver easier.
The physical action of moving should rely on shifting body weight rather than pulling with the arms alone. When turning, the caregiver must pivot their entire body using their feet, avoiding any twisting motion in the spine. Tightening the abdominal muscles helps maintain spinal stability throughout the transfer. Never lift more than is comfortable, and always ask for help if the load is too great or the person is totally dependent.
Core Manual Techniques for Repositioning
Repositioning a heavy person often requires dividing the body into smaller segments to manage the weight. The most common manual technique uses a draw sheet, which is a standard or reinforced sheet placed across the bed beneath the person’s torso and hips. For a boost up toward the head of the bed, the bed should be lowered to flat to allow gravity to assist. Two caregivers, one on each side, should grasp the rolled-up edges of the draw sheet close to the person’s body.
On the count of three, caregivers should use a synchronized movement, shifting their weight from their back leg to their front leg to slide the person up the bed. The movement must be a lift-and-slide action to avoid dragging, which causes friction and damages the skin. For turning the person onto their side, the caregiver should first move the person closer to the edge of the bed opposite the direction of the turn.
To prepare the person for the turn, the far leg should be crossed over the near leg, and the arms should be crossed over the chest. The caregiver stands facing the person, places one hand on the shoulder and the other on the hip, and rolls the person gently toward them, leaning back with their body weight. Rolling the person toward the caregiver is safer than pushing them away, preventing awkward reaching across the bed. Once on their side, pillows can be used behind the back, between the knees, and under the upper arm to maintain the position and relieve pressure.
Essential Assistive Devices for Heavy Individuals
While manual techniques are helpful, assistive devices are necessary when moving heavier individuals to protect both the caregiver and the patient. A reinforced draw sheet, made from a strong, low-friction material, is designed to handle a greater load and reduce the force required to slide the person. Slide sheets are specialized tubes of slippery material placed beneath the person, drastically reducing friction and shear forces during repositioning. These sheets should be removed after the move, as leaving them in place can trap moisture and create pressure points.
For transfers from the bed to a chair, a transfer or gait belt can be used around the person’s waist to provide a secure grip. The belt should be placed over clothing and fastened snugly, offering a secure handle without pulling directly on the person’s limbs or clothing. For individuals who are non-weight-bearing or completely dependent, mechanical or hydraulic lifts are required to avoid manual lifting. These patient lifts use specialized slings that distribute the person’s weight safely, with some bariatric models accommodating individuals weighing up to 500 kilograms.
Monitoring Skin Health and Preventing Pressure Injuries
Regular repositioning is the primary method for preventing pressure injuries, which develop from prolonged, unrelieved pressure on the body. When pressure is sustained, blood flow to the underlying tissue is occluded, leading to tissue damage. A person who is bed-bound should be repositioned at least every two hours to redistribute pressure and restore circulation.
Before and after every move, the caregiver must inspect the skin, paying particular attention to bony prominences like the heels, tailbone, elbows, and hips. The earliest sign of a pressure injury is non-blanchable redness, an area that does not turn white when light pressure is applied. If this sign is observed, the person must be immediately repositioned off the affected area to relieve the pressure. Avoiding friction and shear forces during the move is also important for skin integrity, requiring lifting or sliding with assistive devices instead of dragging.