A draw sheet, often called a lift sheet or transfer sheet, is a piece of fabric placed crosswise on a bed to cover the area between a patient’s shoulders and thighs. Its main purpose is to reduce friction between the patient and the bed surface, allowing caregivers to reposition the individual with less physical strain. The draw sheet is a standard tool, but its use is sometimes contraindicated because the movement it facilitates can cause more harm than good, or because the patient’s condition demands a different approach entirely.
Situations Involving Acute Patient Instability
The simple act of pulling a draw sheet is not appropriate when the patient has acute, unstable injuries that require maintaining absolute anatomical alignment. A primary example is a confirmed or suspected spinal injury, especially of the cervical spine, which necessitates strict spinal precautions. Any rotational or lateral movement, including the slight shifting inherent in pulling a sheet, could exacerbate an unstable vertebral fracture, potentially causing irreversible damage to the spinal cord.
Patients with unstable pelvic fractures or long bone fractures, such as a fractured femur, also cannot be moved using the sliding action of a draw sheet. The horizontal force created by pulling the sheet can displace fracture fragments, leading to increased pain, blood loss, and internal soft tissue trauma. In these situations, the movement technique must be a log-roll or a complete lift that maintains the integrity of the injured area. Following extensive abdominal or back surgery, a physician may also prohibit the use of a draw sheet to prevent strain on surgical sites and sutures.
Compromised Skin Integrity and Localized Wounds
Although a draw sheet is generally used to prevent skin breakdown, its movement is contraindicated when a patient has severely compromised skin in the area of contact. This applies particularly to high-grade pressure injuries, such as Stage 3 or Stage 4 ulcers, or extensive third-degree burns. In these cases, the integrity of the tissue is so poor that any friction or shearing force, even the minimal amount that occurs with a draw sheet, can cause further damage or tear the wound bed.
For patients with severe skin fragility disorders, like Epidermolysis Bullosa, the skin blisters or tears with minimal friction, making any sliding movement unsafe. Rather than using the draw sheet’s sliding mechanism, the repositioning technique must shift to a complete lift. This complete lift raises the patient entirely off the surface before movement, eliminating the harmful horizontal shear force that contributes to worsening skin injuries.
Staffing and Equipment Requirements
A draw sheet is not used when the patient’s size or dependency level exceeds the limits for manual handling established by safe patient handling guidelines. The National Institute for Occupational Safety and Health (NIOSH) recommends that healthcare workers limit the force they exert to 35 pounds or less during patient handling tasks. For the majority of adult patients, this threshold is easily exceeded, making a manual draw sheet boost unsafe for the caregiver and risking musculoskeletal injuries.
For dependent patients who are unable to assist, or for those whose weight is over a facility-set threshold, mechanical lifting devices become mandatory alternatives. These devices, such as ceiling lifts or portable floor lifts, use a sling to lift and reposition the patient entirely, bypassing the need for manual pulling. Furthermore, some specialized therapeutic beds, such as air-fluidized beds, are designed to minimize friction inherently. In these instances, a standard cloth draw sheet would interfere with the bed’s pressure-reducing function, making its use ineffective or counterproductive.