Quick tip: OWN the bed.

How many times do you find yourself performing an assessment or an intervention on your patient all bent over their bed, or reaching forward to do something stooped and twisted at an uncomfortable back-wrenching  angle.

Take a few moments to notice the impact of bed position on your care delivery.

So many times I catch myself out hunched over a difficult cannulation or venipuncture with pain in my lower back.
I thought the task would only take a few seconds, and so I was too lazy to adjust the bed height before I started.
Now it looks like it is going to take a while, and I am very uncomfortable.
Sometimes I am holding myself in such an unnatural position for such extended periods that I actually begin shaking.
A Stress Position is what I believe they call it in the interrogation business.

Most hospitals these days have motor assisted, or foot pump assisted height/tilt controls on their beds.
Sure it takes a few extra seconds to adjust the bed to a useful operational height. But it will save you a great deal of acute discomfort and prevent the very real risk of permanent chronic back injury. An injured back is often a showstopper for a bedside nurse.

Own the bed to get blood

Don’t be afraid to raise that bed up in the air before beginning your veinipuncture or cannulation (or dressing, or auscultation etc, etc).
Make sure the patient will remain safe, and let them know what you are about to do… then raise the bed right up to a comfortable level.

How high?
Well, think of the level of your kitchen bench-top. For me, I think at least belly-button height and perhaps a little bit higher is a comfortable position for cannulating their arm if they are laying near-flat. Lower if they are sitting up.

Build a habit of working this sort of preparation into your routine. It takes a little longer but you can oftentimes save yourself a redraw ‘cause you just couldn’t maintain your pretzel positioning for another second.

Own the bed to help them stand

When helping a frail or incapacitated patient to stand out of bed, lower the bed and get them to sit on the edge with their feet flat on the floor.
Then. Stand in close beside them and use the control to raise the bed as they lean forward and straighten up.

Own the bed to help the family.

When family members are with a patient sometimes you can adjust the bed height to improve their experience. For example when they are sitting beside a dying relative, you can drop the bed down low so they can lean in and easily interact.

Own the bed in an emergency.

Even in an emergency situation. Consider the best bed height & positioning to assist in the response. This may even change a few times during the event. For example during intubation, CPR, X-rays etc.
Whilst we are talking about tilting beds, remember that tilting a patient head down feet up (Trendelenberg) in response to hypotension is no longer recommended.

If fact it is far more likely to do harm than good. It can lead to:

  • Anxiety and restlessness
  • Progressive dyspnea
  • Hypoventilation and atelectasis caused by reduced respiratory expansion
  • Altered ventilation/perfusion ratios from gravitation of blood to the poorly ventilated lung apices
  • Increasing venous congestion within and outside the cranium leading to increased intracranial pressure
  • Pressure from abdominal organs is transmitted into the thoracic cavity, which can impair venous return to the heart, leading to a further decreased cardiac output and hypotension.

Let your patient own the bed when you leave.

Once you have finished doing whatever it is you were doing, consider the optimum height, tilt, and headrest levels, and the need for raised bedside rails for your patients comfort and safety.

 


 

Reference:

  1. Trendelenburg Position [Internet]. Available from: http://lifeinthefastlane.com/trendelenburg-position-for-the-hypotensive-patient-friend-or-foe/

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