Algorithms for\
Safe Patient Handling

VISN 8 Patient Safety Center of Inquiry\
11605 N. Nebraska Avenue\
Tampa, FL 33612\
Phone: 813-558-3902

Fax: 813-558-3990 rev. 10/1/08

Table of Contents

[Assessment Criteria and Care Plan for Safe Patient Handling and
Movement
3](#assessment-criteria-and-care-plan-for-safe-patient-handling-and-movement)

[Algorithm 1: Transfer to and From: Bed to Chair, Chair to Toilet, Chair
to Chair, or Car to Chair
4](#algorithm-1-transfer-to-and-from-bed-to-chair-chair-to-toilet-chair-to-chair-or-car-to-chair)

[Algorithm 2: Lateral Transfer To and From: Bed to Stretcher, Trolley
5](#algorithm-2-lateral-transfer-to-and-from-bed-to-stretcher-trolley)

[Algorithm 3: Transfer To and From: Chair to Stretcher or Chair to Exam
Table
6](#algorithm-3-transfer-to-and-from-chair-to-stretcher-or-chair-to-exam-table)

[Algorithm 4: Reposition in Bed: Side-to-Side, Up in Bed
7](#algorithm-4-reposition-in-bed-side-to-side-up-in-bed)

[Algorithm 5: Reposition in Chair: Wheelchair and Dependency Chair
8](#algorithm-5-reposition-in-chair-wheelchair-and-dependency-chair)

[Algorithm 6: Transfer a Patient Up From the Floor
9](#algorithm-6-transfer-a-patient-up-from-the-floor)

[Bariatric Algorithm 1: Bariatric Transfer To and From: Bed/Chair,
Chair/Toilet, or Chair/Chair
10](#bariatric-algorithm-1-bariatric-transfer-to-and-from-bedchair-chairtoilet-or-chairchair)

[Bariatric Algorithm 2: Bariatric Lateral Transfer To and From:
Bed/Stretcher/Trolley
11](#bariatric-algorithm-2-bariatric-lateral-transfer-to-and-from-bedstretchertrolley)

[Bariatric Algorithm 3: Bariatric Reposition in Bed: Side-to-Side, Up in
Bed
12](#bariatric-algorithm-3-bariatric-reposition-in-bed-side-to-side-up-in-bed)

[Bariatric Algorithm 4: Bariatric Reposition in Chair: Wheelchair,
Chair, or Dependency Chair
13](#bariatric-algorithm-4-bariatric-reposition-in-chair-wheelchair-chair-or-dependency-chair)

[Bariatric Algorithm 5: Patient Handling Tasks Requiring Access to Body
Parts (Limb, Abdominal Mass, Gluteal Area)
14](#bariatric-algorithm-5-patient-handling-tasks-requiring-access-to-body-parts-limb-abdominal-mass-gluteal-area)

[Bariatric Algorithm 6: Bariatric Transporting (Stretcher)
15](#bariatric-algorithm-6-bariatric-transporting-stretcher)

[Bariatric Algorithm 7: Toileting Tasks for the Bariatric Patient
16](#bariatric-algorithm-7-toileting-tasks-for-the-bariatric-patient)

[Bariatric Algorithm 8: Transfer a Bariatric Patient Up From the Floor
17](#bariatric-algorithm-8-transfer-a-bariatric-patient-up-from-the-floor)

[Orthopaedic Algorithm #1: Turning Patient in Bed (Side-to-Side) Patient
with Orthopaedic Impairments
18](#orthopaedic-algorithm-1-turning-patient-in-bed-side-to-side-patient-with-orthopaedic-impairments)

[Orthopaedic Algorithm #2: Vertical Transfer of a Post-Operative Total
Hip Replacement Patient (Bed to Chair, Chair to Toilet, Chair to Chair,
or Car to Chair) 20](#__RefHeading___Toc210631753)

[Orthopaedic Algorithm #3: Vertical Transfer of a Patient with an
Extremity Cast/Splint 21](#__RefHeading___Toc210631754)

[Orthopaedic Algorithm #4: Ambulation
22](#orthopaedic-algorithm-4-ambulation)

[Orthopaedic Clinical Tool #1: Lifting and Holding Legs or Arms in an
Orthopaedic Setting
23](#orthopaedic-clinical-tool-1-lifting-and-holding-legs-or-arms-in-an-orthopaedic-setting)

[Orthopaedic Clinical Tool #2: Alternate Method for Determining Safe
Lifting and Holding of Limbs with Casts
25](#orthopaedic-clinical-tool-2-alternate-method-for-determining-safe-lifting-and-holding-of-limbs-with-casts)

[Orthopaedic Appendix A: Helpful Hints on Slings
26](#orthopaedic-appendix-a-helpful-hints-on-slings)

#   {#section .unnumbered}

# Assessment Criteria and Care Plan for Safe Patient Handling and Movement

Assessment Criteria and Care Plan for Safe Patient Handling and Movement

**I. Patient's Level of Assistance:**

> \_\_\_\_\_ Independent--- Patient performs task safely, with or
> without staff assistance, with or without assistive devices.
>
> \_\_\_\_\_ Partial Assist---Patient requires no more help than
> stand-by, cueing, or coaxing, or caregiver is required to lift no more
> than 35 lbs. of
>
> a patient's weight.
>
> \_\_\_\_\_ Dependent---Patient requires nurse to lift more than 35
> lbs. of the patient's weight, or is unpredictable in the amount of
> assistance
>
> offered. In this case assistive devices should be used.

*An assessment should be made prior to each task if the patient has
varying level of ability to assist due to medical reasons, fatigue,
medications, etc. When in doubt, assume the patient cannot assist with
the transfer/repositioning.*

**II. Weight Bearing Capability III. Bi-Lateral Upper Extremity
Strength**

\_\_\_\_\_ Full \_\_\_\_\_ Yes

\_\_\_\_\_ Partial \_\_\_\_\_ No

\_\_\_\_\_ None

**IV. Patient's level of cooperation and comprehension:**

> \_\_\_\_\_ Cooperative --- may need prompting; able to follow simple
> commands.
>
> \_\_\_\_\_ Unpredictable or varies (patient whose behavior changes
> frequently should be considered as "unpredictable"), not cooperative,
> or
>
> unable to follow simple commands.

**V. Weight: \_\_\_\_\_\_\_\_\_ Height: \_\_\_\_\_\_\_\_\_\_\_**

**Body Mass Index (BMI) \[needed if patient's weight is over
300\]¹:\_\_\_\_\_\_\_\_\_\_\_**

***If BMI exceeds 50, institute Bariatric Algorithms***

*The presence of the following conditions are likely to affect the
transfer/repositioning process and should be considered when identifying
equipment and technique needed to move the patient.*

**VI. Check applicable conditions likely to affect
transfer/repositioning techniques.**

\_\_\_\_\_ Hip/Knee/Shoulder Replacements \_\_\_\_\_ Respiratory/Cardiac
Compromise \_\_\_\_\_ Fractures

\_\_\_\_\_ History of Falls \_\_\_\_\_ Wounds Affecting
Transfer/Positioning \_\_\_\_\_ Splints/Traction

\_\_\_\_\_ Paralysis/Paresis \_\_\_\_\_ Amputation \_\_\_\_\_ Severe
Osteoporosis

\_\_\_\_\_ Unstable Spine \_\_\_\_\_ Urinary/Fecal Stoma \_\_\_\_\_
Severe Pain/Discomfort

\_\_\_\_\_ Severe Edema \_\_\_\_\_ Contractures/Spasms \_\_\_\_\_
Postural Hypotension

\_\_\_\_\_ Very Fragile Skin \_\_\_\_\_ Tubes (IV, Chest, etc.)

**Comments:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**VII. Appropriate Lift/Transfer Devices Needed:**

Vertical Lift:

Horizontal Lift:

Other Patient Handling Devices Needed:

**Sling Type:** Seated\_\_\_\_\_ Seated (Head Support) \_\_\_\_\_\_
Seated (Amputee)\_\_\_\_\_ Hygiene\_\_\_\_\_ Supine\_\_\_\_\_
Ambulation\_\_\_\_\_ Limb Support\_\_\_\_\_

**Sling Size:** \_\_\_\_\_\_\_\_\_\_\_\_\_

**Signature:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Date: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

¹ For Online BMI table and calculator see:
<http://www.nhlbi.nih.gov/guidelines/obesity/bmi_tbl.htm>

# Algorithm 1: Transfer to and From: Bed to Chair, Chair to Toilet, Chair to Chair, or Car to Chair

![](media/image1.wmf){width="6.873611111111111in"
height="8.540972222222223in"}

# Algorithm 2: Lateral Transfer To and From: Bed to Stretcher, Trolley

![](media/image2.wmf){width="6.916666666666667in"
height="6.584722222222222in"}

# Algorithm 3: Transfer To and From: Chair to Stretcher or Chair to Exam Table

![](media/image3.wmf){width="6.846527777777778in"
height="8.233333333333333in"}

# Algorithm 4: Reposition in Bed: Side-to-Side, Up in Bed

![](media/image4.wmf){width="7.497916666666667in"
height="8.38888888888889in"}

# Algorithm 5: Reposition in Chair: Wheelchair and Dependency Chair

![](media/image5.wmf){width="6.960416666666666in"
height="7.926388888888889in"}

# Algorithm 6: Transfer a Patient Up From the Floor

![](media/image6.wmf){width="7.233333333333333in"
height="8.414583333333333in"}

# Bariatric Algorithm 1: Bariatric Transfer To and From: Bed/Chair, Chair/Toilet, or Chair/Chair

![](media/image7.wmf){width="7.430555555555555in"
height="9.000694444444445in"}

# Bariatric Algorithm 2: Bariatric Lateral Transfer To and From: Bed/Stretcher/Trolley

![](media/image8.wmf){width="6.932638888888889in"
height="8.397916666666667in"}

# Bariatric Algorithm 3: Bariatric Reposition in Bed: Side-to-Side, Up in Bed

![](media/image9.wmf){width="7.0in" height="8.997916666666667in"}

# Bariatric Algorithm 4: Bariatric Reposition in Chair: Wheelchair, Chair, or Dependency Chair

![](media/image10.wmf){width="7.152083333333334in"
height="8.747916666666667in"}

# Bariatric Algorithm 5: Patient Handling Tasks Requiring Access to Body Parts (Limb, Abdominal Mass, Gluteal Area)

![](media/image11.wmf){width="7.420138888888889in"
height="7.904166666666667in"}

# Bariatric Algorithm 6: Bariatric Transporting (Stretcher)

![](media/image12.wmf){width="6.7347222222222225in"
height="7.594444444444444in"}

# Bariatric Algorithm 7: Toileting Tasks for the Bariatric Patient

# 

![](media/image13.wmf){width="6.283333333333333in"
height="8.372916666666667in"}

# Bariatric Algorithm 8: Transfer a Bariatric Patient Up From the Floor

![](media/image14.wmf){width="6.347916666666666in"
height="8.175694444444444in"}

# Orthopaedic Algorithm #1: Turning Patient in Bed (Side-to-Side) Patient with Orthopaedic Impairments

![](media/image15.wmf){width="7.496527777777778in"
height="8.761805555555556in"}

![](media/image15.wmf){width="7.496527777777778in"
height="9.50763888888889in"}

[]{#__RefHeading___Toc210631753 .anchor}**Orthopaedic Algorithm #2:
Vertical Transfer of a Post-Operative Total Hip Replacement Patient (Bed
to Chair, Chair to Toilet, Chair to Chair, or Car to Chair)**

![](media/image16.wmf){width="7.497916666666667in"
height="8.916666666666666in"}

[]{#__RefHeading___Toc210631754 .anchor}**Orthopaedic Algorithm #3:
Vertical Transfer of a Patient with an Extremity Cast/Splint**

![](media/image17.wmf){width="7.497222222222222in"
height="8.911805555555556in"}

# Orthopaedic Algorithm #4: Ambulation

![](media/image18.wmf){width="7.496527777777778in"
height="9.129861111111111in"}

# Orthopaedic Clinical Tool #1: Lifting and Holding Legs or Arms in an Orthopaedic Setting

**Introduction**

Often when orthopaedic care is being provided, the care giver must lift
and/or hold a limb in place while some type of treatment is being
provided, such as cast application. It is assumed that you are
maintaining a neutral (upright) body posture (not fully flexed); adjust
the height of the table. When a caregiver must lift a leg or arm, it is
important to make sure that the weight of the limb being lifted does not
exceed the strength capability of the caregiver. An ergonomic tool has
been developed to assist caregivers in determining whether a specific
lift and/or hold of a limb is acceptable and whether some type of lift
or hold assist device is needed. For lifts of limbs with casts, an
alternate method is presented for assessing whether the lift is
acceptable or not as presented in Table #1.

This tool shows the calculation of the average weight for an adult
patient's leg and arm as a function of whole body mass, ranging from
slim to morbidly obese body type. Weights are presented both in pounds
(lbs.) and metric (kg.) units. Maximum lift and hold loads were
calculated based on 75^th^ percentile shoulder flexion strength and
endurance capability for US adult females, where the maximum weight for
a one-handed lift is 11.1 lbs. and a two-handed lift, 22.2lbs.

**Table 1. Ergonomic Tool: Lifting and Holding Legs or Arms in an
Orthopaedic Setting\***

+---------+-------+-------+-----+-----+-----+-------+------+------+
| **      | **B   | *     |     | **  | **  | **H   | **Ho | **Ho |
| Patient | ody** | *Body |     | Lif | Lif | old** | ld** | ld** |
| Weight\ |       | P     |     | t** | t** |       |      |      |
| lbs.**  | **P   | art** |     |     |     | **2-h | **   | **   |
| (kg.)   | art** |       |     | *   | *   | and** | 2-ha | 2-ha |
|         |       | **Wei |     | *1- | *2- |       | nd** | nd** |
|         |       | ght** |     | han | han | **1   |      |      |
|         |       |       |     | d** | d** | m     | **2  | **3  |
|         |       | **L   |     |     |     | in.** | mi   | mi   |
|         |       | bs.** |     |     |     |       | n.** | n.** |
|         |       | (kg.) |     |     |     |       |      |      |
+=========+=======+=======+=====+=====+=====+=======+======+======+
| **\<40  | **    | **    | (3  |     |     |       |      |      |
| lbs.**  | Leg** | \<6.3 | k   |     |     |       |      |      |
|         |       | l     | g.) |     |     |       |      |      |
|         |       | bs.** |     |     |     |       |      |      |
+---------+-------+-------+-----+-----+-----+-------+------+------+
| (\< 18  | **    | **    | (1  |     |     |       |      |      |
| kg.)    | Arm** | \<2.0 | k   |     |     |       |      |      |
|         |       | l     | g.) |     |     |       |      |      |
|         |       | bs.** |     |     |     |       |      |      |
+---------+-------+-------+-----+-----+-----+-------+------+------+
| **40-90 | **    | **\   | (6  |     |     |       |      |      |
| lbs.**  | Leg** | <14.1 | k   |     |     |       |      |      |
|         |       | lbs   | g.) |     |     |       |      |      |
|         |       | .**   |     |     |     |       |      |      |
+---------+-------+-------+-----+-----+-----+-------+------+------+
| (18-41  | **    | **    | (2  |     |     |       |      |      |
| kg.)    | Arm** | \<4.6 | k   |     |     |       |      |      |
|         |       | l     | g.) |     |     |       |      |      |
|         |       | bs.** |     |     |     |       |      |      |
+---------+-------+-------+-----+-----+-----+-------+------+------+
| *       | **    | **\   | (10 |     |     |       |      |      |
| *90-140 | Leg** | <22.0 | k   |     |     |       |      |      |
| lbs.**  |       | l     | g.) |     |     |       |      |      |
|         |       | bs.** |     |     |     |       |      |      |
+---------+-------+-------+-----+-----+-----+-------+------+------+
| (41-64  | **    | **    | (3  |     |     |       |      |      |
| kg.)    | Arm** | \<7.1 | k   |     |     |       |      |      |
|         |       | l     | g.) |     |     |       |      |      |
|         |       | bs.** |     |     |     |       |      |      |
+---------+-------+-------+-----+-----+-----+-------+------+------+
| **      | **    | **\   | (14 |     |     |       |      |      |
| 140-190 | Leg** | <29.8 | k   |     |     |       |      |      |
| lbs.**  |       | l     | g.) |     |     |       |      |      |
|         |       | bs.** |     |     |     |       |      |      |
+---------+-------+-------+-----+-----+-----+-------+------+------+
| (64-86  | **    | **    | (4  |     |     |       |      |      |
| kg.)    | Arm** | \<9.7 | k   |     |     |       |      |      |
|         |       | l     | g.) |     |     |       |      |      |
|         |       | bs.** |     |     |     |       |      |      |
+---------+-------+-------+-----+-----+-----+-------+------+------+
| **      | **    | **\   | (17 |     |     |       |      |      |
| 190-240 | Leg** | <37.7 | k   |     |     |       |      |      |
| lbs.**  |       | l     | g.) |     |     |       |      |      |
|         |       | bs.** |     |     |     |       |      |      |
+---------+-------+-------+-----+-----+-----+-------+------+------+
| (86-109 | **    | **\   | (6  |     |     |       |      |      |
| kg.)    | Arm** | <12.2 | k   |     |     |       |      |      |
|         |       | l     | g.) |     |     |       |      |      |
|         |       | bs.** |     |     |     |       |      |      |
+---------+-------+-------+-----+-----+-----+-------+------+------+
| **      | **    | **\   | (21 |     |     |       |      |      |
| 240-290 | Leg** | <45.5 | k   |     |     |       |      |      |
| lbs.**  |       | l     | g.) |     |     |       |      |      |
|         |       | bs.** |     |     |     |       |      |      |
+---------+-------+-------+-----+-----+-----+-------+------+------+
| (       | **    | **\   | (7  |     |     |       |      |      |
| 109-132 | Arm** | <14.8 | k   |     |     |       |      |      |
| kg.)    |       | l     | g.) |     |     |       |      |      |
|         |       | bs.** |     |     |     |       |      |      |
+---------+-------+-------+-----+-----+-----+-------+------+------+
| **      | **    | **\   | (24 |     |     |       |      |      |
| 290-340 | Leg** | <53.4 | k   |     |     |       |      |      |
| lbs.**  |       | l     | g.) |     |     |       |      |      |
|         |       | bs.** |     |     |     |       |      |      |
+---------+-------+-------+-----+-----+-----+-------+------+------+
| (       | **    | **\   | (8  |     |     |       |      |      |
| 132-155 | Arm** | <17.3 | k   |     |     |       |      |      |
| kg.)    |       | l     | g.) |     |     |       |      |      |
|         |       | bs.** |     |     |     |       |      |      |
+---------+-------+-------+-----+-----+-----+-------+------+------+
| **      | **    | **\   | (28 |     |     |       |      |      |
| 340-390 | Leg** | <61.2 | k   |     |     |       |      |      |
| lbs.**  |       | l     | g.) |     |     |       |      |      |
|         |       | bs.** |     |     |     |       |      |      |
+---------+-------+-------+-----+-----+-----+-------+------+------+
| (       | **    | **\   | (9  |     |     |       |      |      |
| 155-177 | Arm** | <19.9 | k   |     |     |       |      |      |
| kg.)    |       | l     | g.) |     |     |       |      |      |
|         |       | bs.** |     |     |     |       |      |      |
+---------+-------+-------+-----+-----+-----+-------+------+------+
| **      | **    | **\   | (31 |     |     |       |      |      |
| 390-440 | Leg** | <69.1 | k   |     |     |       |      |      |
| lbs.**  |       | l     | g.) |     |     |       |      |      |
|         |       | bs.** |     |     |     |       |      |      |
+---------+-------+-------+-----+-----+-----+-------+------+------+
| (       | **    | **\   | (10 |     |     |       |      |      |
| 177-200 | Arm** | <22.2 | k   |     |     |       |      |      |
| kg.)    |       | l     | g.) |     |     |       |      |      |
|         |       | bs.** |     |     |     |       |      |      |
+---------+-------+-------+-----+-----+-----+-------+------+------+
| **\>    | **    | **\   | (31 |     |     |       |      |      |
| 440     | Leg** | >69.1 | k   |     |     |       |      |      |
| lbs.**  |       | l     | g.) |     |     |       |      |      |
|         |       | bs.** |     |     |     |       |      |      |
+---------+-------+-------+-----+-----+-----+-------+------+------+
| (\>200  | **    | **\   | (10 |     |     |       |      |      |
| kg.)    | Arm** | >22.2 | k   |     |     |       |      |      |
|         |       | l     | g.) |     |     |       |      |      |
|         |       | bs.** |     |     |     |       |      |      |
+---------+-------+-------+-----+-----+-----+-------+------+------+
| \* No   |       |       |     |     |     |       |      |      |
| s       |       |       |     |     |     |       |      |      |
| hading: |       |       |     |     |     |       |      |      |
| Lift    |       |       |     |     |     |       |      |      |
| and     |       |       |     |     |     |       |      |      |
| hold is |       |       |     |     |     |       |      |      |
| appr    |       |       |     |     |     |       |      |      |
| opriate |       |       |     |     |     |       |      |      |
| but use |       |       |     |     |     |       |      |      |
| c       |       |       |     |     |     |       |      |      |
| linical |       |       |     |     |     |       |      |      |
| j       |       |       |     |     |     |       |      |      |
| udgment |       |       |     |     |     |       |      |      |
| and do  |       |       |     |     |     |       |      |      |
| not     |       |       |     |     |     |       |      |      |
| hold    |       |       |     |     |     |       |      |      |
| longer  |       |       |     |     |     |       |      |      |
| than    |       |       |     |     |     |       |      |      |
| noted.  |       |       |     |     |     |       |      |      |
|         |       |       |     |     |     |       |      |      |
| Heavy   |       |       |     |     |     |       |      |      |
| s       |       |       |     |     |     |       |      |      |
| hading: |       |       |     |     |     |       |      |      |
| Do not  |       |       |     |     |     |       |      |      |
| lift    |       |       |     |     |     |       |      |      |
| alone;  |       |       |     |     |     |       |      |      |
| use     |       |       |     |     |     |       |      |      |
| as      |       |       |     |     |     |       |      |      |
| sistive |       |       |     |     |     |       |      |      |
| device  |       |       |     |     |     |       |      |      |
| or more |       |       |     |     |     |       |      |      |
| than    |       |       |     |     |     |       |      |      |
| one     |       |       |     |     |     |       |      |      |
| car     |       |       |     |     |     |       |      |      |
| egiver. |       |       |     |     |     |       |      |      |
+---------+-------+-------+-----+-----+-----+-------+------+------+

The shaded areas of the table indicate whether it would be acceptable
for one caregiver to lift the listed body parts with one or two hands or
hold the respective body parts for 1, 2, or 3 minutes with two hands.
Respecting these limits will minimize risk of muscle fatigue and the
potential for musculoskeletal disorders. If the limb weight exceeds the
values listed in the table it is recommended to use assistive
technology, such as a ceiling lift or floor based lift with a limb
support sling. Orthopaedic caregivers must use clinical judgment to
assess the need for additional staff member assistance or assistive
devices to lift and/or hold one of these body parts for a particular
period of time.

**Note:** It is important to remember that the chart shows the
acceptable weights for limbs without a cast in place. If the caregiver
is lifting a limb with a cast, the additional weight of the cast should
be added to the weight of the limb to determine whether the lift is
acceptable. An alternate method is provided below for limbs with casts.
These are guidelines for the average weight of the leg and arm, and are
based upon the patient's weight. The maximum weight for a 1-handed lift
is 11.1 lbs. and a 2-handed lift, 22.2 lbs.

Patient weight is divided into weight categories (see Table 1), ranging
from very light to morbidly obese. Normalized weight for each leg and
each arm are calculated as a percentage of body weight where each
complete arm weighs 5.1% of total body mass and each leg weighs 15.7% of
total body mass (Chaffin, Anderson, & Martin, 1999). All weights are
presented in both pounds and kilograms, rounded to the nearest whole
unit.

To accommodate 75% of the US adult female working population, maximum
load for a 1-handed lift is calculated to be 11.1 lbs. (5.0 kg.). This
is determined by calculating the strength capabilities for 25^th^
percentile US adult female maximum shoulder flexion movement (the mean
equals 40 Newton meters, standard deviation equals 13 Nm) (Chaffin,
Anderson, & Martin, 1999) and 75^th^ percentile US adult female shoulder
to grip length (the mean equals 610 mm, the standard deviation equals 30
mm) (Pheasant, 1992). Maximum loads for one person for a 2-handed lift
(i.e., 22.2 lbs. /10.1 kg.) are calculated as twice that of a 1-handed
lift. Muscle strength capabilities diminish as a function of time,
therefore, maximum loads for 2-handed holding of body parts are
presented for 1, 2, and 3 minute durations. After 1 minute, muscle
endurance has decreased by 48%, decreased by 65% after 2 minutes, and,
after 3 minutes of continuous holding, strength capability is only 29%
of initial lifting strength (Rohmert, 1973, a, b). If the limits in
ergonomic Table 1 are exceeded, additional staff members or assistive
limb holders should be used.

References

Chaffin, D. B., Anderson, G.B.J., & Martin, B.J. (1999). *Occupational
biomechanics* (3^rd^ ed.). New York, NY: J. Wiley & Sons

Pheasant, S. (1992). *Bodyspace*. Taylor & Francis, Ltd: London.

#### Rohmert,W. (1973a). Problems of determination of rest allowances. Part 1: Use of modern methods to evaluate stress and strain in static muscular work. *Applied Ergonomics,* *4*(2), 91-95.

#### Rohmert,W. (1973b) Problems of determination of rest allowances. Part 2: Determining rest allowances in different human tasks. *Applied Ergonomics,* *4*(3), 158-162. 

Waters, T. (2007). When is it safe to manually lift a patient? *American
Journal of Nursing, 107*(8), 53--59.

# Orthopaedic Clinical Tool #2: Alternate Method for Determining Safe Lifting and Holding of Limbs with Casts

**Table 2.1.** **Predicted Weight for Different Types of Casts**

+------+-------------+----------+----------+--------+--------+--------+
| **Li | **Limb      | **       | **2      | **2    | **2-h  | **2-h  |
| mb** | Weight      | 1-hand** | -hands** | -hands | ands** | ands** |
|      | Factor**    |          |          | 1      |        |        |
|      |             |          |          | min.** | **2    | **3    |
|      |             |          |          |        | min.** | min.** |
+------+-------------+----------+----------+--------+--------+--------+
| Leg  | 0.157       | 11.1     | 22.2     | 11.6   | 7.8    | 6.4    |
|      |             | lbs.     | lbs.     | lbs.   | lbs.   | lbs.   |
|      |             |          |          |        |        |        |
|      |             | (5.1     | (10.2    | (5.3   | (3.5   | (2.9   |
|      |             | kg.)     | kg.)     | kg.)   | kg.)   | kg.)   |
+------+-------------+----------+----------+--------+--------+--------+
| Arm  | 0.051       |          |          |        |        |        |
+------+-------------+----------+----------+--------+--------+--------+

Multiply the patients' weight times the limb factor (0.157 for leg and
0.051 for arm) and add the weight of the cast. Compare the calculated
weight to the value in the appropriate task box. If the total limb
weight exceeds the weight in the appropriate box, then the caregiver
should not manually lift the limb alone, but should use an assistive
device or more than one caregiver to perform the lift. On the other
hand, if the calculated weight is less than the value in the appropriate
box, then it is acceptable to manually lift and hold the limb and the
caregiver should use clinical judgment and not hold longer than noted.

For example if the patient weighs 200 lbs. and has an arm cast weighing
5 lbs., then the total arm weight would be 200 lbs. x 0.051 plus 5 lbs.,
or 15.2 lbs. In this case, the arm should not be lifted with one hand
(i.e., 15.2 lbs. \> 11.1 lbs.) but could be lifted with two hands (i.e.,
15.2 lbs. \< 22.2 lbs.), but not held in that position less than a few
seconds (15.2 lbs. \> 11.6 lbs.). Similarly, if the patient weighs 75
lbs. and has a 5 lb. leg cast, then the total limb weight would be 75
lbs. x 0.157 plus 5 lbs., or 16.8 lbs. In this case, it would not be
acceptable to lift the limb with one hand (i.e., 16.8 lbs. \> 11.1
lbs.), but it would be acceptable to lift it with two hands (i.e., 16.8
lbs. \< 22.1 lbs.), but should not be held more than a few seconds (16.8
lbs. \> 11.6 lbs.).

**Table 2.2. Predicted Weights for a Fiberglass Cast**

The following Table 2.2 provides some predicted weights for a fiberglass
cast.

+---------+---------+-------------+------------+---------+---------+
| **Short | **Long  | **Short Leg | **\        | *       | **Child |
| Arm     | Arm     | Walking     | Long\      | *Infant | Body    |
| Cast    | Cast    | Cast (150   | Leg Cast\  | Body    | Spica\  |
| (a      | (a      | lbs.        | (150 lbs.  | Spica\  | 3-5 yr  |
| dult)** | dult)** | adult)**    | adult)**   | 20-30   | old\    |
|         |         |             |            | lbs.**  | 30-50   |
|         |         |             |            |         |  lbs.** |
+---------+---------+-------------+------------+---------+---------+
| 0.5     | 1 lbs.  | 2 lbs.      | 3.0 lbs.   | 2 lbs.  | 4lbs.   |
| lbs.    |         |             |            |         |         |
+---------+---------+-------------+------------+---------+---------+
| 2 rolls | 1 roll  | 4 rolls 4"  | 3 rolls 3" | 2 rolls | 5 rolls |
| 3"      | 2"      |             |            | 2"      | 3"      |
|         |         |             | 3 rolls 4" |         |         |
|         | 3 rolls |             |            | 3 rolls | 5 rolls |
|         | 3"      |             |            | 3"      | 4"      |
+---------+---------+-------------+------------+---------+---------+
| \+      | \+      | \+ webril\* | \+         | \+      | \+      |
| w       | w       |             | webril\*   | w       | w       |
| ebril\* | ebril\* |             |            | ebril\* | ebril\* |
+---------+---------+-------------+------------+---------+---------+

\*Weight of webril is 0.25 lb. per packet

# Orthopaedic Appendix A: Helpful Hints on Slings

Selection of the appropriate sling accessory for movement / lift
/transfer, must include the following considerations:

-   Decision to transfer patient in sitting vs. supine position --
    choose correct functionality of the sling

-   Select appropriate size

-   Maintain alignment of the affected body part(s) according to
    pre-operative/post-operative guidelines

    -   Consider the patient's body size, shape and features (e.g. very
        large abdominal girth can limit degree of hip flexion )

    -   Features of sling:

        -   consider where material covers the patient

        -   strap options for seated slings-the length of material for
            strap supports of the lower extremities can often be
            modified by selecting differing loop attachment points of
            the sling onto the hanger bar ( e.g. providing more material
            length will allow lower extremity to be in less flexed
            position)

        -   seated slings back height can vary from supporting whole
            trunk and head to covering pelvis/waist only. When upper
            extremities are involved, consider height of the sling --
            high back slings will wrap around and enclose an upper
            extremity, while a low back sling will allow upper extremity
            to be free

-   If alignment/positioning guidelines cannot be met with available
    sling accessory, transfer patient supine with sheet style sling or
    anti-friction methods, then sit upright.

-   The "Patient Care Sling Selection and Usage Toolkit" is available
    for download at:\
    <http://www.visn8.med.va.gov/patientsafetycenter/safePtHandling/toolkitSlings.asp>

# OR Algorithm 1: Lateral Transfer from Stretcher to and from the OR Bed

![](media/image19.wmf){width="6.584722222222222in"
height="7.998611111111111in"}

**OR Algorithm 2: Positioning and Repositioning the Patient on the OR
Bed to and from the Supine Position**

![](media/image20.wmf){width="7.003472222222222in"
height="8.098611111111111in"}

**OR Algorithm 3: Prolonged Standing**

![](media/image21.wmf){width="6.996527777777778in"
height="7.656944444444444in"}

# OR Algorithm 4: Retraction

![](media/image22.wmf){width="6.263888888888889in"
height="6.844444444444444in"}

**OR Clinical Tool 1: Lifting and Holding Legs, Arms, and Heads for
Prepping in a Perioperative Setting**

Key

  ------------ ----------------------------------------------------------
  No shading   OK to lift and hold, use clinical judgment, do not hold
               longer than noted

  Heavy        Do not lift alone, use assistive device or more than one
  shading      caregiver
  ------------ ----------------------------------------------------------

  ---------------------------------------------------------------------------------------------------------------------------------------------------------
  **Patient Weight lbs**  **Body**   **Body Part**                  **Lift**   **Lift**   **Hold**              **Hold**              **Hold**
  (kg)                                                                                                                                
  ----------------------- ---------- ---------------------- ------- ---------- ---------- --------------------- --------------------- ---------------------
                          **Part**   **Weight**                     **1-       **2-       **2-hand**            **2-hand**            **2-hand**
                                                                    hand**     hand**                                                 

                                     **lbs** (kg)                                         **[\<]{.underline}1   **[\<]{.underline}2   **[\<]{.underline}3
                                                                                          min**                 min**                 min**

  **[\<]{.underline}120   **Leg**    **[\<]{.underline}19   (9 kg)                                                                     
  lbs**                              lbs**                                                                                            

  ([\<]{.underline} 54    **Arm**    **[\<]{.underline}6    (3 kg)                                                                    
  kg)                                lbs**                                                                                            

                          **Head**   **[\<]{.underline}10   (5 kg)                                                                     
                                     lbs**                                                                                            

  **120-160 lbs**         **Leg**    **[\<]{.underline}25   (11 kg)                                                                    
                                     lbs**                                                                                            

  (54-73 kg)              **Arm**    **[\<]{.underline}8    (4 kg)                                                                     
                                     lbs**                                                                                            

                          **Head**   **[\<]{.underline}13   (6 kg)                                                                     
                                     lbs**                                                                                            

  **160-200 lbs**         **Leg**    **[\<]{.underline}31   (14 kg)                                                                    
                                     lbs**                                                                                            

  (73-91 kg)              **Arm**    **[\<]{.underline}10   (5 kg)                                                                     
                                     lbs**                                                                                            

                          **Head**   **[\<]{.underline}17   (8 kg)                                                                     
                                     lbs**                                                                                            

  **200-240 lbs**         **Leg**    **[\<]{.underline}38   (17 kg)                                                                    
                                     lbs**                                                                                            

  (91-109 kg)             **Arm**    **[\<]{.underline}12   (6 kg)                                                                     
                                     lbs**                                                                                            

                          **Head**   **[\<]{.underline}20   (9 kg)                                                                     
                                     lbs**                                                                                            

  **240-280 lbs**         **Leg**    **[\<]{.underline}44   (20 kg)                                                                    
                                     lbs**                                                                                            

  (109-127 kg)            **Arm**    **[\<]{.underline}14   (6 kg)                                                                     
                                     lbs**                                                                                            

                          **Head**   **[\<]{.underline}24   (11 kg)                                                                    
                                     lbs**                                                                                            

  **280-320 lbs**         **Leg**    **[\<]{.underline}50   (23 kg)                                                                    
                                     lbs**                                                                                            

  (127-145 kg)            **Arm**    **[\<]{.underline}16   (7 kg)                                                                     
                                     lbs**                                                                                            

                          **Head**   **[\<]{.underline}27   (12 kg)                                                                    
                                     lbs**                                                                                            

  **\>360 lbs**           **Leg**    **[\>]{.underline}57   (26 kg)                                                                    
                                     lbs**                                                                                            

  (\>163 kg)              **Arm**    **[\>]{.underline}18   (8 kg)                                                                     
                                     lbs**                                                                                            

                          **Head**   **[\>]{.underline}30   (14 kg)                                                                    
                                     lbs**                                                                                            
  ---------------------------------------------------------------------------------------------------------------------------------------------------------

# OR Clinical Tool 2: Lifting and Carrying Supplies and Equipment

  -----------------------------------------------------------------------
  **\                                     **\            **Level of
  Lifting Task**                          Lifting        Risk**
                                          Index**        
  --------------------------------------- -------------- ----------------
  3,000 ml irrigation fluid               **\<0.2**      

  Sand bags                               **0.3**        

  Linen bags                              **0.4**        

  Lead aprons                             **0.4**        

  Custom sterile packs (eg, heart or      **0.5**        
  spine)                                                 

  Garbage bags (full)                     **0.7**        

  Positioning devices off shelf or rack   **0.7**        
  (eg, stirrups)                                         

  Positioning devices off shelf or rack   **0.9**        
  (eg, gel pads)                                         

  Hand table (49" x 28")-largest hand     **1.2**        
  table-used infrequently                                

  Fluoroscopy Board (49" x 21")           **1.2**        

  Stirrups (2- one in each hand)          **1.4**        

  Wilson frame                            **1.4**        []{.mark}

  Irrigation containers for lithotripsy   **1.5**        
  (12,000 ml)                                            

  Instrument pans                         **2.0**        
  -----------------------------------------------------------------------

Key

  ------------ ----------------------------------------------------------
  No shading   Minimal risk -- Safe to lift

  Light        Potential risk -- Use assistive technology, as available
  shading      

  Heavy        Considerable risk -- one person should not perform alone
  shading      or weight should be reduced.
  ------------ ----------------------------------------------------------

# OR Clinical Tool 3: Pushing, Pulling and Moving Equipment on Wheels

+---------------------------+------+-------+-----+-----+--------------+
| **OR Equipment**          | *    |       | **  |     | **Ergonomic  |
|                           | *Pus |       | Max |     | Reco         |
|                           | hing |       | P   |     | mmendation** |
|                           | For  |       | ush |     |              |
|                           | ce** |       | D   |     |              |
|                           |      |       | ist |     |              |
|                           | *    |       | anc |     |              |
|                           | *lbF |       | e** |     |              |
|                           | (kg  |       |     |     |              |
|                           | F)** |       | *   |     |              |
|                           |      |       | *ft |     |              |
|                           |      |       | /   |     |              |
|                           |      |       | (m  |     |              |
|                           |      |       | )** |     |              |
+---------------------------+------+-------+-----+-----+--------------+
| Electrosurgery unit       | *    | (3.8  | **  | (6  | Task is      |
|                           | *8.4 | kgF)  | \>2 | 0m) | acceptable   |
|                           | l    |       | 00f |     | for 1        |
|                           | bF** |       | t** |     | caregiver    |
+---------------------------+------+-------+-----+-----+--------------+
| Ultrasound                | **   | (5.6  | **  | (6  |              |
|                           | 12.4 | kgF)  | \>2 | 0m) |              |
|                           | l    |       | 00f |     |              |
|                           | bF** |       | t** |     |              |
+---------------------------+------+-------+-----+-----+--------------+
| X ray equipment portable  | **   | (5.9  | **  | (6  |              |
|                           | 12.9 | kgF)  | \>2 | 0m) |              |
|                           | l    |       | 00f |     |              |
|                           | bF** |       | t** |     |              |
+---------------------------+------+-------+-----+-----+--------------+
| Video towers              | **   | (6.4  | **  | (6  |              |
|                           | 14.1 | kgF)  | \>2 | 0m) |              |
|                           | l    |       | 00f |     |              |
|                           | bF** |       | t** |     |              |
+---------------------------+------+-------+-----+-----+--------------+
| Linen cart                | **   | (7.4  | **  | (6  |              |
|                           | 16.3 | kgF)  | \>2 | 0m) |              |
|                           | l    |       | 00f |     |              |
|                           | bF** |       | t** |     |              |
+---------------------------+------+-------+-----+-----+--------------+
| X ray equip -- C-arm      | **   | (8.9  | **  | (6  |              |
|                           | 19.6 | kgF)  | \>2 | 0m) |              |
|                           | l    |       | 00f |     |              |
|                           | bF** |       | t** |     |              |
+---------------------------+------+-------+-----+-----+--------------+
| Case carts -- empty       | **   | (11.0 | **  | (6  |              |
|                           | 24.2 | kgF)  | \>2 | 0m) |              |
|                           | l    |       | 00f |     |              |
|                           | bF** |       | t** |     |              |
+---------------------------+------+-------+-----+-----+--------------+
| OR stretcher unoccupied   | **   | (11.4 | **  | (6  |              |
|                           | 25.1 | kgF)  | \>2 | 0m) |              |
|                           | l    |       | 00f |     |              |
|                           | bF** |       | t** |     |              |
+---------------------------+------+-------+-----+-----+--------------+
| Case carts -- full        | **   | (12.1 | **  | (6  |              |
|                           | 26.6 | kgF)  | \>2 | 0m) |              |
|                           | l    |       | 00f |     |              |
|                           | bF** |       | t** |     |              |
+---------------------------+------+-------+-----+-----+--------------+
| Microscopes               | **   | (12.5 | **  | (6  |              |
|                           | 27.5 | kgF)  | \>2 | 0m) |              |
|                           | l    |       | 00f |     |              |
|                           | bF** |       | t** |     |              |
+---------------------------+------+-------+-----+-----+--------------+
| Hospital bed --           | **   | (13.5 | **  | (6  |              |
| unoccupied                | 29.8 | kgF)  | \>2 | 0m) |              |
|                           | l    |       | 00f |     |              |
|                           | bF** |       | t** |     |              |
+---------------------------+------+-------+-----+-----+--------------+
| Specialty equip carts     | **   | (17.9 | **  | (6  |              |
|                           | 39.3 | kgF)  | \>2 | 0m) |              |
|                           | l    |       | 00f |     |              |
|                           | bF** |       | t** |     |              |
+---------------------------+------+-------+-----+-----+--------------+
| OR stretcher - occupied   | **   | (19.9 | **  | (6  |              |
| 300 lbs                   | 43.8 | kgF)  | \>2 | 0m) |              |
|                           | l    |       | 00f |     |              |
|                           | bF** |       | t** |     |              |
+---------------------------+------+-------+-----+-----+--------------+
| Bed - occupied 300 lbs    | **   | (22.7 | **  | (3  | Min 2        |
|                           | 50.0 | kgF)  | \<2 | 0m) | caregivers   |
|                           | l    |       | 00f |     | required     |
|                           | bF** |       | t** |     |              |
+---------------------------+------+-------+-----+-----+--------------+
| Specialty OR beds         | **   | (31.7 | **  | (3  |              |
| unoccupied                | 69.7 | kgF)  | \<1 | 0m) |              |
|                           | l    |       | 00f |     |              |
|                           | bF** |       | t** |     |              |
+---------------------------+------+-------+-----+-----+--------------+
| OR bed unoccupied         | **   | (27.9 | *   | (7. | Recommend    |
|                           | 61.3 | kgF)  | *\< | 5m) | powered      |
|                           | l    |       | 25f |     | transport    |
|                           | bF** |       | t** |     | device       |
+---------------------------+------+-------+-----+-----+--------------+
| OR bed occupied 300 lbs   | **1  | (51.1 | *   | (   |              |
|                           | 12.4 | kgF)  | *\< | 7.5 |              |
|                           | l    |       | 25f | m)  |              |
|                           | bF** |       | t** |     |              |
+---------------------------+------+-------+-----+-----+--------------+
| Specialty OR beds -       | **1  | (56.5 | *   | (   |              |
| occupied 300 lbs          | 24.2 | kg)   | *\< | 7.5 |              |
|                           | l    |       | 25f | m)  |              |
|                           | bF** |       | t** |     |              |
+---------------------------+------+-------+-----+-----+--------------+

Key

  ------------ ----------------------------------------------------------
  No shading   Minimal risk - Task is acceptable for 1 caregiver

  Light        Moderate risk -- Minimum of 2 caregivers or powered device
  shading      recommended

  Heavy        Considerable risk - Recommend powered transport device
  shading      
  ------------ ----------------------------------------------------------