How to Set the Patient up for Mobility

General Tips

  • If the patient is sedated, can sedation be lightened or turned off? Coordinate with the bedside nurse to schedule time for therapy when sedation can be weaned to maximize participation

  • Has the patient been getting out of bed and into the chair each day? Do you want to work with the patient while they’re still in bed or seated in the chair? Do you want to see how they transfer and be the one to help them into the chair? It is important to coordinate these things with the nurse.

  • When transferring the patient to the chair, especially if it’s for the first time, be sure to place a Hoyer lift sling in the chair in case the nurse needs to use it when the patient returns to bed.

  • Ensure all drains are clamped and accounted for prior to any position change

  • Lines, wires, and tubes can be easily tangled. Be sure to organize all necessary lines and reposition to the side you will be moving the patient to (generally to the side the vent is on if the Patient is intubated).

  • Be sure to check with the nurse regarding what lines you may be able to disconnect to increase ease of mobility and ADL participation.

Mobilizing a Patient on Mechanical Ventilation 

(Zanni, n.d.)

*If FiO2 is ≥ .60 and/or PEEP ≥ 10 cm H2O, talk with the team to ensure medical stability.

  1. If the patient is orally intubated be sure to first check the ETT placement

—Make sure tape is secure and check marking/number at the lip before/after/during treatment to assure no movement has occurred

2. Note baseline vitals and vent settings

3. Locate and consolidate all wires, tubes, lines. Move lines/equipment to the same side that you are getting the patient up on (usually towards the vent).

—*Of note, there is often water accumulated/condensation on the ETT tubing which should be removed by RN/RT prior to therapy so it isn’t accidentally drained into the lungs.

4. Assist the patient during bed mobility and transfers. Be sure all lines/equipment is accounted for and you have enough slack. Continue to manage lines to ensure clearance and avoid pulling with for activity/transfers/mobility.

5. If ambulating, coordinate with nursing and RT to place on portable vent (if needed). May also coordinate with Physical Therapy. Organize lines/equipment in front of the patient and ensure nothing is dragging on the floor or caught in equipment.

—Generally, the RT manages the vent and the therapist manages the patient and lines. Can also have the RN (or rehab aide) follow with a wheelchair as needed.

References