Use of Different Types of Comfort/Support Devices

 BASIC PRINCIPLES IN POSITIONING OF PATIENTS

Maintain good patient body alignment. Think of the patient in bed as though he were standing.

Maintain the patient’s safety.

Reassure the patient to promote comfort and cooperation.

Properly handle the patient’s body to prevent pain or injury.

Keep in mind proper body mechanics for the practical nurse.

Obtain assistance, if needed, to move heavy or helpless patients.

Follow specific physician’s orders. A physician’s order, such as one of the following, is needed for the
patient to be out of bed.

 “Up ad lib.”

 “Up as desired.”

 “OOB” (out of bed).

Do not use special devices (that is., splints, traction) unless ordered. Ask if you do not know what is
allowed.

Definition

Comfort devices are mechanical invented articles which would add comfort to the patient when used
in appropriate manner and helping to maintain correct alignment or posture of body.

General Requirement

Any position support device should meet the following requirements.

(1) Promote good posture and conform to the part of the body being supported.

(2) Be firm enough to support the part, yet not cause undue pressure.

(3) Be of sufficient size to support a part along its entire length.

(4) Be clean and protected against moisture and body secretions.

1- USING OF MEDICAL SANDBAG

Sr# Types of Comfort Purposes Steps Rationale

Devices

Definition: .
Comfort devices: are Identify the patient Provide the therapeutic

mechanical invented intervention to the

articles right pt.

which would add

comfort to the

patient when used in Explain the procedure to Make mentally and

appropriate the physical

manner and helping to motivate and ready pt

maintain patient to

correct posture adapt the procedure.

Choose the correct size

and
Maintain required
Medical Sandbag body

These are filled with posture and Prevent

sands, weight of sandbag from

made of durable vinyl musculoskeletal injury.

reinforced

material. Wrap the sandbag with

 extra
Prevent from direct
1 skin

linen sheet friction and irritation.

Ask Pt for any skin

allergy to
Should be
Hypoallergenic

fabric?

Tear and damage can

Figure 1: sandbags with check for durability and cause

different sizes and

weight sand leakage.

seaming

Prevent & control pt

from
Should be Infection-
To immobilize the resistant
infection i.e. antifungal
&

body parts. material

antibacterial.

FIGURE 2: Elbow in
Made of Non-magnetic
raw
anteroposterior
position The operation theatre,

materials

with sandbag on palm

MRI/X-rays or the pt
room

might contain various

 electronic equipments
and

To apply traction
to

influence of magnetic

the distal parts of

materials might impact

limbs. the

proper functioning.

FIGURE 3: Patient in

erect lateral cervical

Maintain the skin

position with sandbags integrity

Should be Stain and

moisture free

To support body parts.

FIGURE 4: Hand in

oblique position on sponge

with sandbag across

forearm
Should adjust the
sandbag at
Prevent muscles
from extra

accurate angle and pressure and

required fatigue.

part of the body

1- USING OF MEDICAL SANDBAG

These are filled with sands, made of durable vinyl reinforced material.

Figure 1: sandbagswith
different sizes and weight

While sandbags are often assumed to contain only sand, but some contain ferrous pellets
or iron oxides that add weight to the sandbag without increasing its size.

Purposes

 To immobilize the body parts.

  To support body parts.

 To proper align the skeleton bones during image techniques

 To help the femoral artery heal (hemostasis) after cardiac catheterization procedure.

Sr# Guidelines Rationale

1 Identify the patient Provide the therapeutic
intervention to the right pt.

2 Explain the procedure to the patient Make mentally and physical

motivate and ready pt to
adapt the procedure.

3 Choose the correct size and weight of sandbag Maintain required body
posture and Prevent from
musculoskeletal injury.

4 Wrap the sandbag with extra linen sheet Prevent from direct skin
friction and irritation.
5 Ask Pt for any skin allergy to vinyl fabric? Should be Hypoallergenic.

6 check for durability and seaming Tear and damage can cause
sand leakage.

7 Should be Infection-resistant material Prevent & control pt from

infection i.e. antifungal &
antibacterial.

8 Use only sandbags that are labeled with MR Safe and The magnetic field generated
by an MRI unit will attract
made of Non-magnetic , non conductive raw materials ferromagnetic objects with
considerable force.

9 Should adjust the sandbag at accurate angle and Provide effective support and
required part of the body prevent muscles from extra
pressure and fatigue.

10 Should be Stain and moisture free Maintain the skin integrity.

11 Assist the client in handling and changing site of sandbag Prevent from muscular injury,
sprain or strain.
 

(1) The Gatch bed. Raising and lowering the back and knee rests on the adjustable Gatch bed provides
support and allows for position changes, but there are disadvantages that must be considered. When
the back rest is elevated, the patient tends to slide down in bed, with his body weight concentrated on
the base of his spine. This is undesirable.

Elevation of the knee rest counteracts this to some extent, but continued use of the knee rest causes
undesirable pressure in the popliteal space (behind the knee) and can lead to restrictions in the range
movement of the knee and hip. The Gatch bed should be used for variations in position and not as a
substitute for active movement of the patient.
 
Shoulder Roll
Purposes
1. Use to achieve a clear sniffing position opening during endotracheal tube intubation (ETT).
trochanter roll a wedge (usually a rolled towel) placed from the crest of the ilium to midthigh to
prevent external rotation of the hip when the patient is in a recumbent position. Use of trochanter
roll to prevent external rotation of hip.

The Position Of Trochanter Roll

The patient is placed in a “laying down” position. They will be laying down on their back. The
trochanter roll is placed on both sides the of the hip joints. It ranges in length from the lower back
to the mid thigh.

As mentioned earlier, this keeps the legs (and hips) from rolling outward and away from the body.
When the legs  roll outwards, that will over extend the hips and spine. To protect the spine and
make sure it is properly aligned with the head, a pillow might be placed under the feet to elevate
the leg.

The arms rest along side the body. They can also rest on the chest or stomach.  Also, make sure the
neck and head are properly supported. It is very important that the body maintains proper posture
and that no joints or muscles are put into unnatural positions.
Comfort Pillow has multiple uses, but placement in relation to body curves is essential.

Orthopedic contour pillow specially wedge shape pillows

Pillows come in even greater varieties of materials, shapes and sizes. Choose a pillow that supports
your spine in a neutral position when you are laying on your side or back.
 A healthy pillow keeps your neck and upper back in natural alignment. The head and neck should
always be alignment in whatever position they are sleeping in (see figure below). Patients who have
chronic neck problems and straightened/reversed curves in their neck may benefit from using cervical
support pillows. These are pillows that tend to be firmer that have a “bump” on either side to maintain
a healthy alignment for the neck.

Purposes

Ergonomic Design pillows prevent SNORING sleep wrinkles on body.

Keeps you aligned in a natural position, which expands the breathing passage

 
.

Resting on the Side with Pillows

 Support the head with a pillow.

 Place a pillow behind the back for support.

 Place a pillow lengthwise between the legs. Do not let the knees or ankles touch each other
while on the side.

 Place a foam pad between the ankles and between the bed and the ankle.

 Keep the feet from leaning on the footboard.

  Support the top arm with a pillow (let the arm rest on top of the pillow).

 Do not pull or jerk the arm out from the side.

 Support the top arm with a pillow (let the arm rest on the pillow).

1- Abduction Pillows

There are two common types of abduction pillows.

A. Hip Abduction Pillow

B. Shoulder Abduction Pillow

ABDUCTION PILLOW

Definition
Abduction pillows are wedge-shaped sponge rubber with lateral indentations for the patient’s thighs
and straps that wrap around the thighs to maintain a proper position and body alignment.

Purpose

 It helps to prevent internal hip rotation after a femoral fracture, hip fracture or surgery.  
 It may also be used after surgery such as an open reduction and internal fixation (ORIF) or a hip
arthroplasty. You may need to use a hip abduction pillow for several weeks.

Articles Required
 Abduction pillow
 Hip Abduction Brace
 Extra Pillow (Head)
 Precautions
Encourage patients to avoid bending at the hip past 90°, twisting their leg in or out, and
crossing their legs. Hip precautions focus on limiting the internal rotation, external rotation,
adduction, and flexion of the hip.

Procedure
Sr. STEPS RATIONALE
#
1 Explain the proper procedure to the patient. Mentally, physically relax and ready the patient
for application of procedure.
2 Ask patient to lie flat/supine on bed. Legs are properly aligned.
3 Place the pillow between thighs. The Pillow Prevent the hip/legs from internal rotation.
 should touch each leg from thigh to ankles.
4 Attach the pillow to thighs and ankles. Full support to both legs from hip to the ankle.
5 Wrap the straps around thighs and ankles and Provide extra support to legs and prevent from
attach to the pillow. unnecessary outward/inward movement.
6 Tighten the straps to prevent legs from moving
outward.

Figure: Abduction Pillow

Alignment and Pressure-reducing Devices

Positioning devices are used to maintain the functional position of the wrists, hands, fingers,
ankles and other extremities. To prevent hip and knee contractures, the major joints should be
placed in extension. These devices include:
 Cradle boots
 Abduction pillow
 Trochanter rolls
  Hand rolls
CRADLE BOOTS
Cradle boots are used to protect the heels and help to prevent skin breakdown and footdrop.
These devices are made of rubber with heel cutouts. It cushions the ankle and foot without
completely enclosing it.

Key Concept A lifting sheet is often used to help move clients.This may also be called a transfer
sheet, draw sheet, or turning sheet.
Nursing Alert Only specially trained clinical nurses should attempt to turn clients with an
unstabilized cervical spine injury.

6) Air rings: It is made of rubber and filled with air. It should have sufficient air in it to partially
inflate it but at the same time it should, remain soft and flexible. Air rings are used under a
patient's sacrum to take pressure off the bony prominenees. The air ring is covered with cotton
cloth to prQtect the patient.
7) Air rings are also used to protect the skin over bony prorninences, but caution is
needed while using because they are also known to increase pressure upon tissues and may
interfere with circulation.
Air cushion
1- Coccyx cushion
2- Definition
Designed specifically for the tailbone, this cushion is made of gel or heavy-duty foam-
form, with a cutout at the back to relieve pressure on the tailbone or spine
purpose
One way to alleviate coccyx pain is to use a coccyx cushion.
Sit in a chair with a back. Use the coccyx cushion in a chair with a back that will give you extra
support. The cushion naturally helps improve your posture by slightly elevating your hips, and sitting
in a chair with a back will help you sit up straight and eliminate pressure on your spine and pelvis.
  When using a cushion on a chair that is a comfortable height for you, your thighs may be
slightly higher than usual. To offset this difference, try using a footstool to make sure your
lower body is still in a comfortable position. If the chair is adjustable, then you can also adjust
the height of the seat to make yourself more comfortable.
Some cushions may come with gel insert that you can warm up or freeze before reinserting them
and using the cushion.
Coccyx cushions differ from ring or doughnut cushions, which have a hole in the middle, and help
reduce pressure on the anal and prostate region in cases of hemorrhoids and swollen prostate
 Coccyx cushions are also often used to help relieve pain from other chronic pain conditions
and inflammatory pain or to relieve pressure on the back and pelvic area during pregnancy.
 A coccyx cushion (sometimes called a wedge cushion) is a U-or V-shaped pillow that protects the
coccyx from uncomfortable pressure. Some cushions are also formed as a wedge. The U- or V-shape,
in comparison with the circular doughnut cushions, often provide more comfort for people with
tailbone pain. These cushions can also be used to provide comfort for those with hemorrhoids (piles)
pain, prostate disorders, pilonidal cysts or degenerative bone disease.

Cushions:
A cushion for your wheelchair is essential. Cushions provide pressure relief and weight distribution
and thus aid in the prevention of pressure sores. Many types of cushions exist, but there is no
“ideal” cushion. Use the cushion recommended by your physical therapist/physiatrist.
 If air is used in the cushion, check to see that it is filled correctly. If you are going to a
different altitude, there will be a change in your cushion.
 If your cushion is made of foam, check to see that it is firm and in good condition. If it gets
dry, powdery and loses its firmness, replace it immediately. Use only good quality foam.
Polyurethane foam with a density of 1.2 and compression of 30 to 35 is recommended.
 In case of body weight change, you may need to change the width of your chair, the
frequency of your weight shifts, and the type of cushion you use.
Never use rubber air rings or rubber doughnuts. They are dangerous because they block the flow of
blood to the skin inside the leg.
Weight shifts are essential. The cushion alone will not prevent pressure sores.
In Addition:
 Make sure the foot pedals of your wheelchair are adjusted to the right height for you. If your
foot pedals are too high, it will put pressure on your hips;
 Sit up straight in your chair. Slumping or slouching leads to added pressure over the end of
your tailbone.
 Lean to One Side
Do Not:
 Use a rubber air ring or any kind of doughnut – they create a lot of pressure where you don’t
want it, and block the flow of blood to skin inside the ring.
BED CRADLE

A bed cradle is used to keep the weight of bed coverings off the body part to be protected.

Moreover, the dimensions of the bed cradle enable the limbs to be elevated on pillows when
necessary. When using the bed cradle, bed making is modified for protection and comfort of
the patient and to maintain a neat appearance.

The following equipment and procedures are appropriate when a bed cradle is to be used.

a. Equipment.

The equipment required when using a bed cradle follows:

(1) Bed cradle, standard model or field (collapsible).

(2) Roller bandage.

(3) Usual allowance of bed linen, plus one additional sheet and blanket.

b. Procedure.

The bed foundation is completed as for the patient occupied bed. Proceed as follows:

(1) Place the cradle in position over the patient, with no part in contact with a body part. Secure
the cradle in place with bandage loops tied to the bedframe.

(2) Place the top covers to provide adequate covering for the shoulders, then drag these ends
over the head-end of the cradle.

(3) Place the additional blanket and covering sheet crosswise over the cradle, overlapping the
top covers with the surplus toward the foot of the bed.

(4) Tuck the surplus edges of the cradle covering under the foot of the mattress. Miter corners,
arranging the top folds to hang free. Fold back the overlapped covers as required for access to
the body part protected by the cradle.
(1) The Gatch bed. Raising and lowering the back and knee rests on the adjustable Gatch bed
provides support and allows for position changes, but there are disadvantages that must be
considered. When the back rest is elevated, the patient tends to slide down in bed, with his
body weight concentrated on the base of his spine. This is undesirable. The Gatch bed should
be used for variations in position and not as a substitute for active movement of the patient.