Picture the smallest nurse on your staff poised over a sumo wrestler, readying to shift him onto the OR table. Outrageous? Perhaps, but similar scenes are no longer limited to bariatric centers outfitted for weight-loss surgery. It's no secret that the obesity problem affects the general patient population, filling waiting rooms at surgery centers and hospitals with overweight, if not obese, patients. Regardless of the type of facility you run or the cases you host, your staff and facility must be prepared to lift and move large patients. Thankfully, much of today's transfer equipment is designed to do just that at each stage of the perioperative process. Being familiar with the options will help you supply your staff with equipment to protect themselves and the patients they're lifting.

Slide, shift and lift
One of the most useful products for transferring heavy patients is an inflatable mattress that slides under the patient. When it's time to move the patient, the mattress is inflated and the pillow of air makes it easier to shift the patient from one surface to another. This lets fewer nurses do the same job as many and with less effort, is much more comfortable for patients and can help prevent friction injuries to patients' skin. Inflatable mattresses must be attached to a small motor for inflation. That motor can be cumbersome to maneuver around and store, but the strain avoided and the safety provided by the device are well worth minor inconveniences. The mattress should be removed from underneath the patient after the transfer is complete.

Patient transfer sheets are another option for lateral transfers. Staff place two layers of nylon-coated sheets underneath the patient and simply slide the patient from stretcher to OR table, for instance. The slick surface cuts down on friction injuries and also eases the repositioning of patients once they're placed on the table. Nylon sheets are easy to store, can be kept with a patient throughout their hospital stay and can be used much like a draw sheet in many different clinical situations. It's important to remove the nylon sheets from underneath a patient when not in use, as they don't let skin breathe and could lead to patients inadvertently sliding around the surface on which they lay.

Both air mattresses and patient transfer sheets must be rolled out under the patient, so be sure to match the size of the devices to the width of the beds or stretchers in use at your facility.

Consider purchasing a patient lift if you're dealing with extremely heavy patients who can't be moved with air mattresses or transfer sheets. Several kinds of lifts are available, ranging from full-body lifts to less complicated models designed to help patients stand and walk. With these devices, a nurse places a head-to-toe mat under the patient to support the entire body or, alternatively, uses a chair-type support placed under the buttocks. The mats are then connected to hooks on the lift's crane, lifting the patient with a motorized lifting arm system.

Permanent lifts can be installed in a single room or mobile units can be employed for use in many clinical areas. Costs and sizes of lifts may limit the application in some small facilities, but one mobile lift device could service several units or even a small hospital.

While a clear help to patient transfer, none of these assistive devices can replace adequate staffing or proper body mechanics necessary for safe patient transfers and lifting. To avoid unnecessary strain, you'll probably need at least two people to move an overweight patient from an inflated mattress and three staffers when using patient transfer sheets. The staff making the move should keep patient safety in mind at all times by protecting a patient's head and taking the necessary precautions to avoid other unintentional injures.

In the OR
For those of you in a large hospital setting, many different models of beds currently on the market are specifically designed to accommodate bariatric patients. They are wider than standard beds and accommodate more weight. Some models also feature inflatable mattresses to elevate the patient and to prevent pressure ulcers by distributing pressure evenly across the patient's skin along his buttocks and back.

One main benefit of these beds is that some can be adjusted to put the patient into a seated or even a full standing position. When looking for bariatric beds, consider the width of the bed, the bed's motorized functions and how effectively they will operate in actual practice. Some beds may also be able to weigh patients. Most have motorized functions for lifting a patient's head and feet, which can make them easier to use when lifting a large patient. Be sure to check the ability of inflated mattresses to deflate quickly. You also have to look at the width of doorways, hallways and rooms in your facility because these beds are wider and may not fit in all areas.

If the beds are on wheels, patients can be moved directly into the OR and moved alongside the operating table. The mobility cuts down on the number of transfers performed throughout the perioperative process and the beds' adjustable positioning can assist patients who have trouble standing under their own power.

Heavy patients often have a couple of positioning needs, but it's not just a matter of considering how many pounds they weigh. You also need to be sure the OR table and any attachments necessary for the procedure are wide enough to accommodate the extra girth. The next time you're buying arm boards or leg stirrups, you may want to make sure they can adjust to hold larger-sized limbs and can accommodate heavier patients so they don't strain the support's joints.

One of the top concerns for positioning obese patients on their backs is that the placement will make them prone to sciatic nerve injuries, even during short procedures. Staff should try to position patients to shift the weight from the hips to reduce this risk. This is especially true if a patient's legs are splayed during a procedure because this positioning applies extra pressure on sciatic nerves. Putting pads underneath one side of the patient's back can help alleviate the pressure but won't eliminate the risk.

Constant need
To prepare for the inevitable arrival of larger patients at your facility, first review the weight limits for all of your equipment. Look at wheelchairs and OR tables, but also consider the construction of the chairs in your waiting room, the weight capacity of your public toilets, and the sizes of blood-pressure cuffs and gowns.

When reviewing your equipment inventory, take the time to think about how well they can accommodate the weight and girth of oversized patients. Some OR tables, C-arms and radiology equipment in particular may not be able to handle larger patients. Knowing what your equipment can't do may dictate the appropriate clinical action for your staff to take. For instance, staff might need to utilize a different diagnostic test or procedure if equipment cannot handle a patient.

Developing relationships with vendors that rent transfer devices may be the best way to ascertain what your facility needs before making big purchases. In the long term, renting these devices can help defray costs if you don't routinely host overweight patients. But since obesity rates are rising and obese patients require surgical care that goes beyond weight-loss procedures, all facilities need to plan to safely accommodate overweight patients on a regular basis.