Clinical help needed for a Bariatric patient!

[StewartOT]

Hi,

I just registered for this site to learn more about bariatric nursing care. I'm an Occupational Therapist and have been working in LTC for the past 3 years. I have a patient who has very severe long-standing (20+ years) lyphedema and cellulitis post-MVA. She had undergone several treatments over 10-15 year ago with no improvement and has since declined all attempts to try newer, possibly more effective (like air compression devices). It's understandable in that the therapy at this point may be more painful than just bearing it.

She is not fully independent in her transfers from her bed to her chair (a recliner with full automatic recline and stand-assist) as she requires help getting her feet off the edge of the bed (1-2 staff) as they are too heavy for her to lift. Staff have been using a sheet under her lower legs to pull them to the edge and once they are over the edge, she is able to sit up and stand with her wheeled walker. She is able to walk slowly to her recliner and sit, and is able to get up from her recliner due to the stand-assist feature. She only walks short distances (to and from the dining room). Getting into bed, she required 2-3 staff, as she needs one person to lift each leg (from sitting up at the edge of the bed to getting her legs on the bed) and one to supervise her upper body (upper extremities are WFL, but she is not able to lift herself completely or safely pull her legs up).

She insists on having her legs washes daily and the bandages redone. This is done by bringing her to the bathroom (she walks in) and having her sit on the bariatric shower bench while the nurse washes her legs. She then walks back to her recliner and while reclined, has her banadages and dressings changed. The problem here is that even in full recline, the nurse has to squat, sit on the floor or bend to do the dressings, and requires a second person to lift the patient's lower leg to wrap the bandage around it.

The main issue here at this point is the risk to the staff in performing these lifting and pulling movements repeatedly. We are looking into a hi/lo KCI bed to help manage her pressure ulcers and maximise proper body mechanics during transfers, but other than that, we are at a loss as to how to safely maneuver this patient. Bariatric lifts can manage her weight (~190kg) but the issue is the slings cut into her skin.

Cost is an issue, but if there is a solution I'd still like to hear your ideas(irrespective of cost - let me know!). One product that I found is the BariAir bed from KCI, but what a hefty price tag!

So, my questions are:

1) What are the best means of assisting her on and off her bed to minimise bending, reaching, pulling and lifting?

2) Is there any specialised item/equipment that can be used to lift her legs only? (bariatric slings that take into consideration her skin issues? lifts designed just for legs?)

Anyway, I really appreciate any help that you can provide. We get about one patient with these sorts of needs every couple of years, so the staff (nursing/medical/rehab) are all trying to do what we can for her. Any links to related forums or organisations that may have some more answers would be greatly appreciated as well!

Thanks in advance!

Stewart