Bariatrics: Inserting a sling under a comatose bariatric patient

I have been receiving questions on how to best get a sling under a comatose and vented patient. The patient was extremely obese and log rolling was very difficult. My real question is can slings for bariatric patients be placed using the "jelly roll" technique? Also, is it safe to use a slide similar to a maxi slide as a means of turning the patient and then leave one portion of the slide between the patient and the sling? Thank you for your assistance in this matter.

Joan Blust
Risk Control Specialist/Healthcare
PMA Management Corp. of New England

Dear Joan:

Moving a bariatric patient around the bed, or placing a sling under him, is a challenging task and will often take up to three or more caregivers. To begin, it is important to minimize friction and shear while positioning the patient correctly. There are several types of repositioning equipment available that will help reduce friction and shear, including the slide sheets to which you refer. Following are a couple of different approaches you may wish to consider:

1. Upon admission, or as soon as possible, place the patient onto a repositioning sheet (preferably bariatric size). This will enable you to log-roll the patient more easily using a lift. The sling can then be placed under the patient in the conventional log-roll manner. An overhead lift is the preferred assistive device due to its inherent convenience and the other issues you allude to such as lines, vents, etc. Note that most repositioning sheets can be left under the patient for an extended period of time.


2. The Lift Doctor is not familiar with the “jelly roll” technique you describe; however, sliding sheets or sliding tubes represent another possible solution. Note that it is important to find the correct size for each patient. Sliding sheets or tubes, if appropriately used by the right number of trained staff, will also reduce friction and shear and help the patient to avoid discomfort. Once in place, they can then be used for repositioning, positioning slings or log-rolling the patient where the bed is not wide enough to turn the patient onto their side. Be sure to follow the manufacturer’s recommendations for inserting the sliding sheet under an immobile patient. Also, note that sliding sheets or tubes should not be left under the patient due to the danger of slipping out of the bed or sling and the inability of the fabric to allow the patient skin to breathe properly.