Pre‐procedure

ActionRationale

1. 1.Show
   Introduce yourself to the patient, explain and discuss the procedure with them, and gain their consent to proceed.
   To ensure that the patient feels at ease, understands the procedure and gives their valid consent (NMC [91], C).
2. 2.Show
   Wash hands thoroughly with soap and water or use an alcohol‐based handrub.
   To reduce the risk of contamination and cross‐infection (NHS England and NHSI [83], C; WHO [132], C).

Procedure

1. 3.Show
   Ensure the bed is at the optimum height for the handlers. If two handlers are required, try to match the handlers’ heights as far as possible.
   To minimize the risk of injury to the practitioners (Treadwell [123], E).
2. 4.Show
   Ask the patient to sit up in the centre of the bed. The angle at which the patient sits may be influenced by pain, fatigue, abdominal distension or level of confusion/agitation.
   To reduce the risk of falls by ensuring the patient is not too close to the edge of the bed (Richardson and Carter [107], E).

   To encourage haemodynamic stability (Heravi et al. [45], E).

   To enable effective breathing patterns, maximizing basal expansion (Katz et al. [56], R).

   To assist in functional activities such as eating and drinking (Szczygieł et al. [121], E).
3. 5.Show
   Ask the patient to position their hips in line with the hinge of the automatic mattress elevator or backrest of the bed.
   To ensure good postural alignment – that is, flexing at the hip when sitting up in bed (McInnes et al. [73], E).

   To prevent strain on the spine. (Szczygieł et al. [121], E).
4. 6.Show
   Place a pillow under the patient's knees or use the electrical control of the bed to slightly bend the patient's knees (Figure 7.2). Extra care should be taken if the patient has a femoral line.
   To reduce strain on the lumbar spine (Szczygieł et al. [121], E).

   To maintain the position (McInnes et al. [73], E).
5. 7.Show
   Place a pillow under individual or both upper limbs for patients with a chest drain, upper limb weakness, trunk weakness, or surgery involving the shoulder(s), upper limb, breast(s) or thorax. Also do this for fungating wounds involving the axilla, breast(s) or shoulder(s); for upper limb or truncal lymphoedema; and for fractures involving ribs or upper limbs.
   To provide upper limb support (McInnes et al. [73], E).

   To maintain trunk alignment (McInnes et al. [73], E).

   To encourage basal expansion (Katz et al. [56], R).

Post‐procedure

1. 8.Show
   Document the details of the procedure.
   To fulfil the legal requirements of the professional body and employing institution (NMC [91], C).