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).
3. 3.Show
   Assess the patient's pain and provide prescribed analgesia if required.
   Pain levels should be considered and adequately controlled prior to moving and positioning (Smith et al. [119], C).
4. 4.Show
   Ensure the bed is at the optimum height for the patient and 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 and patient (Aslam et al. [8], R).

Procedure

Upper limb amputee

1. 5.Show
   Ensure the patient is maintaining full range of motion of all remaining joints of the upper limb by encouraging active movements of the limb.
   To prevent contractures in case of possible prosthetic rehabilitation and functional use (Virani et al. [127], R).

Transfemoral amputee (above knee)

1. 6.Show
   Maintain hip in a neutral position.

   • In bed: ensure the patient is periodically lying supine or consider prone‐lying or side‐lying with the hip in a neutral position.
   • In a chair: ensure that the patient does not place a towel or pillow under the residual limb.
   To maintain hip extension and reduce the risk of developing a hip flexion contracture (Ghazali et al. [39], R).

Transtibial amputee (below knee)

1. 7.Show
   Maintain knee extension.

   • In bed: do not place a towel or pillow under the knee unless it is supporting the whole of the residual limb; that is, do not encourage the knee to be maintained in a flexed position.
   • In a chair: use a residual limb board on the wheelchair if one has been issued. If the patient is sitting out in a chair then support the stump with a footstool and pillows.
   To prevent knee flexion contracture (Ghazali et al. [39], R).

   To aid oedema management in the residual limb and promote healing (Smith et al. [119], C).

   To improve patient comfort and protect the residual limb (Bouch et al. [14], C).

Post‐procedure

1. 8.Show
   Document the procedure and its outcome in the patient's notes.
   To ensure effective communication between healthcare professionals and effective documentation of care completed (NMC [91], C).