How to change adult disposable diaper in wheelchair?
The following are the standardized operation procedures and precautions for changing adult diapers in wheelchairs, which are compiled as follows in combination with long-term nursing experience:
Preparation before operation
Fix the wheelchair
Immediately step on the brakes and unfold the bilateral armrest catches to ensure that the wheelchair is stable and does not slide. If necessary, use the safety belt to fix the waist of the elderly to prevent forward leaning during the operation.
Preparation
Unfold the care package (including 1 clean diaper, 2 pairs of PE gloves, 5 medical wipes, skin protection film, dirt bag) and hang it on the hook at the back of the wheelchair. Check that the diaper size matches the waist circumference (standard: waist tacks can overlap by 3-5cm).
Body position adjustment
Tilt back the backboard of the wheelchair by 15°-20°, release the footrest latch and assist the elderly to spread their legs naturally to shoulder width. Put an anti-leakage pad (60cm×90cm) behind the waist to absorb accidental drips.
Replacement procedure
Release the old diaper
Fix the waist of the elderly with one hand, insert the other hand from both hips and peel off the Velcro along the groin downwards. When folding the contaminated side inward, you need to use your thumb to hold the edge of the lining to prevent staining the skin.
Cleaning
Use the three-stage wiping method:
① Perineum: clean in one direction from pubic bone to anus, repeat 3 times;
② groin: unfold the skin folds spiral wipe;
③ perianal: to the anus as the center of radial cleaning outward. Change wipes for each wipe, keeping the total duration within 90 seconds.
Positioning the new diaper
Unfold the back piece of the adult diaper and tuck it along the gap between the backrest of the wheelchair and the buttocks, ensuring that the absorbent core completely covers the sacrococcygeal area. When lifting the front piece between the legs, keep it flush with the navel level, and turn out both sides of the leak-proof compartment at a 45° angle.
Pressure Adjustment
Insert two fingers to test the tightness after fixing the Velcro fastener (standard: it can accommodate the index finger and the middle finger sliding in parallel). Leave 2cm of movement space at the waistband to avoid affecting blood circulation.
Handling of Special Situations
Self-mobility assessment
For the elderly who can stand briefly, three-point support method is used: the caregiver's left knee pushes against the front crossbeam of the wheelchair, and both hands hold the elderly's armpits, assisting them to hang in the air for 2-3 seconds to complete diaper change.
Urinary incontinence with skin breakdown
When pressure ulcers of degree II or above are found, first apply wet compresses with 3% boric acid solution for 5 minutes, then apply zinc oxide ointment (thickness ≥2mm), and finally cover with hydrocolloid dressing before wearing diapers.
Fourth, quality control standards
Operation timeliness: the whole process ≤ 5 minutes (from preparation to finishing)
Leakage rate: ≤1 in 24-hour monitoring cycle
Skin integrity rate: incidence of perineal erythema ＜5%
It is recommended to check the use of adult diapers at 3 fixed times of the day (morning, after lunch break, and before bedtime), and to establish the regularity of excretion in conjunction with water intake time.
Preparation before operation
Fix the wheelchair
Immediately step on the brakes and unfold the bilateral armrest catches to ensure that the wheelchair is stable and does not slide. If necessary, use the safety belt to fix the waist of the elderly to prevent forward leaning during the operation.
Preparation
Unfold the care package (including 1 clean diaper, 2 pairs of PE gloves, 5 medical wipes, skin protection film, dirt bag) and hang it on the hook at the back of the wheelchair. Check that the diaper size matches the waist circumference (standard: waist tacks can overlap by 3-5cm).
Body position adjustment
Tilt back the backboard of the wheelchair by 15°-20°, release the footrest latch and assist the elderly to spread their legs naturally to shoulder width. Put an anti-leakage pad (60cm×90cm) behind the waist to absorb accidental drips.
Replacement procedure
Release the old diaper
Fix the waist of the elderly with one hand, insert the other hand from both hips and peel off the Velcro along the groin downwards. When folding the contaminated side inward, you need to use your thumb to hold the edge of the lining to prevent staining the skin.
Cleaning
Use the three-stage wiping method:
① Perineum: clean in one direction from pubic bone to anus, repeat 3 times;
② groin: unfold the skin folds spiral wipe;
③ perianal: to the anus as the center of radial cleaning outward. Change wipes for each wipe, keeping the total duration within 90 seconds.
Positioning the new diaper
Unfold the back piece of the adult diaper and tuck it along the gap between the backrest of the wheelchair and the buttocks, ensuring that the absorbent core completely covers the sacrococcygeal area. When lifting the front piece between the legs, keep it flush with the navel level, and turn out both sides of the leak-proof compartment at a 45° angle.
Pressure Adjustment
Insert two fingers to test the tightness after fixing the Velcro fastener (standard: it can accommodate the index finger and the middle finger sliding in parallel). Leave 2cm of movement space at the waistband to avoid affecting blood circulation.
Handling of Special Situations
Self-mobility assessment
For the elderly who can stand briefly, three-point support method is used: the caregiver's left knee pushes against the front crossbeam of the wheelchair, and both hands hold the elderly's armpits, assisting them to hang in the air for 2-3 seconds to complete diaper change.
Urinary incontinence with skin breakdown
When pressure ulcers of degree II or above are found, first apply wet compresses with 3% boric acid solution for 5 minutes, then apply zinc oxide ointment (thickness ≥2mm), and finally cover with hydrocolloid dressing before wearing diapers.
Fourth, quality control standards
Operation timeliness: the whole process ≤ 5 minutes (from preparation to finishing)
Leakage rate: ≤1 in 24-hour monitoring cycle
Skin integrity rate: incidence of perineal erythema ＜5%
It is recommended to check the use of adult diapers at 3 fixed times of the day (morning, after lunch break, and before bedtime), and to establish the regularity of excretion in conjunction with water intake time.