SPECIAL ORTHOPEDIC BEDS--TURNING FRAMES
a. Turning frames are devices used to provide immobilization and to facilitate
nursing care for the patient who, while immobilized, requires frequent repositioning from
supine to prone. In addition to its orthopedic applications, a turning frame is used in the
treatment of patients with such conditions as spinal cord injuries and severe burns.
b. The major advantage in the use of turning frames is the prevention of the
complications given below.
(1) Pressure sores. With relief of pressure from body weight on bony
prominence and pressure areas, blood supply is improved. Additionally, large body
areas may be exposed for skin care.
(2) Respiratory congestion. Rotation of the patient from face-up to
face-down aids in loosening and ridding the lungs of fluid accumulation. The patient
can cough and expectorate more effectively in the prone position.
(3) Kidney and bladder complications. Rotation of the patient aids in
elimination of urine sediments that are potential causes of kidney stones.
c. Nursing management of a patient in a turning frame is the same as for any
other immobilized patient. The nature of the care required depends upon the reason for
immobilization (casts, traction, paralysis, and so forth). Nursing care of the immobilized
orthopedic patient is discussed later in this lesson in Sections V and VI.
1-10. TYPES OF TURNING FRAMES
a. Double Frames. The Foster reversible orthopedic bed (see figure 1-3) and
the Stryker turning frame (see figure 1-4) are commonly used. Both are double frames,
which are rotated on the longitudinal (side-to-side) axis. The operation of both is similar
in principle, with variations in the details of preparation for use. Both have a
rotary-bearing turning apparatus at each end, which allows traction to be maintained
during the turning process. The patient is "sandwiched" between two canvas-covered
frames when he is turned. The anterior frame, on which the patient lies prone, is
constructed of either two pieces of canvas or one piece of canvas with a perineal cutout.
The posterior frame, on which the patient lies supine, is constructed with two pieces of
canvas that have an open space between them for the buttocks. A canvas buttocks
strap is used between the two sections to keep the buttocks from sagging. This strap is
removed only for skin care or bedpan use.
b. Improvised Litter Frames. Two canvas litters, padded with blankets, may
be used as anterior and posterior frames when commercially manufactured frames are
not available. The frames are placed on sawhorses for greater stability, but may also
be used with standard litter brackets. Litter straps are used to bind the two frames
together for turning.