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01.02 Linen Change

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Overview

  1. Purpose
    1. Clean linens improve patient comfort and skin condition
    2. Required after bed bath or episode of incontinence

Nursing Points

General

  1. Supplies needed
    1. Supplies for incontinence care, if needed
    2. Fitted sheet
    3. Draw sheet
    4. Incontinence pad (optional)
    5. Top sheet and blanket
    6. Pillowcase(s)
    7. Linen cart/bag

Nursing Concepts

  1. Steps and Nursing Considerations
    1. Gather supplies
    2. Explain procedure to patient
    3. Perform hand hygiene
    4. Place bed at comfortable working height, lock wheel brakes, and place patient in appropriate position
      1. Laying flat if tolerated
      2. Be sure to pause enteral feedings when laying flat for prolonged periods of time
    5. Apply clean gloves if risk of contact with bodily fluids
    6. Remove top sheet and blanket
      1. Ensure privacy of patient
    7. Turn patient to one side
      1. If patient is unable, have a UAP or other nurse to assist
      2. Ensure side rails are up/locked
    8. Remove corners of fitted sheet from the side of the bed the patient is not turned toward
    9. Roll old linens toward the center of the bed (dirty side in) and tuck under patient’s back
    10. Apply the new linens, fitted sheet → draw sheet → incontinence pad
      1. PRO tip: make the bed roll of linens first, then just roll out onto the bed
    11. Roll or fan-fold new linens under old ones
      1. Use a towel or incontinence pad to protect clean sheets if needed
    12. Have patient roll back over the linens to their other side
      1. “Roll over a big lump”
    13. Carefully remove the old linens and discard appropriately
      1. Roll/fold so the dirty side stays on the inside
      2. Avoid touching your scrubs
    14. Roll out the clean linens and secure the fitted sheet
    15. Pull/stretch sheets to smooth out wrinkles
      1. Wrinkles can cause pressure ulcers
    16. Turn the patient to desired/comfortable position, raise head of bed, apply new top sheet and blanket
    17. Remove pillow from old pillowcase
    18. Turn new pillowcase inside out and grab the corners of the pillow. Pull the pillowcase over the pillow and place behind patient’s head, under arms, or wherever the patient desires
    19. Return bed to low/locked position
    20. Ensure patient is comfortable
    21. Document procedure and patient response/tolerance
  2. Notes
    1. All dirty linens should go directly in a linen cart, not on the floor
    2. Ensure to restart any tube feeds if you paused them for the procedure

Video Transcript

In this video, we’re going to show you how to change the linens with a patient in the bed. This might be after a bed bath or during incontinence care. So check out the bed bath video to see what got us up to this point.

To start, make sure you have all of the linens that you need. A fitted sheet, a draw sheet, an incontinence pad (which is optional), a top sheet, a blanket, and replacement pillow cases for your pillows. You also want to make sure you have a linen cart close by because we never throw linens on the floor.
If you haven’t already, remove the top sheet and blanket, then turn your patient to one side. If the patient can’t turn themselves, you’ll need a helper for this part.
Then you’re going to remove the fitted sheet from your side of the bed and roll the linens inward toward the patient. You’ll want to kind of tuck them under the patient’s back or hips.
Then you’ll get your new fitted sheet and secure it to the corners of the bed and drape it up over the patient for a minute. This gives you a chance to lay out your draw sheet and your incontinence pad so they’re centered before you start rolling the sheets up. A little pro tip here – I make my full bed roll before I start, that way all of the sheets are already centered and all I have to do is lay it own, secure the fitted sheet, and tuck it under the patient.
So once you have your sheets laid out, you want to roll or fan-fold them toward you and then tuck them up under the dirty sheets that are already under the patient. If you need to, you can place a towel between the dirty and clean sheets to protect them.
Now you’re going to have your patient roll back over the linens. I always say something like “Okay you’re gonna roll over a big hump in the sheets now”. Once they’re on the other side, gently, carefully pull out the old linens – I usually keep rolling and tucking them to keep from splashing or splattering anything. You also want to keep from touching your scrubs with them. Once they’re off, throw them in the linen cart or bag.
Then pull out the new sheets from under the patient, secure the fitted sheet in the corners, and make sure there are no wrinkles in the draw sheet or incontinence pad. Even wrinkles in the sheets can cause pressure ulcers in high risk patients.
Now you can turn your patient back on their back and put them in a comfortable position, cover them with a sheet and blanket and give them a new gown if you haven’t already.
Now you can change the pillowcases. Here’s our cool trick. First, of course, take the pillow out of the old pillowcase and throw the case in the linen bag. Then turn the new pillowcase inside out. Reach in and grab the corners, then grab the corners of the pillow and shake! Okay, sometimes you have to pull the pillowcase down over the new pillow. But, I promise it’s better than trying to shove a pillow into a pillowcase!
Give your patient their new pillows, prop up their arms, make them comfortable, and then you’re all set!

So that’s how to change linens in an occupied bed. Of course, if your patient gets up to a chair or goes out to ambulate, those are GREAT times to change linens when they AREN’T in the bed, too!

Now, go out and be your best selves today. And, as always, happy nursing!

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