Assisting a Patient With Ambulation Using Crutches

Goal: The patient ambulates safely without experiencing falls or injury.

1. Review the medical record and nursing plan of care for conditions that may influence the patient’s ability to move and ambulate. Assess for tubes, IV lines, incisions, or equipment that may alter the procedure for ambulation. Assess the patient’s knowledge and previous experience regarding the use of crutches. Determine that the appropriate size crutch has been obtained.

2. Perform hand hygiene. Put on PPE, if indicated.

3. Identify the patient. Explain the procedure to the patient. Tell the patient to report any feelings of dizziness, weakness, or shortness of breath while walking. Decide how far to walk.

4. Encourage the patient to make use of the stand-assist device, if available. Assist the patient to stand erect, face forward in the tripod position. This means the patient holds the crutches 12 inches in front of and 12 inches to the side of each foot.

5. For the four-point gait:
a. Have the patient move the right crutch forward 12 inches and then move the left foot forward to the level of the right crutch.
b. Then have the patient move the left crutch forward 12 inches and then move the right foot forward to the level of the left crutch.

6. For the three-point gait:
a. Have the patient move the affected leg and both crutches forward about 12 inches.
b. Have the patient move the stronger leg forward to the level of the crutches.

7. For the two-point gait:
a. Have the patient move the left crutch and the right foot forward about 12 inches at the same time.
b. Have the patient move the right crutch and left leg forward to the level of the left crutch at the same time.

8. For the swing-to gait:
a. Have the patient move both crutches forward about 12 inches.
b. Have the patient lift the legs and swing them to the crutches, supporting his or her body weight on the crutches.

9. Continue with ambulation for the planned distance and time. Return the patient to the bed or chair based on the patient’s tolerance and condition, ensuring that the patient is comfortable. Make sure call bell and other necessary items are within easy reach.

10. Remove PPE, if used. Perform hand hygiene.