This article describes the supplies and steps required to change briefs (diapers) on a patient, along with management of potential skin issues.
Exercise caution when applying briefs to ensure that any excess skin around the upper thigh and groin is pulled out of the way before securing the brief to reduce friction and risk of skin breakdown.
Use the following procedure for changing briefs on a patient that is lying down:
Tear-tab briefs are recommended in this scenario as they are easier to apply and remove.
If the patient is in an adjustable bed, make sure to raise it to appropriate working height before starting to reduce the risk of injury.
If the patient is already wearing a brief, begin by undoing the tear tabs or rip/cut the sides if no tear tabs are present.
Have the patient start by turning onto their side. Should they require assistance with this reposition, have them cross their arms over their chest, bend the opposite knee to the side they will be turning on and gently roll them onto their side. If the bed has an adjustable head or foot, make sure it is in a flat position, provided the patient lying down is able to tolerate it.
Once on their side, pull the front existing brief down so it is flat on the bed and tuck as much of it as possible underneath the patient. If there is stool or urine in the brief, be careful to fold the material over the excrement when tucking so it does not get on the patient's skin.
Place the new brief opened flat underneath the patient and tuck the one side of it underneath them. (If they are lying on their left side, tuck the left side of the new brief underneath them).
Reposition the patient onto their opposite side (if they are requiring assistance to do this, keep their arms crossed across the chest, straighten the leg that had previously been bent as they roll onto their back and bend the opposite knee prior to rolling them over).
It should now be possible to pull the soiled brief out from underneath the patient, and flatten out the half of the new brief that has been tucked underneath them.
The patient can now be repositioned flat on their back, and the new brief closed up.
If skin breakdown in the groin folds is occuring due to friction: begin applying a barrier cream to this area once a day (Critic-Aid®, Sudocrem®, Zinc Oxide cream). Consider using a larger size brief if sizing appears to be an issue.
If skin breakdown in the groin folds is occuring due to moisture from incontinence/sweating etc: ensure to regularly pat dry the groin folds. Products such as baby powder or corn starch can be used to keep the area dry and products such as gauze or Interdry® can be used to wick away moisture.
Public healthcare services in some regions may be able to provide a supply of gauze, moisture-wicking fabric (such as InterDry®) or barrier cream.
If skin irritation/breakdown in this area is a recurring issue an optional intervention can include leaving the brief open and placing it under the patient as an absorbant pad overnight in order to give the skin in this area a break. Note that this intervention typically only works if the person is not frequently moving overnight. Soaker pads or disposable absorbant pads can also be placed with the brief for additional protection.
If the patient is nonverbal and not able to communicate when briefs are soiled, be sure to check briefs at least every couple of hours. Briefs should be changed if they are soiled in any capacity; do not leave the product in place until it is "full" as leaving soiled products in place increases the risk for skin breakdown.
If the patient is a female with ALS who is still menstruating, high absorbency briefs may be useful to use during menstruation as they are more absorbant than a menstrual pad alone and will allow for reduced changing frequency.