Need a lift? Why one sling doesn't fit all

Choose based on medical needs

A patient who is recovering from abdominal surgery needs to be lifted from the bed to a chair. Another patient with a pressure ulcer needs to be repositioned. Putting a sling under these patients to use lift equipment seems out of the question.

Yet an array of sling choices are available, enabling nurses and nursing assistants to use lift equipment even with patients with delicate medical conditions. In fact, lift equipment has evolved to provide solutions for patient handling dilemmas of acute care, says Andrea S. Baptiste, MA (O.T), CIE, an ergonomist/biomechanist with the Patient Safety Center at the James A. Haley VA Medical Center in Tampa, FL. Baptiste was the chair of a task force that created a Patient Care Sling Selection and Usage Toolkit ( http://www1.va.gov/visn8/patientsafetycenter/safePtHandling/toolkitSlings.asp.)

Many employee health professionals are not aware of the choices beyond the "universal sling," she says. But just as health care workers should assess patient handling needs, they should consider the most appropriate sling, Baptiste adds.

"The decision about what sling you're going to use is dependent on the transfer you're trying to accomplish, the patient's medical condition or medical status, and their functional ability," she says. "Do they have head control? If they don't have head control, then you need a high back to support their transfer.

"The seated sling is most commonly used to transfer the patient in a seated position. If you have someone who needs to stay supine, you just need a supine sling," she says.

Because different units handle patients with different acuity levels, sling selection will vary. Frontline health care workers need to be involved in the choice, just as they are in evaluating and selecting safe needle devices, Baptiste notes.

"The biggest mistake people make is they find one solution for one [type of lift] and then they say, 'OK, let's put these all the units.' The needs in other units may be totally different," she says.

Here are some things you should know about slings:

Slings are categorized by function. There are five categories of slings, based on the function you need to perform. A standing sling provides assistance to patients who are weight-bearing and need help standing upright. It may be used in a sit-to-stand lift. A seated sling often is considered the universal sling. The patient remains seated during the lift. The sling may come with head support, padding, positioning handles, or special fabrics. Supine slings are also available for patients who need to remain flat.

Patients wear an ambulation sling when they need fall protection while they're walking. It is often used in a rehabilitation unit when patients are just beginning to walk again. The limb support sling holds a patient's limb in place while the nurse performs wound care, bathing, or other procedures. "Holding a limb in an outstretched position for five minutes can put a lot of stress on the shoulder [of nurses]," says Baptiste. (For more information on selecting slings for different medical conditions, see chart.)

  • New sling technology can reduce repositioning injuries. With the new repositioning sling, caregivers can slide the sling under the patient and hook it to just one side of the lift. It is especially easy to use with a ceiling lift, notes Baptiste, and may help reduce pressure ulcers. A new product called Vander-Clips by Vancare of Aurora, NE, hooks to the patient's sheet and allows the lift to roll the patient over.
  • Slings require different attachment points on the spreader bar. Lifts are available with 8-point spreader bars, which provide more versatility in the use of the slings. For example, you would need the wider 8-point bar to transfer a patient in the supine position. The universal, or seated, sling can be used with a 2-point bar.
  • Sling comes in different sizes and materials. A mesh sling could be used while bathing a patient and an open-bottomed sling can be used with toileting. A reinforced sling would be the appropriate choice for a bariatric patient. Amputees have special slings as well. Infection control is a challenging issue with slings, which sometimes mysteriously disappear when they're sent off to be laundered. Some facilities use disposable slings.
  • You can't mix and match slings and lifts. Don't use slings from one manufacturer with a lift from another manufacturer. Each lift vendor makes a range of slings, says Baptiste. If you're concerned about the sling choices, be sure to ask before you purchase the lift equipment.
  • Don't keep damaged slings. With constant use and laundering, slings will become damaged. "If they're frayed or worn, you should throw them out," she says.
  • Some equipment allows for lifts without slings. Lateral transfers can be accomplished with an air-assisted device or other slides. Chairs that convert into stretchers can be used for transport and can enable caregivers to transfer patients laterally.