ARJO Slings User Guide Issue 1 March 2005

Contents

Introduction... Sling descriptions ... Residents gallery ... When using a sling always ensure Maxislide...

Page No. 3 4-8 9-10 11-12 13

Care of your Arjo slings ...

14

Identification of quick reference symbols.

15

Components of a sling ... Sling Size Guide Tape ... Lifting From a chair ... Lifting from a bed ... Raising from the floor ... At the toilet... 2 Point Spreader Bar (Loop sling) ... Lifting from a chair ... Lifting from a bed and using the soft stretcher ... Lifting from the floor ... Patient specific Slings (Flites) ... Bariatric slings ... Standing and Raising slings- Loop and Lock and Clip fixings... Boss Slings ... Walking jackets... Arjo Tailor Made slings... Sling Range and part numbers- Clip and Loop & Bariatric... Warning and safety instructions...

16 17 18 19 20 21 22-25 22

SECTION

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23-24 25 26 27 28-32 33-34 35 36 37-39 40

Introduction

Using the correct sling for each patient is an essential element of safe patient handling. In some cases, medical and physical factors mean that a patient's comfort and safety can only be assured by the provision of a correctly fitted sling. Carers also benefit from fitting the correct sling on a patient as their work is made easier and there is less chance of back injury. Arjo has long experience of making slings with people in mind. A powered sling lifter offers the most secure transfer method for many patient-handling procedures. However, providing the optimum sling for the patient and the purpose is vital in order to ensure safety and comfort. A sling that is the wrong size or a bad fit for its patient creates discomfort and increases the risk of injury. This guide has been produced to provide users of Arjo slings with the help and information they need to ensure safe and comfortable transfer of patients, whether it's from a bed, the floor, a chair or the toilet.

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Clip Slings

MAA2000-xx MAA4000-xx

Unpadded clip sling

Padded sling

The above has no padding in the leg area and therefore is easier to apply to residents with skeletal issues such as contractures and curvatures of the spine. These slings are commonly used on people who are in moulded wheelchairs.

Padding adds a level of comfort to the leg area of the slings. The Padding also helps to prevent the material roping and creasing under legs.

MAA4060-xx MAA4031xx

Mesh clip sling Toilet clip sling

The above is most commonly used for showering or bathing. The mesh allows the water to pass through the material therefore retaining less water when the patient is being towel dried. This is a benefit when the patient is hoisted back into their wheelchair or onto a towel in bed. The porous material also allows the skin to breath and can be left underneath the patient.

Used for toileting, dressing and undressing patients. The padded arm supports provide the comfort and support. Leg supports are padded for comfort but again are narrower to allow clothing to be removed. Careful patient assessment is necessary before this sling is used.

4

Clip Slings

MAV4828/

MAA4031xx

Extended leg padded clip sling

Amputee clip sling with Velcro flap

The leg pieces are extended by 100mm (4 inches) to allow easier attachment of the leg clips. Used for patients who have larger thighs and hips.

Used on double amputee above or below knee. The design allows easier application to the patient rather than having to log role them in their chair or bed. The sling is applied as with a normal sling and the Velcro fastened to provide more support.

MAV4826

MAV4873

Right leg single amputee clip sling

Left leg single amputee clip sling

Used for Left single leg amputee patients above, below or total hip. The larger leg pieceprovides more support to the stumps of the affected side.

Used for Right single leg amputee patients above, below or total hip. The larger leg piece provides more support to the stumps of the affected side.

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Clip Slings

MAA2090-xx

MAV7121

Amputee clip sling

Amputee clip sling with commode aperture

Used for Bilateral leg amputee patients with above knee or total hip. The design requires the patient to be log rolled onto the sling while on the bed or rolled from side to side in a chair. The aperture does not allow toileting.

Used for Bilateral leg amputee patients with above knee or total hip. The design requires the patient to be log rolled onto the sling while on the bed or rolled from side to side in a chair. The aperture allows toileting of a patient who's lower clothing has already been removed while on the bed.

6

Loop Slings

MAA1211-xx

MAV1816

Unpadded loop sling

Padded loop sling

This sling has no padding in the leg area and is easier to apply to patients with skeletal issues such as contractures and curvatures of the spine. These slings are commonly used on people who are in moulded wheelchairs.

Padding adds a level of comfort to the leg area of the slings. The Padding also helps to prevent the material roping and creasing under legs.

MAV7123

MAV1848

Loop toilet sling

Loop amputee sling

Used for toileting dressing and undressing patients. The padded arm supports provide the comfort and support, which is lost when providing good access to the patient's perineum area. Leg supports are padded for extra comfort but again are narrower to allow clothing to be removed.

Used for Bilateral leg amputee patients with above knee or total hip. The design requires the patient to be log rolled onto the sling while on the bed or rolled from side to side in a chair. The aperture does not allow toileting

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Loop Slings

MAV1852

MAV1857

Right leg single amputee loop sling

Left leg single amputee loop sling

Used for Left single leg amputee patients above, below or total hip. The larger leg piece provides more support to the buttocks and stump of the affected side.

Used for Right single leg amputee patients above, below or total hip. The larger leg piece provides more support to the buttocks and stump of the affected side.

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Residents Gallery

BARBARA

Residents in elderly care and other facilities are very different, they have different diseases and problems and different backgrounds yet they all need to be offered a high quality of care.

CHARACTERISTICS • Uses walking frame or similar • Can support herself to some degree • Dependant on carer who is present in demanding situations • Not physically demanding for carer • Stimulation of remaining abilities (e.g. ambulation) is very important

Choices in care are made on the basis of assessments of each resident, choices tailored to their needs and desires as a "typical" resident does not exist. In order to plan care for residents there needs to be a system of standardisation and classification. This is the reason Arjo developed the Residents Gallery, it is a classification of five typical residents based on their degree of functional mobility. But it is more than just a classification system; it offers colourful images of five residents who you would actually meet in real life health care settings. By envisaging them it makes it possible to discuss choices in care and rehabilitation in a realistic way.

The resident is partly capable of performing daily activities by him- or herself. However, the assistance that is required is in general not physically demanding for the carer/the nurse. The assistance may consist of verbal support, feedback or indications, but light physical assistance is also possible. This assistance can be given in combination with smaller aids (walking aids, support or grips and handles) or adaptations in the environment of the resident. Barbara's remaining capacity should be stimulated.

We know them as Albert, Barbara, Carl, Doris and Emma and they represent the five different mobility levels (A-E).

CARL

ALBERT

CHARACTERISTICS

CHARACTERISTICS

• Sits in wheelchair • Is able to partially bear weight on at least one leg • Has some trunk stability • Dependant on carer in most situations • Physically demanding for carer • Stimulation of remaining abilities is very important

• Ambulatory, but may use a cane for support • Independent, can clean and dress himself • Can tire quickly • Stimulation of abilities is very important The resident is able to perform daily activities by him- or herself without assistance from another person, It is possible that the resident needs special aids or appliances. As a rule there is no risk of physically overloading the carer. Albert requires careful monitoring.

The resident is not capable of performing daily activities by him- or herself, but is able to contribute to the action or perform part of the action by him- or herself The assistance would, if given without special precautions, lead to the risk of physically overloading the carer/the nurse. The resulting load for the nurse would be in excess of safe limits for manual handling or static loads. In these cases it is necessary to use equipment that will reduce the exposure of the nurse to safe levels. The resulting load for the nurse would be in excess of safe limits for manual handling or static loads.

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Residents Gallery

EMMA

In these cases it is necessary to use equipment that will reduce the exposure of the nurse to safe levels. At the same time these residents are able to actively contribute to the movement and it is important for the resident to maintain or improve this capacity as much as possible. The assistance that is given in these instances is, for example, transfer using an active lifter. It is important to stimulate remaining capacity and slow down deterioration of mobility.

CHARACTERISTICS • Passive resident • Might be almost completely bedridden • Often stiff, contracted joints • Totally dependent • Physically demanding for carer • Stimulation and activation is not a primary goal

DORIS CHARACTERISTICS

The resident is not capable of performing daily activities independently or to contribute to these activities actively. The assistance in this case will, without special precautions, result in a risk of physically overloading the nurse/carer. It is necessary to use equipment that eliminates this risk of overloading. In Emma's case it is not considered important any more to stimulate her to contribute to the movement and become active. Promoting or stimulating mobility and activating the resident is not a goal in the care plan anymore. Providing optimum care and/or prevention of the complications of immobility, e.g. good skin care, are given priority. Transfers will in this case be performed with for example a passive litter. The aim is to avoid complications caused by long-term confinement to bed and make her as comfortable as possible.

• Sits in wheelchair • No capacity to support herself at all • Cannot stand unsupported and is not able to bear weight, not even partially • Dependent on carer in most situations • Physically demanding for carer • Stimulation of remaining abilities is very important The resident is not capable of performing daily activities independently or to contribute to this actively in any substantial or reliable way. The assistance in this case will, without special precautions, result in a risk of physically overloading the nurse/carer. It is necessary to use equipment that eliminates this risk of overloading. The resident can, in this case, not contribute substantially to this movement. In spite of this, where- and whenever possible it remains important to activate these residents. The assistance provided in this case is for example the transfer with a passive lifter. An extra point of attention in this case is the prevention of the risks of immobility, (e.g. give good skin care). It is important to slow down deterioration of mobility.

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When using a sling always ensure…

The sling is smoothly fitted from the base of the spine (coccyx) to the top of the head. (See fig 1 & 2) An indication of a badly fitted or wrongly sized sling may be that the head support is 3 or 4" (76102mm) above (sling may be too large) or below the top of the head (sling may be too small).

Arjo have now produced a sling-size guide tape to act as a guide to fitting the correct size sling on a patient. (See fig 3)

Fig. 3

Instructions for using the sling-sizing guide are as follows. • Ensure that the tape is used the correct way round. (Teal (seaweed green) colour - XXS at the coccyx) • Ideally the patient should be in a seated position • Measure from the coccyx to the top of head. The colour level with the top of the head indicates the required size. • If the size falls between two sizes always use the smallest size • Patient width and body proportions, should also be considered and a professional judgement made • This sizing tool is only intended as a guide and is an approximation. Other factors like the patients physical disabilities, weight distribution and general physique all need to be taken into consideration. • The tape can be used to make dimensional records of patient for Tailor Made sling Requirements. (See fig 4 )

Fig. 1

Fig. 2

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When using a sling always ensure…

During the lift, the patient will settle into the sling as their weight is taken up. Ensure the sling adequately supports the head and the patient's buttocks are not slipping through the sling aperture. (See fig 6) Should this happen stop the lift immediately and retry with a smaller sling size.

Fig. 4

Centre line stitching has also been introduced down the back of Arjo slings to make it easier for carers to see exactly where the patient should be positioned in the sling. The centre line stitching should be positioned along the patient's spine to give the sling a perfectly centred fit. Ensure the leg supports are placed smoothly under the patient's thighs so that the attachment clips/ loops are between the patient's legs towards the middle of the thighs. (See fig 5) Indications of a badly fitted or wrongly sized sling may be the sling clips/loops only just appearing between the patients thigh, (sling may be too small) or the leg supports of the sling digging into the back of the patient's knees with the sling clips/loops several inches above the front of the patients thighs (sling may be too large).

Fig. 5

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Maxislide

52% of accidents and injuries that are suffered by nursing staff occur during manoeuvres in and around the bed. Nurses have always recognised that the principle of sliding patients in bed reduces the effort, and have traditionally used sheets and even plastic bags to aid this movement. The Maxislide is a unique, ergonomically designed device having ultra-low friction properties, which aid carers in moving or positioning patients whilst, at the same time, encouraging good posture without causing undue stress to either the patient or carer. The Maxislide will also encourage patients to help themselves wherever possible. The Maxislide CD-ROM is available which can be used as a user guide; its step-by-step instructions take the user through the most commonly used manoeuvres, showing at each stage how the Maxislide should be used.

Maxislide CD

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Care for your Slings

• The sling should be inspected before use. It is essential that the slings, their stitching, their straps, the trim and attachment clips are carefully inspected. If the slings, trim or straps are frayed or cut or the clips show any signs of damage DO NOT USE. Consult the person responsible for Patient/Resident care. The sling should be withdrawn from use immediately and replaced. • If the sling label is missing or cannot be read the sling should also be withdrawn from use. • When laundering slings, they should not be classified as linen, but as a medical accessory to a patient transfer lifter and therefore classified as a medical device. • Slings should be cleaned and disinfected only in strict accordance with the manufacturers instructions. (Refer to sling instruction sheet MAX. 81687- INT and MAX01510- INT, supplied with every sling and covered briefly below). •

Note: If the slings are contaminated or soiled then the following is a summary of the washing and drying procedure.

• DO NOT IRON. • Slings may be air-dried. • Before washing remove plastic stiffness from the pockets in the sling and replace before use. • Wash using normal detergents. Chemical Decontamination: Sodium hypochlorite (chlorine) 150-300 ppm (parts per million) or milligrams per litre, Low temperature tumble dry 40ºC/104ºF (test house conditions). We recommend that the sling is washed before being used on the next patient, if suspected of being contaminated or soiled. •

Note: Note: Always follow washing guidelines indicated on the sling Washing and Using instruction label, prior to washing your sling. .

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Identification of quick reference symbols

3 4

2

5

1

6 1.

Stop and read Hoist Operating Instructions before using this sling

2.

Maximum washing temperature °C

3.

Do not iron

4.

Do not tumble dry

5.

Maximum weight to be lifted in kilograms - 190kg. Hoist lifting capacity may vary. Refer to hoist load rating label

6.

Sling only to be used on Arjo Sling Lifters 4 6

3 2

7 1 9

1.

8 5 Stop and read operating instructions before using this sling

2.

Maximum washing temperature (or 194ºF)

3.

Do not Iron

4.

Low temperature tumble dry

5.

Maximum weight to be lifted in Kilograms (or 440lbs)

6.

Date of Manufacture

7.

Serial number of sling

8.

Sling only to be used on these Arjo sling lifters

9.

Space for ward/facility/patient name

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Components of a Sling

Stiffeners

Head piece Stiffeners pocket Attachment clip

Head section

Body section

Shoulder strap

Leg section

Leg piece with padding Leg strap

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Sling Size Guide

Please refer to the sling-sizing guide tape, which can be used as a guide to which sling to use f or which patient. See page 11for full instructions.

Passive lifters sling range. Fig a

Sling tape size

The measuring tape has centimetres and Inches on it and is colour coded to represent to colour of the sling needed for the patient. Active lifters sling range. Fig b

Arjos standard sling range is now available in 8 sizes. Extra sizes have been added to lessen the gap between each size and provide customers with greater choice and better fit. (fig a)

All Arjo slings are tested to a maximum weight of 200kg or 440lbs.

Arjo standing and raising aid slings are available in 4 sizes (fig b). •

This patient sling size guide is only an approximation, other factors which must be considered when selecting the appropriate sling are:

Note: IF THE PATIENTS WEIGHT FALLS INTO TWO SIZES OR THERE IS ANY DOUBT ON CHOOSING THE RIGHT SIZE SLINGS, ALWAYS GO FOR A SMALLER SIZE.

• Patient's distribution of body weight, i.e. hips, thighs, upper body. • Patient's height, torso length. • Patient's physical condition, i.e. amputee.

Sling size guide: SIZE

COLOUR

Extra Extra small Extra small Small Medium Large Large Large Extra Large Extra Extra Large

Teal Brown Red Yellow Green Purple Blue Terracotta

WEIGHT RANGE

0 - 25 Kg 25 - 35 Kg 35 - 60 Kg 55 - 75 Kg 70 - 120 Kg 100 - 140 Kg 120 - 160 Kg 160 - 190 Kg

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0 - 55 lbs 55 - 77 lbs 77 - 132 lbs 121 - 165 lbs 154 - 264 lbs 240 - 270 lbs 264 - 352 lbs 352 - 418 lbs

Lifting from a chair

P1392d, P1002a,b,c

Using the Dynamic Positioning System ((DPS) Clip Sling) Ensure the spreader bar is securely attached to the lifter before commencing with the lifting procedure. ('Lock and Load' combi system jib only). Place the sling around the patient so that the base of his/her spine is covered, and the head support area is behind the head. Place each leg piece under the thigh so that it emerges on the inside of the thigh. (See fig. 1). You may wish to use the Maxislide to help in this situation. For reference, see Maxislide CD-Rom, Technique 24.

Fig. 3

P1146a,b

If necessary, lower the spreader bar using the handset control, being careful not to lower it onto the patient, although if this should happen inadvertently, there is a built in cut-out device which will prevent any further downwards movement. Do not continue to press the handsetlowering button. •

Fig. 1

Ensure the positioning handle on the spreader bar is facing away from the patient, and that the wide part of the spreader bar is at, or just below shoulder level. (See fig. 2).

Note: If the handset button is released during lifting or lowering, powered motion will stop immediately.

P1392c

Raise the patient by operating the handset control, move the lifter away from the chair then carefully lift the positioning handle until the patient is reclined in the sling - the head support will now come into use. This is the most comfortable position for transportation, as it reduces pressure on the thighs. The angle of recline can be adjusted for increased comfort, if the patient is restless, using the positioning handle. Before transportation, turn the patient to face the attendant at approximately normal chair height. This gives confidence and dignity and also improves the Lifter mobility.

Fig. 2

Ensure that the Lifter is close enough to be able to attach the shoulder clips of the sling to the spreader bar. To accomplish this you may have to put the patient's feet on, or over the chassis. Once the Lifter is in position, first attach the leg clips to the spreader bar; this will stop the patient slipping down. Then attach the shoulder strap attachment clips to the pegs on the spreader bar. (See fig. 3)

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Lifting from a bed

P1133b

P1393e

Position the patient onto the sling by rolling the patient towards you then folding the sling in half and placing it behind the patient's back (see fig. 1). Position the sling carefully so that when rolled back the patient will lie centrally on the sling (see fig. 2) and check that the head support area of the sling covers the patient's head. If the patient is unable to be rolled, either because of their size or the fact that they may be in pain, a Maxislide can be used to slide the patient onto the sling. Refer to the Maxislide CD-ROM for details of use.

Fig. 3

P1395a, P1002 a,b,c

Using the positioning handle, tilt the spreader bar until the shoulder attachment points can be connected to the sling shoulder strap attachment clips. (See fig. 4).

P1022a

Fig. 1

Fig. 4

Press down on the positioning handle until connection of the sling leg pieces is possible. (See fig. 5) The leg pieces must be brought under the thighs to connect up, this may involve supporting one leg at a time to connect up. You may need to lower the spreader bar a little more, using the handset control.

Fig. 2

Note: When rolling the patient back onto the sling, roll the patient slightly in the opposite direction so that the folded part of the sling can be brought out.

P1395b

•

Alternatively, the patient can be brought into a sitting posture then position the sling as detailed in the section "To Lift From A Chair". Approach the bed with the open side of the spreader bar towards the patient's head. (See fig. 3). Using the adjustable width chassis, it is possible to make adjustments to chassis leg widths to assist manoeuvrability around obstructions, for example, bed legs.

Fig. 5

Position the Lifter so that the spreader bar is just above

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Raising from the floor

Put the sling around the patient as before, either by using the rolling, sitting or Maxislide method.

the effect of raising the patient's head and shoulders slightly.

P1394a

P1394c

Put the sling around the patient as before, by using the rolling or sitting up method or use the Maxislide if the patient cannot be rolled or sat up, see Maxislide CD-ROM Technique 27. Depending on circumstances, space and/or position of patient etc. approach the patient with the open part of the chassis. Open the chassis legs if necessary, and lift the patient's legs over the chassis as shown in fig 1.

Fig. 3

When lifting from the floor, some attendants prefer to connect the leg pieces first. This in particular applies to the very large patient with large thighs. In this case, raise the hip and knee into maximum flexion, and attach the leg straps first, then tilt the spreader bar towards the shoulders to enable the shoulder straps to be connected. When all the straps have been properly connected, raise the patient from the floor in a semi-recumbent position. Supporting the head can be comfortable and reassuring for the patient. Once raised from the floor, ensure the patient's legs are clear of the chassis before continuing to lift. (See fig. 4). The leg sections of the sling will tend to be fairly high up the thigh, so straighten them out for added comfort. The patient may be positioned in a chair, or placed onto a bed. If the patient is prone to extensor spasm, he/she may be lifted by the Arjo passive lifter, but special attention should be paid to supporting the legs during the early part of the lift.

Fig. 1

The patient's head and shoulders could be raised on pillows for comfort, if required, but this is not essential when connecting up the sling to the spreader bar.

P1394d

P1394b, P1002 a,b,c

With the open part of the spreader bar pointing down towards the shoulders, attach the shoulder strap attachment clips, as shown in fig 2 and inset. The lifters brakes should be applied once the lifter is in the correct position. This ensures the lifter does not move and injure the patient.

Fig. 2

Once connected, raise the hip and knee into maximum flexion, and push down on the positioning handle in order to connect the leg strap attachment clips as shown in fig 3. This will have

Fig. 4

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