Applying a Sling

Skill 9-13

Applying a Sling

A sling is a bandage that can provide support for an arm or immobilize an injured arm, wrist, or hand. Slings can be used to restrict movement of a fracture or dislocation and to support a muscle sprain. They may also be used to support a splint or secure dressings. Health care facilities usually use commercial slings. The sling should distribute the supported weight over a large area of the shoulders and trunk, not just the back of the neck, to prevent pressure on the cervical spinal nerves (Hinkle et al., 2022).

Delegation Considerations

The application of a sling may not be delegated to assistive personnel (AP). The application of a sling may be delegated to licensed practical/vocational nurses (LPN/LVNs). The decision to delegate must be based on careful analysis of the patient's needs and circumstances as well as the qualifications of the person to whom the task is being delegated. Refer to the Delegation Guidelines in Appendix A.

Equipment

Commercial arm sling
ABD gauze pad (if the sling does not include padding for the neck strap)
Nonsterile gloves and/or other PPE, as indicated

Assessment

Assess the situation to determine the need for a sling. Assess the affected limb for pain and edema. Perform a neurovascular assessment of the affected extremity. Assess body parts distal to the site for cyanosis, pallor, coolness, numbness, tingling, swelling, and absent or diminished pulses.

Actual or Potential Health Problems and Needs

Many actual or potential health problems or issues may require the use of this skill as part of related interventions. An appropriate health problem or issue may include:

Acute pain
Altered skin integrity risk
Risk for impaired peripheral neurovascular function

Outcome Identification and Planning

The expected outcomes to achieve when applying a sling are that the arm is immobilized in proper alignment; the patient shows no evidence of contractures, venous stasis , thrombus formation, or alterations in skin integrity; and the patient demonstrates proper use of the sling.

Implementation

Action	Rationale
1. Review the health record and prescribed interventions to determine the need for the use of a sling.	Reviewing the health record and prescribed interventions validates the correct patient and correct procedure and prevents injury.
2. Perform hand hygiene. Put on PPE, as indicated.	Hand hygiene and PPE prevent the spread of microorganisms. PPE is required based on transmission precautions.
3. Identify the patient. Explain the procedure to the patient.	Patient identification validates the correct patient and correct procedure. Discussion and explanation help allay anxiety and prepare the patient for what to expect.
4. Close the curtains around the bed and close the door to the room, if possible. Place the bed at an appropriate and comfortable working height (VHACEOSH, 2016).	Closing the door or curtains provides for privacy. Proper bed height helps reduce back strain.
5. Perform a pain assessment. If the patient reports pain, administer the prescribed medication in sufficient time to allow for the full effect of the analgesic.	Injury to the arm requiring the use of a sling may cause discomfort and/or pain. Allowing sufficient time for analgesic to take effect promotes optimal patient comfort.
6. Assist the patient to a sitting position. Place the patient's forearm across the chest with the elbow flexed and the palm against the chest. Measure the sleeve length, if indicated.	Proper positioning facilitates sling application. Measurement ensures proper sizing of the sling and proper placement of the arm.
7. Enclose the arm in the sling, making sure the elbow fits into the corner of the fabric (Figure 1) and extends from the elbow to at least the palmar crease. Run the strap up the patient's back and across the shoulder opposite the injury, then down the chest to the fastener on the end of the sling (Figure 2).	This position ensures adequate support and keeps the arm out of a dependent position, preventing edema.
8. Place the ABD pad under the strap, between the strap and the patient's neck (Figure 3). Ensure that the sling and forearm are slightly elevated and at a right angle to the body (Figure 4).	Padding prevents skin irritation and reduces pressure on the neck. Proper positioning ensures alignment, provides support, and prevents edema.
9. Place the bed in the lowest position, with the side rails up. Make sure the call bell and other essential items are within easy reach.	Having the bed at the proper height and leaving the call bell and other items within reach ensure patient safety.
10. Remove PPE, if used. Perform hand hygiene.	Proper removal of PPE reduces the risk for infection transmission and contamination of other items. Hand hygiene prevents the spread of microorganisms.
11. Check the patient's level of comfort, pain, arm positioning, and neurovascular status of the affected limb every 4 hours or according to facility policy. Assess the axillary and cervical skin frequently for irritation or alterations in integrity.	Frequent assessment ensures patient safety, prevents injury, and provides early intervention for skin irritation and other complications.

Evaluation

The expected outcomes have been met when the patient's arm has been immobilized in proper alignment. In addition, the patient has showed no evidence of contractures, venous stasis, thrombus formation, or alterations in skin integrity, and the patient has demonstrated proper use of the sling.

Documentation

Guidelines

Document the time and date the sling was applied. Document the patient's response to the sling and the neurovascular status of the extremity. Document the pain assessment and associated interventions, as well as patient response.

Sample Documentation

Developing Clinical Reasoning and Clinical Judgment

Unexpected Situations and Associated Interventions

Patient needs a sling to support a wrist fracture, but you cannot obtain a commercially prepared sling: Make a sling using a triangular bandage or cloth. Place the cloth or bandage on the chest with a corner of the cloth at the elbow. Place the affected arm across the chest with the elbow flexed and the palm on the chest. Wrap the end closest to the head around the neck, on the opposite side from the injured arm. Bring the end of the cloth that is farthest from the head up over the injured arm and tie it at the side of the neck. Make sure that the sling and forearm are slightly elevated and at a right angle to the body.

Special Considerations

If the sling is used for a patient with a hand or wrist injury or after surgery to the hand or wrist, ensure the arm is supported in the sling with the hand elevated at the level of the heart to decrease the risk of swelling (Hinkle et al., 2022).
Be sure that the patient's wrist is enclosed in the sling. Do not allow it to hang out and down over the edge. This prevents pressure on nerves and blood vessels and prevents muscle contractures, deformity, and discomfort.
Assess circulation and comfort at regular intervals.

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Skill 9-13