Definition
Slings are used to support and immobilize the forearm, the elbow and upper arm.
Types of slings
- Arm slings.
- Elevation slings.
Arm Slings
Arm slings are commonly used to support injuries to the upper limb or to immobilize an upper limb in case of chest injury.
Elevation Slings
These are used to support a hand in well-raised position to control bleeding or to immobilize the upper limb if there is a broken collar bone or there are rib injuries.
Purposes
- To support or immobilize parts of upper extremity.
- To limit movement of upper extremity in presence of fracture, muscle strain or sprain, and joint dislocation.
- To prevent dependent edema.
- To control pain.
- To promote rest.
- To aid healing.
Articles
- Prepackaged sling or triangular bandage.
- Safety pins.
- Padding or folded gauze squares.
Procedure
| Nursing actions | Rationale | |
| 1. | Before procedure Assess patient’s presenting conditions (stroke, fracture, dislocation). | Determines the motor and sensory status of affected extremity. |
| 2. | Observe condition of patient’s upper extremity (mobility, presence of suture line, presence of cast, level of comfort, skin integrity). | Provides baseline data to determine changes in patient’s condition. |
| 3. | Review patient’s medical record for physician’s prescription in relation to desired angle of forearm and other determinants. | Venous return, prevention of edema, and maintenance of functional alignment result from properly applied slings. Slings may be ordered round the clock or whenever patient is sitting or out of bed. |
| 4. | Identify patient’s learning needs regarding condition and correct application of sling. | Identifies areas for patient teaching for increasing patient’s self-care ability. |
| 5. | Explain procedure. | Reduces anxiety. |
| 6. | Teach skill to patient or significant others. | Promotes coping ability and reduces stress. |
| 7. | During procedure Wash hands and provide privacy. | Prevents cross-infections, reduces anxiety, and maintains personal dignity. |
| 8. | Assess pulse on affected extremity. | |
| 9. | Prepare patient: Position patient sitting or supine with forearm at angle with fingers higher than hand, hand higher than wrist, and wrist higher than forearm, all in anatomically correct alignment. | Ensures patient’s cooperation facilitating rapid application of sling. |
| 10. | Open sling and place over patient’s torso with binder centered under arm. Place longest side at wrist and apex of triangle extending of beyond arm at elbow. | Facilitates placement of closure beyond center of neck. Ensures support of forearm. |
| 11. | Bring the binder to level pointing upward over neck on affected side of body, continuing around patient’s neck to affected side. At this point, the longest side of triangle will extend straight down in vertical line on unaffected side of body. | Provides support to the patient’s affected side as the sling is applied. Prevents pressure on cervical spinal nerves. |
| 12. | Bring lower binder point over forearm and hand up to neck on affected side. | Provides support to the patient’s affected side as the sling is applied. Prevents pressure on cervical spinal nerves. |
| 13. | Reassess angle of forearm and adjust position if needed. | Proper positioning facilitates venous return and reduction of edema of digits. |
| 14. | Secure closure of sling at shoulder level on unaffected side using square knot, and fold remaining loose areas of binder around elbow and maintain fold and secure with safety pin. | Prevents pressure from knot on affected shoulder, provides support to bow elbow and maintains appropriate alignment. |
| 15. | Apply padding as needed. | Reduces localized skin pressure: Prevents cervical flexion related to pressure. Avoids excoriation of skin. |
| 16. | Inspect applied sling for adequacy of support, position of lower arm above level of elbow, and avoidance of pressure on cervical vertebra. | Maintains proper alignment of affected arm. |
| 17. | After procedure Wash hands. | Reduces transmission of microorganisms. |
| 18. | Evaluate distal pulses, sensation to fingers, and condition of skin. | Determines adequacy of neurovascular status to distal area. |
| 19. | Inspect alignment of shoulder and extremity. | Determines adequacy of support and alignment provided by sling. |
| 20. | Question patient regarding level of comfort. | ldentifies presence of any pain or discomfort. |
| 21. | Report patient’s responses to application of sling. | Maintains continuity of care and denotes patient’s response to sling application. |
| 22. | Record alignment, circulation, sensation, and skin integrity of affected extremity. | Denotes the presence or absence of complications related to application of sling. |
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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