Hoist and Sling Selection Guide

Contents

1. Introduction
2. Active Transfers
3. Passive Transfers
4. Slings for Passive Transfer

1. Introduction

This resource is designed to help assess a suitable hoist and sling for your client. All assessment and equipment selection needs to incorporate balanced decisions. Elements include: client need, the physical environment, as well as the needs and capability of the person that will operate the equipment.

1.1. Safe Patient Handling

When should we consider using a hoist?

• If manual handling is too heavy
• If there is a risk of injuries to the client or carer(s)
• To keep the client active longer

Safe patient handling involves the use of mechanical equipment and safety procedures to lift and move clients so that health care workers can avoid using manual exertions and thereby reduce their risk of injury. The right selection of equipment can reduce the number of carers required for client moving and handling.

Avoiding Accidents & Injuries

Throughout Europe, Governments aim to reduce the risks to clients and carers alike via legislation. Check the regulations in your country to ensure compliance.

Client

The most important criteria when considering a suitable solution is the client's mobility level as this indicates their level of body control. The various products available in the market are designed to give support in those areas where body control and muscle tone are reduced.

To narrow down the equipment decision, we can assess the client's control of four different body parts:

• Legs / weight bearing capability
• Hip control
• Trunk control
• Head control

Body Control Assessment:

[Icon: Person with good control] Good | [Icon: Person with limited control] Limited

1.2. PEO Model

It is important when choosing equipment that we remain holistic, by using a framework alongside a standardised risk assessment to help inform and guide us towards choosing appropriate types of equipment.

Law Et al (1996) state that a person's ability to carry out their occupations, is determined directly by the balance between themselves as a person and their environment.

Person

An individual is more than just their weight and height (load). Consideration needs be given to their degree of physical, emotional and psychological autonomy. This includes elements such as:

• Upper and lower limb strength or range of movement
• Posture
• Skin integrity
• Emotional or psychological needs
• Hip stability

Environment

We also need to consider anyone or anything that interacts with or impacts the environment such as:

• Carers, family and friends
• Physical environment
• Equipment
• Health care professionals

Occupation

These are the tasks that are being completed both by the person being transferred, care giver or personal assistant. It can often be overlooked that the person being transferred can actively engage in elements of the process and therefore maintain some form of control, so it is critical to consider what is meaningful to them when completing the assessment.

[Diagram: Venn diagram showing Person, Occupation, Environment]

Figure 1: Representing each component of PEO Model.

Reference: Law, M., Cooper, B., Strong, S., Stewart, D., Rigby, P. & Letts, L. 1996. The Person-Environment-Occupation Model: A Transactive approach to occupational performance. Canadian Journal of Occupational Therapy. 63(1):9-23

2. Active Transfers

2.1. Active Lifters

Active lifters, also known as stand assist lifters or raising aids, are used to support a person into a standing or semi-standing position for transfers or rehabilitation exercises. They depend on the client being actively involved in the transfer. The client must have some strength in the quadriceps and gluteus muscle groups, in order to participate in the manoeuvre.

Stand assist lifters provide safe, comfortable and mechanical assistance from one seated position to another for people who have limited mobility and/or rehabilitation needs.

[Image: Person being assisted by a stand assist lifter]

2.2. Slings for Stand Assist Lifters

Commonly, there is a choice of two types of sling that are compatible with Stand Assist lifters.

Stand Assist Sling

Can be used with people who have some weight bearing ability, good trunk control and ability to hold onto the lifter. Can be used for seat to seat transfers or depending on the model, assist with walking.

[Image: Stand Assist Sling]

Transfer Stand Assist Sling

The sling is fitted with additional sections and useful for people with less standing ability, risk of falling or reduced trunk stability.

[Image: Transfer Stand Assist Sling]

Avoid sliding in the sling: It is very important to select the correct size sling and ensure that the client leans backwards when being lifted.

3. Passive Transfers

3.1. Mobile Floor Lifter

Mobile floor lifters work in many environments and are, in most circumstances, very effective. They provide flexible movement so that transfers can be facilitated from anywhere in the domestic or care environment.

Standard equipment can be acquired at a lower cost than a ceiling hoist system, but have limitations regarding the fit between person, environment and occupation (PEO model):

• Required floor space to manoeuvre
• A higher lifting range is sometimes required
• Plus sized clients may exceed the width and/or the safe working load of standard equipment

Before selecting a hoist, consider the client's anthropometrics, body shape, size and weight as well as the environment in which the equipment is being used.

[Image: Woman being transferred by a mobile floor lifter]

3.2. Ceiling Hoist Systems

A ceiling hoist system overcomes those limitations of a mobile floor lifter and is therefore easier for care staff to use; improving the fit between the person and their environment.

By improving the fit between a person and their environment, it can be easier for them to carry out their daily tasks such as accessing the toilet, leisure activities, being able to sit outside, or be hoisted into a wheelchair for day trips. It also increases the option of a family member managing care or even a single-handed care package.

[Image: Ceiling hoist system with single track]

Single track systems: Take a client to and from fixed points along a single straight, angled or curved track (this can also be mounted on a Gantry system for temporary use).

[Image: Ceiling hoist system with X-Y tracks]

X-Y systems: Are where one track is positioned between two other parallel tracks thus allowing for infinite pick up / lowering points within the range of both tracks.

[Image: Gantry system]

Gantry systems: In instances where a track cannot be installed or if only a temporary solution is needed, a Gantry system can be used. Usually located over a bed, a gantry allows a client to be lifted from bed to chair or wheelchair, with minimal effort.

3.3. Spreader Bars

After identifying the most appropriate hoist for the person and environment, some improvements for safer patient handling can be made by selecting a suitable spreader bar. The spreader bars are the stable structure which the sling is hung from. As spreader bars come in various shapes and sizes, there are different benefits.

Spreader bars with loop fixings are most common and are the only type which Invacare manufacture because of the sheer variety of slings that use loop attachments, therefore offering cross compatibility.

Slings are often fixed with several loops on each strap to give you flexibility in positioning when lifting the individual. However, slings and spreader bars which use clip fixings tend to be a little shorter, resulting in the spreader bar having to be brought down lower, often in front of the client's face which can be intrusive.

There are also 2-point vs. 4-point spreader bars which have various advantages and disadvantages.

Two Point Spreader Bars

Advantages:

• Quick and easy to apply as the sling straps are close together
• Can be used for most of the transfer and facilitates a more aggressive sitting position
• Assists management of spasm or high muscle tone because of closed postural position
• Reduces risk of hoist related falls because of the closed postural position
• Useful for smaller clients.

Disadvantages:

• Reduced comfort for some clients, due to closed position
• Not useful with plus sized clients
• Closed postural positioning will reduce access when used with slings with apertures

[Image: Two-point spreader bar]

The Invacare Robin lifter is unique in the sense that it doesn't feature spreader bars. The advantages of this include:

• Continuous eye contact can help reassure the client
• Avoids contact injuries during use
• Width adapts to the client's size
• Easier application

Four Point Spreader Bars

Advantages:

• Easy to position taller/bigger clients
• Easier to attach sling loops when carrying out a floor lift
• Easier to position to middle of larger bed.

Disadvantages:

• Can exacerbate spasm because of more 'open' postural position
• Difficult to position in a chair in a 90º angle.

[Image: Four-point spreader bar]

Clearance risk! Could the client hit any part of their body on the equipment? Will the selected combination adequately lower/raise the client relative to other equipment being used? For example, an inappropriate sling choice may result in the spreader bar being too close to the client's face.

How to select the correct spreader bar size: Measure the client's shoulder width and choose a spreader bar where the distance between the hooks is closest to this measurement.

4. Slings for Passive Transfer

When considering a passive transfer solution, such as a mobile floor lifter or ceiling hoist, the correct selection of sling is paramount in providing a safe, dignified and comfortable transfer.

Selecting the correct type of sling depends on:

• Client's body control and need for support (medical condition, functional level, sitting ability)
• Type of transfer – from which position. Sitting to lying or vice versa, sitting to sitting or transfer from floor
• Comfort for the client – consider chronic pain, medical attachments
• The hoist and spreader bar that the sling will be interfaced with

Sling and Lifter Compatibility

The sling represents the interface between the client and hoist and should be selected with care.

There are considerations around the use of a manufacturer's slings used with another manufacturer's hoist. If in doubt, contact the sling manufacturer.

It is considered essential to perform a risk assessment of each moving and handling task, to document in detail.

Consider whether the attachment method on both designs is as the manufacturer intended; are the attachment points of a suitable size, position and shape? Could the sling become inadvertently detached or is the selected method likely to cause undue wear or damage to either hoist attachment or sling? For example, a sling with a keyhole clip attachment should only be used with compatible clip spreader bar attachments.

[Image: Invacare Birdie Evo Compact hoist with a person in a sling]

4.1. Selecting the Right Sling Model

Always ensure the sling is specifically designed for the hoist you are using, as failing to do so may cause serious injury. There are different types and sizes of slings available. Selecting the most suitable sling for your client will ensure safety and improve comfort during the transfer. You should consider:

• Client's functional level, size, width and weight
• The type of transfer
• Sling shape matching body control e.g. U-shape or full-body support
• Any preferred position as the result of any medical condition e.g. stroke or amputation
• Material type and any padding
• Any sensitivity to pressure in any area

The main objective of sling selection is to give the amount of body support that is needed. Invacare Slings are designed to give support in those areas where body control and muscle tone are reduced. The main body parts to assess are the legs, hip, trunk and head. The following chart gives an overview of which sling model is suitable depending on the client's physical ability:

Body Control Assessment: [Icon: Person with good control] Good | [Icon: Person with limited control] Limited

Body Support provided by Invacare Slings model:

*Less optimal: It is important to consider that the client has more remaining capabilities than the sling allows them to use. Thus, they will be immobilised over time. Additionally, more fabric than needed is used, hence it's a bigger effort to apply the sling.

4.2. Sling Shapes

Slings with divided legs

The sling is easier to place and remove because of the divided leg support. The user can participate during sling application and removal. Depending on transfer task and the risk of sliding out, the Invacare Slings offer three different opening widths.

• Regular opening: For universal transfer purposes. Invacare Universal Sling family: Universal Low, Universal Standard, Universal High, Universal High Plus.
• Small opening: For users with atrophy in their gluteal muscles. The leg supports can be safely placed in hammock position. Invacare slings: Easy-Fit, Amputee.
• Wide opening: Mainly for hygiene purposes with a very good access to the client. With less fabric than other models, it's very easy to apply and remove - especially when sitting in a wheelchair. Invacare slings: Dress Toileting Low, Dress Toileting High.

[Diagrams of different sling shapes]

Undivided legs

A sling for users that need more support. The lower part of the sling should be placed 10 cm behind the hollow of the knee.

Invacare Comfort Slings: Comfort Standard, Comfort In Situ, Comfort High.

Vest for standing and walking training

A sling that gives users a more active and independent transfer with safe support. Can be used as a training tool e.g. standing or balance training.

• Standing Transfer Vest

Light Transfer Support

Sling for supporting, repositioning and/or lifting a part of a body.

• Light Transfer Support

4.3. Selecting the Right Size

To select the correct sling size, the most important measurements are hip width and back height in the sitting position. For slings with belts, the waist circumference is important, too.

[Diagram showing body measurements for sling sizing: Low, Standard, High]

Invacare Slings sizes and safe working load

The client's weight needs to be considered mainly for the sling's maximum safe working load. It's inferior to indicate the right sling size.

If no head support is needed, the correct back height is from the lower back until the shoulder/neck. With the need of head support, the measurement needs to include the head, too.

If the sling is too big, the client may slip out. If the sling is too small, the client may still slip out, particularly with less body control. It could also exasperate the client's medical condition. When selecting a size, if your client is in-between sizes, having a slightly smaller sling could keep your client more secure.

Some medical conditions such as stroke, orthopedic conditions, amputations or certain wounds may affect sling choice.

Measurements

One of the most important factors to perform a safe transfer is the match between hip/trochanter width and the measurement of the sling's opening between the leg support. If between sizes, the smaller size may keep the client more secure.

Invacare Slings with divided legs

Small opening

Wide opening

Invacare Slings with undivided legs for full body support

Vest for Standing and Walking Training

Invacare Slings for stand assist lifters

Size: XS, S, M, L, XL, XXL

Safe Working Load (kg): 200 kg, 200 kg, 200 kg, 200 kg, 250 kg, 300 kg

4.4. Fabrics

Polyester - Solid: A strong material that is hard-wearing and easy to apply. It slides smoothly into place and dries quickly after washing. This comes as standard on all models.

Polyester - Net: Also known as mesh fabric, the net option is ideally suited for bathing or showering environments. It has quick drainage and drying properties.

Spacer: The breathable spacer fabric is two-way stretch allowing the material to adapt to the contours of the user, resulting in high levels of comfort and support.

[Image: Close-ups of Polyester - Solid, Polyester - Net, and Spacer fabrics]

Certified flame-retardant material: Available for the Comfort In Situ sling in Spacer fabric. Environmentally friendly. Third-party tested against EN 1021:2014 parts 1 and 2.

4.5. Choosing the Right Loops

It will be necessary to trial several different loop positions onto the spreader bar before the most comfortable and posturally appropriate position is identified. Once identified, it is advisable to mark the loops with loop markers to ensure that all carers use them correctly. It should be noted that a client with a changing condition may well need this modifying, depending on how they are presenting at any given time.

For example, if there is an increase in spasm it may be necessary to shorten the leg support a little, relative to the shoulder support, in order to lift the client in a position that reduces hip flexion, thus reducing the effect of that spasm.

A risk assessment with written instructions should be left with client and carer denoting which loops to use.

Informed Equipment Choices

All assessment and equipment selection needs to incorporate balanced decisions. Elements include client need, the needs of the organisation providing the equipment, as well as the needs and capability of the person that will operate the equipment. It may be necessary to make compromises, but these compromises should never threaten the health and safety of the client or the carer.

For Guidance Only

This document provides general opinions and advice. However, it does not deal with specific individuals or situations. A practitioner should always seek appropriate and specific advice from a suitably qualified professional before attempting to use methods outlined above. No liability whatsoever shall be incurred by Invacare Ltd. in respect of any representation made by Invacare or its agents in respect of this document where such representation related or referred in any way to the suitability of the content of this document. Invacare Ltd. cannot accept responsibility for any loss or consequential loss occasioned to any person acting or refraining from action as a result of this material.

Contact your local Invacare representative to discuss your training needs.