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Immobilisation - Broad and high arm sling

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Indications

Upper limb soft tissue injuries requiring elevation

Upper limb plaster recently applied (all require elevation)

Contraindications (absolute in bold)

None

Alternatives

Shoulder immobiliser

Collar and cuff

Informed consent

Verbal consent

Less complex non-emergency procedure with low risk of complications

Potential complications

Abrasions and pressures sores (with risk of infection)

Joint stiffness

Procedural hygiene

Standard precautions

PPE: non-sterile gloves

Area

Anywhere

Staff

Procedural clinician

Equipment

Standard triangular arm bandage for slings (consider folding in half for smaller patients or children)

Positioning

Patient seated or standing with shoulder adducted and internal rotated

Elbow flexed just greater than 90 degrees (broad arm) or much greater than 90 degrees (high arm)

Sequence (broad arm sling)

Ensure adequate analgesia prior to procedure

Point apex of bandage to elbow and apply sling across chest of patient (under the arm)

Fold lower half of bandage up over for forearm and tie a knot behind patient’s neck

Secure at elbow by tying a knot in excess bandage or folding and securing with a safety pin

Sequence (high arm sling for hand elevation)

Ensure adequate analgesia prior to procedure

Point apex of bandage to elbow and apply sling across chest of patient (over the arm)

Fold lower half of bandage underneath the forearm, through axilla and tie a knot behind patient’s neck

Tuck bandage underneath forearm anteriorly

Secure at elbow by tying a knot in excess bandage or folding and securing with a safety pin

Post-procedure care

Check elbow flexion at greater than 90 degrees (adjust knot if adjustment required)

Check wrist is supported by sling

Advise to remove sling and move non-immobilised joints hourly (to prevent stiffness)

Advise patient to limit sling use to three days (limiting swelling and joint stiffness)

Tips

Consider the forces acting on the injured bone/joint when choosing sling type

Consider whether hand elevation is required when choosing between broad or high arm sling

A broad arm sling can also hold the arm high by taking up more slack at the neck before tightening the knot

Peer review

This guideline has been reviewed and approved by the following expert groups:

Emergency Care Institute

Please direct feedback for this procedure to ACI-ECIs@health.nsw.gov.au.

References

NSW Agency for Clinical Innovation. Orthopaedic/musculoskeletal. Sydney: ACI; 2020. Available from https://www.aci.health.nsw.gov.au/networks/eci/clinical/clinical-resources/clinical-tools/orthopaedic-and-musculoskeletal

Roberts JR, Custalow CB, Thomsen TW. Roberts and Hedges’ clinical procedures in emergency medicine and acute care. 7th ed. Philadelphia, PA: Elsevier; 2019.

Dunn RJ, Borland M, O’Brien D (eds.). The emergency medicine manual. Online ed. Tennyson, SA: Venom Publishing; 2019.

Eiff MP, Hatch R. Fracture management for primary care. 3rd ed. Philadelphia PA: Saunders; 2011.

Stracciolini A. Basic techniques for splinting of musculoskeletal injuries In: UpToDate. Waltham (MA): UpToDate. 2019 April 18. Available from: https://www.uptodate.com/contents/basic-techniques-for-splinting-of-musculoskeletal-injuries

Liverpool hospital emergency department: Liverpool Hospital: Plaster booklet: 2019

© Agency for Clinical Innovation 2021