An elevation sling, sometimes referred to as a high arm sling, is a specialized first-aid device used to immobilize an injured upper limb. Its primary function is to support the forearm and hand in a significantly raised position, typically with the fingertips resting near the opposite shoulder. This high positioning helps to reduce localized swelling, or edema, in the hand and wrist by counteracting the effects of gravity on fluid dynamics. This measure is generally intended as a temporary means of support until professional medical assessment and treatment can be obtained.
Necessary Materials and Preparation
The most effective material for constructing an elevation sling is a large, commercially available triangular bandage. If a dedicated bandage is not available, acceptable alternatives include a large square of cloth, a wide scarf, or any piece of fabric that can be folded into a suitable triangle. The material should be wide enough to support the entire forearm comfortably, extending from the elbow to beyond the hand.
If starting with a square or rectangular piece of cloth, fold it diagonally to create the necessary triangular shape. The resulting triangle should be large enough that its longest edge, known as the base, can span the distance from the person’s elbow to the opposite shoulder. Before beginning the application, the injured person should be asked to gently support their injured arm across their chest, with their fingertips touching the shoulder of the uninjured side. This pre-positioning ensures the arm is correctly elevated and stabilized before the sling is secured.
Step-by-Step Guide for Creating the Sling
The construction of the elevation sling begins by carefully draping the triangular bandage over the injured arm and chest. Position the apex, or point, of the triangle just beyond the injured person’s elbow. One end of the bandage should hang down over the shoulder of the uninjured side, while the base runs parallel beneath the forearm.
Next, the lower portion of the bandage is brought up and over the forearm, folding it upwards to meet the other end. This action creates a hammock that supports the entire forearm and hand. The end of the bandage that was tucked underneath the arm is then brought diagonally across the person’s back to meet the first end at the shoulder. This diagonal path ensures that the force of the arm’s weight is distributed across the back and shoulder, rather than pulling directly on the neck.
The two ends of the bandage are then tied together using a secure knot, like a square knot or reef knot, directly above the collarbone on the uninjured side. The knot must rest on the solid structure of the collarbone, avoiding the sensitive area directly over the neck vertebrae. Tuck the free ends of the knot away neatly to prevent them from loosening or catching on anything.
Finally, secure the excess material at the elbow where the triangle’s apex is located. This can be done by twisting the fabric at the elbow point and tucking the excess material into the sling. Ensuring the material is snug at the elbow prevents the arm from slipping out and provides a complete, supportive pocket for the limb.
Proper Application and Safety Checks
Once the sling is fully constructed and tied, the fit must be immediately confirmed to ensure maximum therapeutic benefit and comfort. The primary check is verifying that the hand and forearm are elevated high above the elbow and the level of the heart. This specific angle facilitates the drainage of venous blood and interstitial fluid, minimizing swelling in the distal extremities. A properly applied elevation sling should support the arm entirely, extending support all the way down to the person’s fingertips.
Monitoring the person’s circulation and nerve function, collectively known as neurovascular status, is a necessary and ongoing safety measure. The skin color and temperature of the exposed fingers should be checked, comparing them to the uninjured hand; they should remain warm and have a natural color.
Capillary Refill Test
A more specific test involves checking capillary refill time, which assesses blood flow to the tiny vessels beneath the nail bed. To perform the capillary refill test, press firmly on a fingertip’s nail bed for five seconds until it turns pale, then release the pressure. In a healthy circulatory system, the color should return to the nail bed within two seconds. A prolonged refill time, or a bluish or pale appearance, suggests that the sling might be too tight, potentially compromising blood flow. Additionally, the person should be questioned about any sensations of numbness, tingling, or increased pain, as these are signs the sling needs immediate adjustment to relieve pressure on nerves or blood vessels.