A sling and swathe combination is a two-part immobilization technique used to stabilize injuries affecting the shoulder, clavicle, or upper arm. The process involves first supporting the forearm with a sling to bear the limb’s weight, followed by applying a swathe to bind the arm securely to the chest wall. This approach minimizes movement, which helps reduce pain and prevent further damage to the injured area, especially during transport. It provides rest for the affected structures by limiting the range of motion in the upper extremity.
Necessary Materials and Preparation
The required materials include a large piece of cloth, such as a triangular bandage, for the sling. A second, wider piece of material, like a cravat, elastic bandage, or folded cloth binder, is needed for the swathe to secure the arm against the torso. Padding, such as cotton gauze or a folded towel, should be used under knots or in the armpit for comfort and to protect the skin from pressure points.
Before application, the person should sit upright in a comfortable position. The injured arm must be supported manually to prevent unnecessary movement of the injury site. Maintain the limb in a position of comfort, ideally with the elbow bent at a 90-degree angle across the body. Remove any jewelry, such as rings or wristwatches, from the injured arm, as swelling may occur after immobilization.
Step-by-Step Guide for Applying the Sling
The sling holds the elbow and forearm at a right angle across the person’s chest. Unfold the triangular bandage and place it under the injured arm, positioning one point just past the elbow. The base of the bandage should run parallel to the torso and extend past the hand.
Bring the upper end of the bandage up over the shoulder on the injured side. Bring the lower end up and across the chest to the opposite shoulder. Secure the two ends using a square knot, placing it above the collarbone on the uninjured shoulder. This placement prevents pressure on the neck or the injured side.
Adjust the sling so the hand is slightly elevated above the elbow to assist in reducing swelling. Twist or fold the excess fabric near the elbow and secure it, perhaps with a safety pin, to form a cup that fully supports the elbow. Ensure the sling supports the arm from the wrist to the elbow, but the fingertips must remain exposed for monitoring circulation and sensation.
Securing Immobilization with the Swathe
After the sling is secured, the swathe is applied to bind the supported arm to the person’s body. The swathe prevents the arm from moving outward or swinging, which is common with shoulder and clavicle injuries. The material, often a wide cravat or elastic bandage, is wrapped horizontally around the torso and the injured arm.
Position the wrap to cover the upper arm and the elbow resting in the sling. Start below the armpit of the uninjured side and wrap across the chest, over the injured arm, and around the back. Secure the material, usually by tying a knot or using tape, on the side of the uninjured arm or on the back.
The swathe tension must be snug enough to hold the arm firmly against the chest wall without restricting breathing. It must not interfere with the sling or create uncomfortable pressure points. This binding creates a stable environment for the injured structures during movement or transportation.
Post-Application Safety Checks and Monitoring
After applying the sling and swathe, check the person’s circulation, sensation, and movement (CSM) in the extremity. Assess circulation using the capillary refill test on the exposed fingertips. Press a fingernail until it turns pale, release, and observe the color return, which should occur within two seconds.
Confirm sensation and motor function by asking the person to wiggle their fingers and if they can feel touch. Signs that the binding is too tight include numbness, tingling, or increased pain in the hand or fingers. Pale, white, or bluish discoloration or a cold temperature indicates compromised blood flow and requires immediate adjustment of the materials. Continuous monitoring is necessary until the person receives definitive medical care.