Selecting the best lift or sling for any immobile patient can be challenging. But the challenge can seem daunting when you’re selecting equipment for special-needs patients, such as a patient with a spinal cord injury, a morbidly obese patient, an elderly patient, or an orthopedic patient.

Identifying the key selection criteria for these patients will help you better assess, plan, and implement their care—and reduce you own risk of work-related injury.

Lifting patients with spinal cord injuries
When selecting a lift for a patient with a spinal cord injury (SCI), your key criteria include:

• patient safety
• stability.

You’ll need a lift that can handle several lifting requirements. You’ll also need stretchers, slings, and accessories designed for safe, comfortable supine maneuvering.

Because many SCIs are permanent, the most practical solution may be an overhead lifting system. Although you can use a mobile lift for these patients, overhead systems are better when a condition such as orthostatic hypotension requires a supine transfer or when you must maneuver around patient-care equipment. The lift should also be able to safely hold the SCI patient upright on a toilet or bedside commode.

No matter which lift you use for an SCI patient, keep these points in mind:

• Provide adequate support for the spine.
• Protect dangling limbs.
• Use a proper fitting sling.

Lifting morbidly obese patients
When selecting a lift for a morbidly obese patient, your key criteria include:

• lifting capacity, which may need to be 1,000 pounds or more
• sling comfort
• overall safety
• maneuverability
• ambulation capability
• capability to solve unanticipated problems.

Slings, vests, and lifts must be designed to handle the variety of distinct weight distribution patterns in people whose body mass index is greater than 40 and to handle physical limitations, such as a lack of range of motion at the hips and knees. Slings must be designed specifically for morbidly obese patients. They shouldn’t simply be larger versions of existing slings.

Consider lifts that allow you to provide the best skin care. You must be able to assess and treat the skin, including the skin under the pannus and in the perineal area, for irritation, infection, and breakdown.

Morbidly obese patients need to become active as quickly as possible—they must stand, bear weight, walk, and maintain an exercise regimen. When the patient can’t stand or walk without assistance, you may need bariatric lifting equipment to achieve the prescribed level of ambulation and exercise without injuring yourself.

Lifting elderly patients
When selecting a lift for an elderly patient, your key criteria include:

• smooth operation, free from jerky or unanticipated movements
• availability of slings and accessories to accommodate delicate skin and brittle bones.

Two common objectives when handling elderly patients are maintaining their mobility and preventing common manual lifting injuries, such as bruising under the arms and skin breakdown. Depending on the patient’s condition, consider these lifting options: sit-to-stand lifts for those requiring standing assistance and general-purpose lifts for those requiring lifting, repositioning, or ambulation assistance.

Elderly patients who are bedridden and require extensive assistance in bed and during transfers are at risk for skin shearing and similar injuries. The risk may be exaggerated in those with kyphosis. Injuries typically occur during routine activities, such as bathing, using the toilet, and transferring between bed and wheelchair. One of the most effective ways to reduce skin shearing is to provide a well-padded, properly fitted sling or lifting vest.

Lifting orthopedic patients
When selecting a lift for an orthopedic patient, your key criteria include:

• capability for frequent transferring and repositioning
• ability to initiate physical therapy.
Because of the need to immobilize a specific part of the orthopedic patient’s body, caregivers can end up placing extraordinary stresses and strains on their own bodies when handling these patients.
When caring for an orthopedic patient, follow these tips:
• Check for the proper sling type to accommodate the specific orthopedic situation, such as maintaining a proper hip angle with a patient who has had a total hip arthroplasty.
• Plan for specific actions, such as gait training, getting on and off a commode or toilet, and applying and removing anti-embolism stockings.
• Identify procedures that could be done more safely using special “lift straps,” such as turning in bed or providing support to the affected limb.
• Lift in stages to allow time to check that the hip or knee bend angles are protected.

Preparing for discharge
Before discharge, help family members select the type of lift and accessories they will need for the patient at home. Teach the patient and family members how to lift safely, using the type of equipment they will have at home. An alarming number of wheelchair-bound patients require readmission for fall-related fractures. And one-half of these injuries occur during patient transfers from a wheelchair to a car, bed, toilet, or shower seat—and from the floor to a wheelchair after a fall.

The task of transferring special-needs patients can seem overwhelming. But if you follow these guidelines, you’ll be able to make transfers that are safe for your patient and for you.

Selected references
Alexander JW, Cafiero M, Conroy S, Gallagher Camden S, Milne C, Rowen L, et al. Does skin care for the obese patient require a different approach? Bariatric Nursing and Surgical Patient Care. November 2006. Available at: http://www.liebertonline.com/doi/pdf/10.1089/bar.2006.1.157. Accessed January 25, 2007.

American Nurses Association. Position statement on elimination of manual patient handling to prevent work-related musculoskeletal disorders. Available at: www.nursingworld.org/readroom/position/workplac/pathand.pdf. Accessed January 25, 2007.

de Castro AB. Handle With Care®: the American Nurses Association’s campaign to address work-related musculoskeletal disorders. Available at: www.nursingworld.org/ojin/topic25/tpc25_2.htm. Accessed January 25, 2007.

Jurska JJ, Alvero AM. A discussion of safety training for caregivers of people with spinal cord impairment. Organizational Behavior Management Network. Available at: http://www.obmnetwork.com/resources/articles/student/Juska_Spinal.htm. Accessed January 25, 2007.

Nelson A, Baptiste A. Evidence-based practices for safe patient handling and movement. OJIN. Available at: www.nursingworld.org/ojin/topic25/tpc25_3.htm. Accessed January 25, 2007.

For a complete list of selected references, see March 2007 references.

JoAnn F. Bunke, MA, RN, is the Midwest Clinical Coordinator for Liko Inc., a global patient lift manufacturer with North American headquarters in Franklin, Massachusetts. She consults with and educates healthcare specialists as they consider or implement a safe lifting environment in their acute care setting.