Mechanical Lift Transfers: Assessing the Patient and Fitting the Sling
Check a patient's ability before a move, choose between a full sling lift and a sit-to-stand lift, fit and test the sling, and respond when a lift or sling fails.
Table of contents
Falls from patient lifts can cause head injuries, broken bones and death, according to FDA. Its safety guide warns about the wrong sling, a bad attachment and a patient who should not be in a lift that day. A lift removes the strain from your back, but it adds a new set of decisions: is this the right device for this person today, is the sling right, and does every rating cover this patient? This guide covers those decisions. It assumes you know the basics of a sling lift transfer. Lifts differ by model, so the maker's manual and your employer's policy come first. You need hands-on training on your own lift before you use it, and reading this does not replace that training. The nurse or therapist sets the transfer method. You check it before every move and speak up when it no longer fits.
What You Will Be Able to Do
- Check a person's condition before any lift, and know when to stop.
- Read a mobility level, and match it to a device.
- Choose and size a sling, and check every weight rating.
- Run a safe lift, including the test lift.
- Respond when a lift, sling or patient does not behave as expected.
Before You Touch Anything
Knock and say who you are, even if the door is open. The room is the person's space, and knocking respects their dignity. Clean your hands before you touch the person, which protects them, and clean them again afterward, which protects the next person and you. Then tell the person what you plan to do, and ask how they feel today.
Assess the Patient Every Time
The care plan tells you the planned method. It was written on some earlier day. Before each move, check that it still fits today's patient.
FDA's lift safety guide says to check three things:
- Physical ability. Can the person help with the move? What is their current weight and condition?
- Medical condition. Will the lift or sling make anything worse, such as a fresh surgical wound, a fracture or an amputation?
- Mental status. If alert, can the person understand and follow directions? Are they ready to go in a lift?
Add these quick checks of your own:
- How is the person's alertness compared with yesterday?
- Any new pain, dizziness, weakness or shortness of breath?
- Any new tubes, drains, or a new order such as bed rest?
- How many staff does this move need, and are they here?
Warning: FDA says to avoid using a lift if a patient is agitated, resistant or combative. A person who is thrashing in a sling can tip the lift or slide out. Stop, calm the situation and call the nurse for a new plan.
Mobility Levels
Many facilities use a mobility tool so that everyone shares the same language. One common example is the Bedside Mobility Assessment Tool (BMAT). The nurse runs the test, usually on admission, once a shift and after any change. You are not scoring it, but you should know what the level means.
| Level | What the nurse checks | If the person cannot do it |
|---|---|---|
| 1. Sit and shake | Sits at the edge of the bed, reaches across to shake hands | Full-body lift, repositioning aids |
| 2. Stretch | Sits, straightens each knee, pumps each ankle | Full-body lift or sit-to-stand lift |
| 3. Stand | Stands from sitting and holds balance | Sit-to-stand lift, or a walking aid if suitable |
| 4. Step | Marches in place, steps forward and back | Stand aid, or walking with a device or lift support |
A person who passed Level 2 yesterday may fail it today after a bad night or a new medicine. If what you see does not match the level on the plan, tell the nurse before you do the move. Do not move down to an easier method on your own, even if the person asks.
Choosing the Device
The method is the nurse's or therapist's decision, but you should understand why.
| What the person can do | Usual device | Key limits |
|---|---|---|
| Stands and walks with little help | Gait belt, walker or cane | Must be able to follow directions |
| Holds on, bears some weight, follows directions | Sit-to-stand lift | Needs weight on at least one leg |
| Cannot bear weight or cannot follow directions | Full-body sling lift | At least two people for most lifts |
| Needs to move between two flat surfaces | Slide sheet or air-assisted device | Never drag a person by hand |
A safe patient handling benchmark helps here. Veterans Affairs guidance treats a person as fully dependent if you would need to lift more than 35 pounds of their body weight, and it says assistive devices must be used in that case.
Slings
A wrong or worn sling can drop a person. Think of the sling as part of the lift, not as a separate piece of cloth.
Type
Choose based on the task and the person's body. Hygiene slings leave the bottom open for toileting and should be used only with enough upper-body control. Full-back slings support the whole trunk, and many have head support. Conditions such as stroke, amputation, wounds and orthopedic injuries can change the choice. If you cannot tell which sling the plan means, ask.
Size
Use the maker's sizing chart with the person's size, weight and hip measurement. Sizes are not the same from brand to brand.
- Too large: the person may slip out.
- Too small: the person may fall out, and the sling can make their condition worse.
- Between sizes: the smaller size may keep the person more secure, FDA says.
Compatibility
FDA says that a sling must be approved by the lift's maker, and no sling works with every lift. Clip slings and loop slings do not swap with each other. Taking a sling from another unit because "it looks about the same" is a real risk.
Inspection
Check every sling before every use, along with its straps and clips.
- Cuts, tears and holes.
- Frayed edges and loose stitching.
- Damage from heat or rubbing.
- A label you cannot read.
If you find any of these, take the sling out of use. A sling with an unreadable label is out, because you can no longer confirm its size or its rating. Many slings are damaged by high heat or bleach, so follow the care label. Slings are usually not shared between patients without cleaning, for infection control.
The Lowest Rating Wins
The lift, the sling, the sling bar and the surface the person lands on each have a weight limit. The safe limit for the whole transfer is the lowest number in that chain.
Worked example. Mr. Boyd weighs 340 pounds.
- Lift rating: 400 pounds.
- Sling rating: 300 pounds.
- Wheelchair rating: 350 pounds.
The lift and the wheelchair both pass, but the sling does not. The lowest rating in the chain is 300 pounds, and he weighs 340. Stop and get a sling rated for his weight. If you do not know a patient's current weight, ask. Do not guess.
Setting Up the Lift
- Test before you bring it to the patient. Run the controls up and down. Check that the battery is charged and that the emergency release works. Know where the emergency stop and release are on this model.
- Clear the path. Make sure the lift can move and turn, and that it fits through the door and under the bed.
- Get your team. Most lifts need two or more people. Never run a lift alone if the maker requires more than one person. Decide who runs the controls and who guides the person.
- Prepare the surface. Lock the wheels of the bed, wheelchair or commode that the person will land on, and set it to the right height.
- Open the base legs. Base legs are usually most stable when fully open, and you should keep them open during the lift. Close them only as the manual allows, such as to pass a doorway.
What About the Lift's Own Wheels?
This is a common point of confusion. Always lock the surface the person is going to. The lift's own casters are different. Several makers' manuals say to leave them unlocked during lifting, so that the lift can settle under the person's center of gravity. Locking them can make the lift tip. A few models and uses, such as a lift from the floor, have other rules. Read the manual for your model, and follow it.
Running the Lift
- Place the sling. Roll the person, center the sling under the spine and lay the leg pieces flat, with no folds. Keep any seams and clips away from fragile skin.
- Bring the lift in. Lower the bar carefully. Do not let it hit the person.
- Attach the straps. Use matching loops on each side so that the sling is balanced, and check that no strap is twisted. Keep the person's arms inside the straps.
- Do the safety check. Tug each attachment. Confirm that hooks and clips will not unhook.
- Do the test lift. Raise the person about 2 inches off the surface, then stop. Check that the straps are secure, the weight is even and the person will not slide or tip. Check that the sling is not pinching their skin. Ask if they are comfortable, and watch their face if they cannot say.
- Raise slowly, only as high as the move needs.
- Move slowly. Keep the lift moving smoothly, with your hand on the person to guide them. A floor lift is for transfers. Do not use it to transport someone down a hall unless it is designed for that.
- Lower slowly. Position the person's body before you release their weight. Do not hold or carry their weight while they are in the sling, because that can let straps or hooks come loose.
- Detach and remove. Keep a seated person from falling forward while you take the sling out, and be careful of their skin. Leave a sling under someone only if it is made for that and the plan says so. Wipeable slings do not breathe, and hard clips or seams left under a person can damage skin.
- Check the person. Look at the skin and straighten the clothes. Make sure that tubes are clear, and that they have the call light. Then clean your hands.
Never leave a person unattended in a lift, and do not keep them hanging for more than a few minutes.
Sit-to-Stand Lifts
A sit-to-stand lift raises a person who can bear some weight and follow directions. It uses a band around the back or under the arms, plus a footplate and a knee pad. It is good for toileting, because the pants can be reached.
- Check each time that the person can hold on, bear weight and follow you.
- Place both feet on the plate, and shins against the pad.
- Coach the person through the rise as your training and the manual direct.
- Stop and lower them if their knees buckle, they slide down in the band, they get dizzy or they let go.
- Do not use it if the person cannot bear weight, has new shoulder pain or has a weight-bearing order that rules it out.
If a person who has been using a sit-to-stand lift gets weaker, tell the nurse. They may need a full-body lift.
When Something Goes Wrong
Stay calm and keep your hand on the person. Your first job is to get them safely down.
| What happens | Likely cause | What to do |
|---|---|---|
| Person slides down in the sling | Wrong size or strap setting | Lower right away and refit |
| Person tips backward or forward | Loops not matched | Lower and reattach evenly |
| Lift stops in the air | Dead battery or fault | Use the emergency release to lower them |
| Strap or stitching starts to tear | Worn sling | Lower at once to the nearest surface |
| Person becomes dizzy or short of breath | Medical change | Lower right away, call the nurse |
| Person gets agitated | Fear or pain | Lower right away, then stop and call the nurse |
| Lift feels unstable | Base closed, uneven floor | Lower right away, then fix the setup |
After any problem, take the equipment out of use and tag it, tell the nurse and file the report your employer requires. Report near misses too. A lift that "acted funny" this morning may drop the next person.
If you work in a home, have a backup plan. Ask the agency what to do if the lift stops working. Keep the manual close by, and keep the battery charged.
Common Mistakes
| Mistake | What it costs |
|---|---|
| Using the sling that happens to be in the room | Wrong size or wrong lift, and a fall |
| Skipping the 2-inch test lift | Problems found high in the air |
| Forgetting to check the sling's own rating | Sling failure |
| Doing a two-person lift alone | Tipping or a fall |
| Locking the lift's casters when the manual says not to | A tipped lift |
| Using a lift with an agitated patient | A fall and injury to staff |
| Leaving a person hanging while you fetch something | A fall, and fear |
Check Your Understanding
1. The care plan says sit-to-stand lift, but today Mrs. Shaw is very sleepy and cannot hold the handles. What do you do?
Do not use the sit-to-stand lift. She has to be able to hold on and follow directions. Tell the nurse about the change, since it may be a medical problem, and get a new plan for the move.
2. A patient's weight is listed as 280 pounds. The lift is rated for 450 pounds and the sling for 250 pounds. Can you use them?
No. The lowest rating in the chain is the sling's, and 250 is less than 280. Get a sling that is rated for his weight and approved for this lift.
3. At the test lift, the patient starts to slide down in the sling. What do you do?
Lower her right away to the bed. Check the sling size, the leg pieces and the loops, and refit before you lift again. If the size is wrong, get the right sling.
4. Halfway through a transfer, the lift stops and the controls do nothing. The patient is in the air. What do you do?
Keep a hand on the patient and reassure him. Use the emergency release to lower him to a safe surface. Do not lift him out by hand. Tag the lift and report it.
5. A coworker says the sling from room 12 "looks the same" as the one you need, but the label has worn off. Can you use it?
No. Without a readable label you cannot confirm its size, its rating or that it fits your lift. Take it out of use and get the right one.
Key Takeaways
- Check the person's body, condition and thinking before every lift. The plan can be out of date.
- Do not use a lift with someone who is agitated, resistant or combative.
- Use the sling made for your lift and sized for this person, and inspect it every time.
- The lowest weight rating in the chain sets the limit.
- Lock the receiving surface. Follow your lift's manual about its own casters.
- Do a 2-inch test lift, and never leave a person hanging.
- If something goes wrong, lower the person first, then take the equipment out of use.