The Impact of Sling Materials on Gluteal Interface Pressure While Sitting

The following is a summary of a recent research study completed to examine the effects of several common materials, used in the construction of patient handling/lifting slings, on gluteal interface pressure in sitting.

Note, many of the sling models recommended for use in North America do not require a client to “sit” on the sling. Therefore, gluteal interface pressure is not of utmost importance. This area, however, represents a) the area of highest concern due to the frequency of pressure ulcers in this region and b) this area represents the site of highest potential interface pressure. In addition, there are new models and fabrics introduced, from the UK, that require the user to sit on the sling, and for the sling to remain in situ. Thus the importance of examining the gluteal interface pressure has, potentially, greater importance as these products are introduced into the North American marketplace.

Background

People who are in a seated position for long periods of time are, generally, at higher risk for developing a pressure ulcer. This is due, in part, to the fact that their weight is distributed over a smaller surface area with resulting greater higher interface pressure in the gluteal region.

At the same time, people with restricted mobility are often lifted, from one seat to another, through the use of a lift and sling. Current organizational guidelines advise that slings are removed from behind clients when they are sitting. However, due to culture, within a facility, many clients are left “sitting” on slings, for a variety of reasons.

With this obvious lack of compliance with organizational policy, this study attempted to review the potential risk of development of pressure sores, by examining the gluteal interface pressure between the client and different materials of slings. The hope was to identify sling materials, and perhaps sling models, that if left behind a client would represent the lowest possible increase in risk or, perhaps, a decrease in risk.

Method

Healthy individuals were asked to sit on three (3) different types of sling materials. A control group also sat in the same chair without the sling. The same chair was used for all clients.

The three (3) materials used included:

1. Polyester – a warp, knitted, heat set polyester
2. SlipFit – a woven parachute silk/nylon material made from high tenacity nylon yarn
3. Spacer Fabric – a warp, knitted, polyester (similar to the plain polyester but with a monofilament spacer yarn separating the two sides)

These three (3) sling fabric were chosen because they represent, in the UK, the most commonly used fabrics in the manufacturing of slings.

Summary

The findings of the study showed that sling fabric can increase surface area across the gluteal region, and therefore, affect pressure on the gluteal area and the ischial tuberosity in healthy volunteers.

Reduction in mean interface pressure, across the gluteal region, was noted using the spacer and polyester fabrics. This may be explained by the nature of the material to provide 2-way and/or multi-direction stretch properties. This may allow the load to be distributed over a larger surface area, thus decreasing interface pressure.

The result suggests that a lift sling provided the correct fit, model, and the material is used, can reduce the impact of pressure on the “standard” high-pressure areas/regions, with Spacer fabric shown to be the most effective. In fact, spacer fabric was shown to reduce pressure greater than when compared to the control group, sitting in a chair without a sling.

In addition, the spacer fabric was the preferred choice of all participants, described as being the most comfortable. This gives some support to the claim that spacer fabric offers substantially enhanced air and moisture permeability, and eliminates shear due to the structure of the fabric.

Conclusion

In contrast to the advice of many moving and handling experts, these findings suggest that sitting on a sling may not increase pressure ulcer risk, depending on the type of sling material.

More research and peer review are required but these findings may be helpful in assisting clinicians in decision making regarding the correct sling choice.

In addition, this may also mean that clients could safely sit on the sling, between uses and reduce the effort and indignity of additional moving and handling often required for sling application and removal.

As always a thorough client assessment, by a qualified health care professional will always be required, regardless of the supporting evidence.

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