PS201 Week 3 Cue Cards - Attachments and Hoists
Overview
Hybrid lecture format with breakout rooms; focus on attachments, slings, hoists, and safe management during transfers.
Based on the work of Dr. Anna Phillips; material used in acute care, inpatient, and practical settings.
Acknowledgement of country: Kaurna and Boandik lands; ties to course objectives on safe and effective manual handling and assessment/management in different health settings.
Emphasis on planning phase of transfers, not just the mechanical execution.
Topics to cover: attachments and how to manage them safely, assistive devices, application of devices, transfer planning, infection control, risk assessment, and real-case scenarios.
Key Concepts and Definitions
Attachments: external items connected to the patient during care that may need to be moved or managed during transfers. Examples include:
Intravenous therapy (IVT) lines and IV cannulas
Intravenous drips and catheters (e.g., indwelling catheter)
Nasogastric (NG) tube and drainage bags
Wound drains (e.g., underwater seal drain, suction)
Central venous catheters and arterial lines (monitoring)
Oxygen delivery devices (e.g., non-rebreather bag, nasal cannula)
TED stockings (compression stockings)
ECG leads and monitoring cables
Slings, splints, cushions, pillows for comfort
HALT assessment: used to determine how much assistance a patient requires (light, moderate, heavy). Guides selection of assistive devices and transfer strategy.
Assistive devices (Aids for transfer):
Slide sheets, slide boards
Overhead triangle/monkey bars
Bed rails, bed sticks
Wheelchairs and commodes
Gate aids (e.g., hover mats used in some transfers)
Gate devices like hover mats for patient movement between beds (common in clinical practice for certain transfers)
CereSteady: a standing-type assistive device used for gradual progression from full hoist to stand-assisted transfer; explained in depth later.
Hoists/Lifters: including mobile full-sling lifters, ceiling lifters, and stand-up lifters
Slings: attachments that connect the patient to the hoist. Important factors:
Weight ratings and safety checks (rip/tear/soiling)
Materials: mesh, polyester/nylon (polynylon), lamb’s wool (for skin protection)
Size and color-coding to ensure proper fit (XS to XXL)
Special features: handles on the back of some slings to assist with patient control during transfer
Common sling types: universal, hygiene, hammock (full head/trunk support), standing sling, walking sling, lamb’s wool sling, and standing/Hammock variations
Slings and hoists in practice:
Full hoist (mobile lifter) vs ceiling lifter
Stand-up lifter (stand-up hoist) for patients who have trunk control but poor weight-bearing
CereSteady: a non-battery, stand-assisted device used with stand lifters for patients progressing from full stand/weight bearing to standing-supported transfer
Infection control considerations:
Do not let catheters, wound drains, or NG tubes touch the ground
Keep lines and attachments organized and elevated away from floor contact
Secure tubing to minimize pulling or snagging during movement
Environmental considerations:
Surface type (linoleum vs carpet) affects hoist maneuverability
Door width, furniture layout, and space constraints
Availability of emergency stop and battery status on hoists
Safety and clinical decision rules:
Do not mobilize if a critical attachment (e.g., IVT bag during transfusion) is present
Oxygen safety: decide on removal only with nursing approval and adequate oxygen saturation
For urinary catheters, keep the catheter and bag below insertion site when moving and manage bag fullness
If an attachment is essential (e.g., oxygen), plan around it; do not disconnect without clear clinical justification
Two-person vs one-person transfer decisions depend on patient and attachment complexity
Planning a Transfer (Key Steps)
Stage 1: Pre-transfer assessment
Conduct HALT assessment to determine patient’s level of assistance needed
Perform environmental risk assessment (pathways, bed/chair positions, doorways, floor conditions)
Establish start position (patient in bed) and finish position (to chair, etc.)
Identify what the patient can do independently
Stage 2: Attachment assessment
List all attachments on the patient; categorize as movable, removable, or unsafe to remove
Determine attachments that can be safely moved with the patient (e.g., IV lines, wound drains, catheter bags, NGT) vs those that should remain in place or be disconnected only if nursing approves
Typical movable items include: indwelling catheter, wound drain, underwater seal drain, nasogastric tube, IV line extensions (if clinically safe)
Items that can sometimes be disconnected with nursing approval: ECG leads, blood pressure cuff, pulse oximeter, oxygen delivery (depending on saturation and clinical status)
Items that generally should stay attached during transfer: TED stockings, hinged knee brace, any lines critical to ongoing therapy unless nursing approves removal
Important restriction: Do not disconnect an IVT line if the patient is receiving therapy or if there is risk to ongoing treatment
If a blood transfusion is running, postpone mobilization until completed
Stage 3: Determine assistive device needs
Based on HALT results, decide if light, moderate, or heavy assistance is needed
If more than moderate assistance is required, select an assistive device and potentially a hoist
Common devices: slide sheets, overhead triangle/monkey bar, bed rails, walk aids, gate aids, hover mats, universal slings, hygiene slings, hammock slings, standing slings, walking slings, lamb’s wool slings
Stage 4: Sling and hoist selection and preparation
Choose the correct sling type and size; ensure color-coded size matches the patient measurements
Check sling integrity (no tears, dirt, or damage) and ensure proper leg strap height settings
Attach sling correctly to the hoist spreader bar; confirm safety features (emergency stop, battery status, track alignment for ceiling hoists)
If using CereSteady, ensure patient grip and knee rest setup; confirm cleaning and infection control requirements
Stage 5: Planning the safe pathway
Create a clear, obstacle-free route from start to finish position
Ensure the environment can accommodate the hoist or assistive device (room space, door widths, flooring)
Prepare for multiple hands if needed (one or two assistants) and assign roles
Stage 6: Execution and monitoring
Execute transfer with attention to patient comfort and safety
Monitor lines for tangling, tension, or dislodgement during movement
Communicate clearly with the patient and team
Post-transfer: re-check attachments and ensure devices are secure and functioning; reposition patient as needed
Attachments in Practice: Which Can Move, Which Can Be Removed
Movable/disconnectable attachments (depending on clinical status and nursing approval):
Indwelling catheter (IDC) — can be moved with caution; ensure bag does not touch ground; maintain asepsis
Wound drain and underwater seal drain — can be moved if secure and not compromising function; drain level and suction need monitoring
Nasogastric (NG) tube — moves with patient but bag needs securement; avoid traction; ensure entrance to nose and throat is comfortable
Blood pressure cuff (BP cuff) — can be disconnected from the patient but may require reattachment
Pulse oximeter leads — can be disconnected from patient wiring, with the sensor remains on patient and connected to a small box or monitor
ECG leads — can be disconnected from the patient, with leads organized into a box/monitor unit
Oxygen delivery (nasal cannula, face mask) — may be disconnected if the patient can tolerate; practice requires nursing clearance; use portable oxygen if needed
Oxygen extension and wall supply can be used to facilitate movement when portable oxygen is not available
Attachments that typically should stay in place or be handled with caution:
TED stockings (thromboembolism prevention) typically remain on for mobilization; can be removed for showering but stay during mobilization
Hinged knee brace and leg supports (slings/braces) usually stay in place during mobilization unless necessary for cleaning or showering
IV lines — generally cannot be removed; disconnect only with nursing approval and when safe to do so
Attachments that can be moved around with support:
IV lines and surgical drains may be moved with caution; keep lines untangled and away from the feet and chair
Urinary catheters and bags — keep bag below insertion and above the ground; ensure bag not overfull; empty if necessary with nursing assistance
Pneumothorax or chest tubes mentioned as do-not-move items; this is context-dependent and requires clinical judgment
Example reasoning: If a patient is on a 2 L IV bag (approximate weight), the bag can create drag; plan to empty fullness before moving and keep bag secure along the patient’s side
Important caution: Do not remove oxygen or IV lines simply to facilitate movement if clinical status requires ongoing therapy
Oxygen and Airway Support Considerations
Oxygen management during transfer:
Portable oxygen is preferred for mobility; if not available, use extension cords and wall supply connected to the oxygen source, ensuring the tubing length allows safe maneuvering
Always confirm with nursing staff before removing oxygen support
Avoid tethering or snagging tubing during movement
Airway/feeding/other lines:
NG tube causes gagging and discomfort; ensure securement and avoid pull on the tube
Nasal cannula tubing should not cause claustrophobia or hinder movement; adjust patient position accordingly
Infection Control and Ground Contact
Do not allow attachments to touch the ground (e.g., catheters, wind drains, NG tubes)
Secure all external devices to prevent accidental dislodgement
Clean reusable devices per infection control guidelines (e.g., CereSteady surfaces) with appropriate wipes between patients
Assistive Devices and Slings (Details)
Common assistive devices used across the course:
Slide sheets and slide boards for reducing friction
Overhead triangle/monkey bar for patient pulling and balance assistance
Bed rails and bed sticks/poles for patient leverage
Wheelchairs and commodes (portable toilet seating on wheels)
Gate aids and hover mats for certain bed-to-bed transfers (often in hospital/operating room to ward transitions)
Universal sling: trunk/shoulder support; good for seated-to-seated and bed-to-seated transfers
Hammock sling: provides head/full trunk support; sits around the outside of the legs; used for reclined positioning
Hygiene sling: designed to facilitate transfers to bathroom/shower and repositioning for hygiene tasks
Standing sling (standing transfer sling): used with stand lifter; belly wrap and harness that helps secure patient to the stand lifter
Walking sling: used for gait retraining and transfers when walking is a goal
Lamb’s wool sling: preferred for delicate skin, burns, allergies, or long seating; provides comfort and reduces skin damage risks
Sling selection considerations:
Weight rating and color-coded sizing; ensure straps match sling size (e.g., green top with blue/purple leg straps in the example)
Slings with back handles provide grip for the operator; improper wiring can remove the handle
Material considerations: mesh slings for showering; poly/nylon slings for routine transfers; lamb’s wool for sensitive skin and prolonged seating
CereSteady (standing transfer assist):
Intermediate device between stand lifter and full overhead hoist
User stands and sits on a small seat that moves up/down with user grabbing handles
No battery required; easier to manage and can be operated by one physiotherapist
Requires cleaning/disinfection between patients (hard plastic surfaces)
Hoist types and typical usage locations:
Mobile hoist (full sling lifter): portable, used in many wards/practice areas
Ceiling hoist (ceiling lifter): tracks in ceiling; two-way or four-way operation; easier to use with one or two clinicians; suitable for fixed routes
Stand-up hoist: useful for toileting and dressing tasks; engages in stand/transfers with trunk control
Practical notes for practice rooms:
Expect to encounter Arjo Maxi SkyLifters in SA hospitals (Calvary, Adelaide, Royal Adelaide); newer hospitals may have more ceiling lifts, while residential care facilities may rely more on mobile hoists
Slings come in different sizes and materials; ensure correct fit and avoid skin injury; ensure color-coded sizing is matched before use
Slings can be used with different transfer types: bed-to-chair, chair-to-chair, bed-to-shower chair, etc.
Case Scenarios: Breakout Discussion Summary
Setup: Five case scenarios to apply planning and risk management for manual handling and attachments. Each room discusses risk strategy, attachments, and transfer planning.
Case 1: Gym client on low-flow oxygen backpack (long-COVID recovery)
Setting: Independent and previously fit; oxygen tank worn in backpack; stationary bike planned
Attachments strategy: Oxygen backpack is essential and cannot be disconnected; plan movement with patient and oxygen in a safe configuration
Movement approach: Likely standby or light assistance; patient manages oxygen with minimal risk; place oxygen backpack behind the bike to avoid interference
Pathway planning: Ensure it does not create entanglement; allow space for movement and monitor tubing length
Case 2: Private practice; 64–65-year-old post-TKR (two weeks); four-wheeled walker; COPD with oxygen cylinder on walker frame
Start on treatment plinth for ROM/strength assessment
Oxygen: leave on walker; move walker within reach; measure ROM and strength with adequate space
Activity plan: static exercises to minimize risk of tubing entanglement; ensure tubing length is safe; move oxygen within arm reach
Case 3: Hospital physio; 26-year-old day 1 post left rotator cuff repair; sling on left arm; TED stockings; IV line in right hand
Task: get patient out of bed
Key points: protect healing shoulder; avoid pulling on sling; manage IV line and potential tubing during transfer; plan pivot or stand-and-serve transfer with standby assist on the correct side
Case 4: Hospital case; 76-year-old post left rotator cuff repair; IV line; indwelling catheter; mobilizes with a stick
Task: sit patient out of bed into chair for assessment
Attachments: move IV line on a portable pole; manage catheter; avoid weight-bearing on the healing arm
Transfer strategy: standby assist on the opposite side of the arm with sling; manage lines and maintain safe distance between lines and chair
Important: Rotator cuff repair restrictions include no weight bearing or active movement for at least two weeks
Case 5: Kindergarten case; 4-year-old with limited elbow motion; post-septic arthritis; above-elbow plaster; sling for comfort; IV antibiotics via belt
Task: assessment at table; consider age, engagement, and safety
Attachments: sling cannot be removed; IV line can be moved but stay secured to belt; ensure tubing visible but not a hazard
Environment and safety: kindergarten setting with trip hazards; keep IV line protected under clothing as needed; ensure other children cannot tug at tubing
Key learning from cases:
Always begin with a thorough planning step; identify what can be moved or removed safely and what requires ongoing attachment
Use appropriate assistive devices and hoists based on patient potential and risk
Maintain infection control and avoid ground contact with any attachment; secure lines during movement
Two-person transfers may be required for complex cases, particularly when multiple attachments are present
Adjust plan based on patient condition and clinical status; consult nursing/medical teams when uncertain about removing or moving attachments
Practical Takeaways and Best Practices
Always start with a clear goal and finish position for the transfer; plan the route and ensure space for safe maneuvering
Thoroughly assess attachments and determine which can be moved or removed; communicate with nursing for any removal
When in doubt, delay transfer if an essential attachment (e.g., blood transfusion ongoing) is contraindicated for movement
Use portable oxygen when possible for mobility; if not available, coordinate with nursing to extend tubing or use a wall supply with careful management of extensions
Ensure infection control by avoiding contact with ground; secure tubes and ensure clean handoffs between patient and clinician
Select sling type and size carefully; ensure colour-coding aligns with size; verify safety features (back handles, straps)
Understand the hierarchy of devices: from full hoist (no trunk control) to stand-up lifter (partial control) to CereSteady (stand-improved progression) to ceiling vs mobile lifts; know when each is appropriate
In real clinical settings, expect variations in equipment across hospitals and care facilities; be prepared with knowledge of the specific devices available at your placement site
The content integrates ethical and practical implications: prioritising patient safety, minimising risk to staff, ensuring patient autonomy while applying clinical judgment, and collaborating with nursing and other clinicians
Equations and Quantitative References
For an IV bag with a volume of 2 litres (V = 2 L), the mass (m) of the fluid, assuming it's saline or a similar IV solution, is approximately 2 kilograms. This is because the density of these solutions is very close to 1 gram per millilitre, which is equivalent to 1 kilogram per litre. Therefore, m is roughly = ρV, where ρ (density) is approximately 1 kg/L and V (volume) is 2 L, results in a mass of roughly 2 kg.
