A 25 year-old male presents to the ED complaining of left upper extremity pain, redness, and swelling. His cat bit him 2 days ago and his symptoms started today. On exam he has impressive induration, erythema, and warmth to the dorsum of the hand and forearm. He is neurovascularly intact and able to range his joints freely. In addition to IV antibiotics, you would like to keep his arm elevated while in the hospital. What is an easy and simple way help ensure that this patient keeps his arm elevated?

Tricks of the Trade: DIY Skyhook

When and Why?

This technique allows the patient to fully relax the offending extremity, keeps it elevated far above the head, and does not run the risk of causing limb ischemia with finger traps or other constrictive dressings.

Equipment

• Shears
• Stockinette
• IV Pole

Technique

• Appropriately size and cut your stockinette. An average adult patient’s arm will fit comfortably in a size 3 stockinette. A pediatric patient generally fits well in a size 2 stockinette. For larger patients, a size 4 stockinette may be used.

• Stretch the stockinette across your body from fingertip-to-fingertip, and cut the stockinette at the end of its length.

• Use your shears to further cut the stockinette, lengthwise this time, for about one arm’s length. This should be about 1/3 to 1/2 of the total stockinette length. Insert the patient’s injured arm in the stockinette so that the ends that have been cut lengthwise hang anteriorly and posteriorly to the patient’s torso.

• Tie the cut ends under the contralateral arm like a “Miss America” sash and use the remaining uncut stockinette to elevate the patient’s affected arm and tie it to an IV pole. (Pro Tip: If you have cut the stockinette too short in step one, you can use extra stockinette to bridge between the IV pole and the nearest aspect of the stockinette.)

• If the patient has an injury that is particularly painful, or a cellulitis that requires frequent reassessments, cut a hole in the stockinette in that location. This allows for the painful area to be free of friction and facilitates serial examinations.

Video Demonstration

Photo credit: Cat bite image

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